Daniel: Welcome to “The Future Adjustment-Chiropractic Economics Podcast” series on what’s new and notable in the world of chiropractic. I’m Daniel Sosnoski, the editor in chief of chiropractic economics, and our guest today is Chad Finnegan. He’s Vice President of Business Development for Impact Cryotherapy. We’d been seeing cryotherapy emerging as a popular modality for doctors of chiropractic. We thought it’d be a good idea to delve into the science and the business of offering this type of treatment to patients. Chad, it is a pleasure to have you on our podcast. Thank you for making the time available.

Chad: Absolutely, Daniel. Looking forward to it.

Daniel: Okay. Well, hey, for our listeners who are unfamiliar, could you tell us a little bit about cryotherapy? What is cryotherapy?

Chad: Yeah. So cryotherapy, in general, is cold therapy, right? So ice packs or ice baths, even in cold showers. Cryotherapy in kind of these specific terms in the niche market that we work in is the use of cold, dried nitrogen air to stimulate the body’s response such as a cold ice bath would, but obviously, much different and colder and much more evenly cold.

Originally, the concept was created in Japan for arthritis and reducing inflammation and kind of made its way to Europe where a few designs were created and ultimately, here into the States. And so, today, we work in all kind of different verticals from health professionals, from chiropractors and sports chiropractors to orthopedic rehab, pro-college programs in athletic training rooms and spas and entrepreneurs.

Daniel: Yeah. And I think it’s notable that it’s really moving into the sports therapy world. Doctors of chiropractic who work on sports teams are using it, sports teams are buying this equipment and using it and in general, professional athletes aren’t going to mess around with things that don’t work. So it’s sort of proving itself on the field of performance. Can you give us a little bit of a sense of what the science and the facts are behind cryotherapy? Sort of, you know, how does it work? Why does it work?

Chad: Oh yeah, absolutely. And you know, here in the United States we’re kind of leading the way in case studies. And Dr. James Andrews is chair of our board and we got several other orthopedic and pain docs that we work with on trying to understand and create American data. But for the last 20 years or so, a lot of that data’s coming out of Europe because the equipment’s predominantly been there longer and has more resources and assets around it.

But yeah, anytime you stimulate the body with these kind of cold temperatures, it’s turning on the central nervous system to trigger and fire up as well as creating blood flow, and really the idea behind cold therapy, in general, is to really trick the brain into thinking that you’re going into a fight or flight mode, that blood rushes to the core and creates fresh resources. And then once you warm back up, you flush that blood back out. Similar to putting an ice pack on your ankle, right? But we’re doing it here in this case in three minutes and it’s a complete overall cold so that it shocks the body a little bit differently. In doing so, it really…people…it’s across the spectrum and the benefits that we’ve seen with our clients and their clients.

Daniel: Right. We’ve seen in newspaper reports of, you know, when a child falls through the ice into a super cold water, often, they survived for quite a long time because the body kind of starts a conserving its resources and all the blood is going just to the core, just to the vital organs of the body and that’s sort of the main mechanism involved. I’ve had a chance to try something called a Finnish sauna where you go into a super-hot sauna and stay there as long as you can, and then you go out and you jump into an ice bath after. That feeling of…

Chad: Absolutely.

Daniel: That feeling of going from warm to super cold and back to a warm again, it feels really good, actually. I can see why people like doing that. Who are some of the people who were using cryotherapy both practitioners as well as users?

Chad: Yeah, and this is the part where we are more students, right? And being an entrepreneur and just being around business all my life, I’m never the guy that said, “This is what I want the market to have,” right? We really listened to the market and especially with a new product and concept where probably 95% of the United States market has no idea what you and I are talking about right now. So…

Daniel: Gotcha.

Chad: It’s a great deal of education and kind of getting people out there, they are evangelists for you. So we’ve seen our product be really successful. Obviously, we built our foundation in sports, so training rooms and athletes, they’re very familiar with ice baths and like you said, going from hot to cold, that’s not unfamiliar experience for them either. And cryotherapy is just a different kind of cold and we believe a more efficient cold, obviously.

But then it, you know, from there we really splintered off into sports chiropractic world where they’re working with a lot of athletes and a quick three-minute cold experience, it helps reduce inflammation and age and kind of their recovery time. It’s a great add-on to all the other great services and work that they’re doing. So we got a huge footprint there. And we’re pushing over 500 units in the U.S. market and producing about 40,000 sessions a week, so…

Daniel: Wow.

Chad: It stretches from the health professional side all the way to the entrepreneur that’s opening up a wellness center and is creating these experiences that are trending upward and you know, health and recovery that’s a little outside of your norm.

Daniel: Let me ask you about that. So let’s say that I’m a doctor of chiropractic and I have one of these units in my practice. What do I tell potential patients why they should use it? What kind of conditions is it good for…kind of what are the…do I say is it for anti-inflammatory or…

Chad: Absolutely.

Daniel: How do I sell it to patients?

Chad: Yeah. And this is where I’m going to tip my hat, right, Daniel, because I’m not a doctor, but I am the guy that’s… I say “I.” Our team, we are the company that’s really created the business solution for this space. And so efficiency and safety standards, protocols, our training and certification process, and our compliance status across the country. I can give you the tool, but it’s the Dr. Troy Van Biezens of the world, that really take that tool and incorporate it into their client base for benefits. Now there’s a couple things that we all stand on that it’s going to reduce inflammation, create some blood flow, it’s going to fire up some endorphins. So are we going to do that prior to doc working on them or are we going to do that post, right? Is it going to work on them pretty hard and create some inflammation and soreness? And you wanna do cryo afterwards to kind of get that blood flowing again? So we’re learning from them on that side, but we’re the team that’s going to make sure this tool is working correctly.

Daniel: Gotcha. Hey, how cold do these units get at their maximum frigidity?

Chad: So when we entered this space, Daniel, almost all of the equipment in the United States came from European markets and manufacturers. So it was a great opportunity to us to fill what we were looking for. What we were looking to purchase was an American company. In doing that, we wanted to create and build something that we would buy and in that sense, we created something that is very accurate in temperatures. One of the hard pieces with that was a lot of the equipment out there gives you a temperature, but that’s not what’s actually being exposed to the body. That’s the temperature entering the sauna most likely. Well, that’s a very different temperature.

So we use minus 191 Celsius or 320 Fahrenheit to enter the sauna. However, we measure the temperatures within the sauna, which is about a 70-degree swing. And then we set it on three levels that are easily to reproduce and create a consistent experience for the client. So in reality, what we created was something that was very reproducible, once the client’s at the right level they like. Maybe it’s 110, 115 Celsius every Monday, Wednesday, Friday. Daniel feels great at that level and in Impact or you know, in our sauna, it’s really whether it’s LA, New York, or Miami, you’re going to get that same experience. So we led the way in actually showing the market how to produce the right temperatures effectively, safely, and consistently, but also, delivering a consistent, reusable experience for the client.

Daniel: Okay. Well, if you’re talking about minus 200 degrees Celsius, that is really cold. Are there safety mechanisms to ensure the safety of customers?

Chad: Oh, absolutely. And it does sound cold, right, but we got to remember it’s a cold, dry cold. So it’s a different cold. And sometimes we illustrate it. If you stick your hand in an oven and you touched the sides or the top, it’s going to burn you. If you stick your hand in 300-degree oven and you just stick it in the heat, that’s a different sensation, right? And so that, in part, is similar to cryotherapy.

And so, it is extremely cold that’s why it’s a three-minute experience. The temperature’s skin is dropping rapidly, which triggers the body’s response and the benefits, but it definitely sounds cold and a little scary, right? I mean, you know, we’re building projects every day all around the planet. One of the things we come up against is, “Oh, I don’t know, that sounds really cold,” but once you get in it and experience it, it’s not as cold as you thought and it’s refreshing. Your endorphins are fired up. It’s a very tangible experience you want to do again. And that’s where I think at the core of cryotherapy where it’s growing.

Daniel: So, I mean, if I’m evaluating a unit, are there typical safety features that I should be looking for? Like, I don’t know, something like a dead man’s switch or a door that opens automatically, you know, what kind of things do you guys have?

Chad: So, we’ve worked and led the way with the FDA and being classified as a 513(g) device, which is a consumer device. So we play more of the fitness space world, right? And that comes from experience in our company with the medical device space. But in that, we also…because it’s a very unique and organic design that we created ourselves, not following the other designs that were in the market before us, we really focus every day on safety and that rolls in our design.

So, three of the biggest points are 1, we have a 30-second interface program on our controller so that when the operator is doing a session, every 30 seconds, they have to push, “is everything okay” button on the screen. This ensures two things. One, the operator’s engaged with the equipment, and two, the unit’s never used alone, right? The operator always engaged with the client inside the sauna.

Another really strong feature, and it’s a big part of how the sauna communicates to the operator is a pressure transducer system. So the unit actually knows what it’s hooked up to, high, low, great pressure and it communicates that to the operator, and it even shuts itself down in some cases when it sees it getting out of the bandwidth of which, you know, a lot of our protocols and sessions have considered safe. So that’s technology that really nobody else is doing. And that our sauna is actually smarter and communicates to the operator in real time.

The other thing, Daniel, and you’ll relate to this, I think, with your background, is that nothing covers safety and the future of safety and lowers your risk on that side as proper training. And so, we’ve created very in-depth protocols and training procedures with our equipment. Our team’s onsite for two days with every client we have around the planet, and we’re literally going through our training certification program that we’ve created and we’re leading the market in. But to back that up, we’ve also created a client portal on which we’re constantly engaging with our clients post installation on additional training materials and furthering education around, you know, proper ways to create the right experience and most importantly, the safe experience for their clients.

We got good at building, selling, and installing our equipment long time ago. Where we’re constantly working all day, every day, is creating the orbit of things like safety and business strategies and things like that around our product. And that’s really where I think our clients fall in love with our company is not just selling them a piece of equipment and wishing them the best of luck, but it’s the ongoing relationship in the infrastructure and foundation we build to not only be their partner today for the sale, but to be their partner in five years from now.

Daniel: Gotcha. Hey, you know, if you’re looking at a sauna, for example, your main consumable is going to be electricity, but with one of these units, it’s going to be using both electricity and liquid nitrogen?

Chad: Correct. Correct.

Daniel: So that would be a consumable. How often do you have to buy a nitrogen tank or do you get those delivered, or do you have to order them locally from a scientific supply store? How does that work?

Chad: Yeah, and that’s a great question. It’s probably…from a business side of this space, it’s the most important, right? So, because it is your consumable. We pull less power than a microwave, so all the energy that we use really to create the cold experience is from the nitrogen side.

We were very innovative in our design and enrolling into the market, but we knew we also needed to be innovative on the energy source side because this space wasn’t developed yet, right? So early on, we were hooking our equipment up to cylinders that were 10, 15, 20 years old, didn’t hold pressure, didn’t create the right experience, weren’t the right business efficiencies and cost per session we wanted. So we started working with the manufacturers on that side. And so today, fast forwarding, Daniel wants to open up cryotherapy studio or put it in his practice, we’ll set you up with a local gas supplier that one, has experience with us, and two, has been educated on our equipment’s needs.

His company, most likely, has already made an investment into our SPEC tanks, right?

Daniel: Gotcha.

Chad: And so when he gets an Impact account or an account with us, he knows the right cylinder to hook up to provide the optimal source, which is business, safety, and operation advantages. So, that’s a big piece of the work that we do and why people choose to partner with us. And I think it’s probably the most important when it comes to the business.

Daniel: Gotcha.

Chad: A standard 230 liter cylinder, our national average with our clients is about 35 to 40 sessions per cylinder, right? So you’re rotating cylinders once or twice a week on average. Now there’s hundreds of different ways to go into the bolt world where you have a larger tank outside, it’s piped in and filled with a truck. That’s a little more upfront investment, it’s lower cost per session, and it’s less hands on. So we do a lot of those kind of projects as well, but yeah, that side of the business as you’ve indicated is almost nobody knows, right? And so, a big part of what we bring is the experience, contact, and infrastructure that we built to support our product on that side too.

Daniel: Gotcha. Hey, we got time for one more question and that would be the demographic. You know, different chiropractors see different mixes of patients. Is there a type of patient demographic that this is gonna be easier to sell to than others?

Chad: That’s a great question, Daniel, and this is probably where we got really excited about cryotherapy early on is that Miss Johnson, that’s the 65-year-old tennis pro, is not going to jump in an ice bath tonight. However, she probably would do a three-minute cryo session in her doctor’s office. And so, the spectrum…obviously, we’ve got a lot of traction and attention in pro-sports and athletes and pro-teams and those guys get it and they love it and they use it, but it’s John that wants to play an extra 18 this week. He goes to his chiropractor once a week and he’s still got inflammation. This is a perfect add-on instead of taking five more Advil today. And…

Daniel: Gotcha.

Chad: It’s quick, it’s dry, it’s effective and it brings a lot of value, not only into the practice, but it brings a lot of value to his life and his lifestyle.

So we really find ourselves in that wellness space more than just cryo.

Daniel: Gotcha.

Chad: Obviously, we manufacture cryo, but it’s much bigger than that. So the 16-year-old Division I soccer athlete, all the way to my grandfather that’s trying to play an extra 18 and reducing inflammation and aches and pains and creating blood flow can help almost everybody.

Daniel: Gotcha. Hey, well, if anybody would like to jump online and learn a little bit more about cryotherapy, about Impact, where can they go online?

Chad: Yeah. So our website’s probably the most powerful resource and that’s impactcryo.com. That would be a great resource. You can put your email and phone in there and we can dive in and our job’s not always every day to sell equipment. Our job is really to educate the market and find the right partners and strategies that will, you know, cryo there should be a part of.

Daniel: Okay. Well, you know, one of the reasons that we asked you to be on our show was because I visited your website and your equipment really does look state-of-the-art. It’s very, very impressive.

Chad: Thank you.

Daniel: It does not look like something that somebody built in their garage, it just looks like something that NASA would have built, you know, so I was looking forward to talking with you. I want to thank you very much for spending this time with us today, Chad. It’s been informative, it’s been enjoyable, and you’ve given us a chill look at “The Future Adjustment.” I’m Dan Sosnoski, and we’ll see you next time.

The post The Future Adjustment Podcast Episode 26: Cryotherapy and chiropractic appeared first on Chiropractic Economics.

Daniel: Welcome to “The Future Adjustment,” Chiropractics Economics’ podcast series on what’s new and notable in the world of chiropractic. I’m Daniel Sosnoski the editor-in-chief of Chiropractic Economics. And our guest today is Alex Vidan, DC, the owner of Vidan Family Chiropractic in St. Louis. In addition to his doctorate from Logan, he also holds a degree in Kinesiology from Louisiana State University. He served as the team chiropractor for the St. Louis Cardinals during their World Series win and he worked with the St. Louis Rams cheerleaders prior to their move to LA. He’s also been on the news as a health and wellness contributor over 200 times and he’s here to share with us his insights on techniques for new patient acquisition. Welcome to “The Future Adjustment” Dr. Vidan. I understand you were a speaker at Parker seminars this year at Las Vegas.

Dr. Vidan: I was. Well, you know, first I wanna say, thank you for having me. And yeah, I’m really looking forward to be a part of this. Yeah, I was a speaker at Parker, they did a great job, you know, they had over 3,000 people there in attendance. So it was great to get to reach so many people.

Daniel: Wow, that must be really something to be looking out at a room full of your peers.

Dr. Vidan: Yes, it certainly was.

Daniel: I get butterflies every time. Can you tell us about how you came to formulate your talk that you gave there that was titled, “Unlocking the New Untapped Market for New Patients.”

Dr. Vidan: Yeah. So, I really wanted it to be a talk that was something that people could take and use and implement some things and make it really action oriented. So the first idea was, look, what is it that’s something that’s a topic that we can touch on to help docs get new patients and then what are action steps that they can take right away. So that was the whole formula for the talk. It was here it is, take action and do these things. So we talked about it from the aspect of temporomandibular joint dysfunction, it’s a huge market that’s out there and it’s the actually the second largest musculoskeletal disorder that there is and it’s a vastly untapped market that a lot of people just don’t know how to get into, but they want to do it once they find out more about it so they can help more people in their community.

Daniel: Yeah. I know a few people who have that and it’s very troublesome when they go to the dentist you know, it causes them no matter of…also what you were talking about with your talk you know, we do the same thing here at the magazine. We try to make every article, give you something that you can like use right away. Try to do that with the podcast as well.

Dr. Vidan: Sure. And that’s what I like, you know, whenever I spend my, invest my time into something I want to make sure that it’s something that what am I gonna be able to glean from this. What am I gonna be able to learn from this, so that I can then expand myself and make myself better, whatever it is, and I like those kind of things. So I like to give anybody that’s listening to me those kind of options too.

Daniel: Okay. Well, you know, since you were talking about that subject there, what does the research tell us about temporomandibular joint disorder or TMJD?

Dr. Vidan: Yeah. So the research basically lies into the fact that, number one, it’s vastly underserved. Number two, it’s a huge market. And then number three, that we can be as chiropractors, that we can be perfectly positioned in order to help these people. I mean, that’s really what everything points to. We just have to know what do I do? How is it that I speak to the other oral care professionals? How is it that I speak to my patients? How is it that I let people know how is that we do it and then main thing is how do I deliver the goods? So how do I actually help my patients do this?

Daniel: Yeah, you know, when I visit my dentist, usually somewhere in the line of sight or the chair there’s a sign on the wall that’ll say things like, do you suffer from sleep apnea? You know, ask your dentist, you know, is that the kind of thing where you might put some signage in your practice and say, you know…

Dr. Vidan: That’s one aspect. I say this, I say, utilize whatever works best for you. So here, I’ll give a couple of things. So number one is, yeah, you can put a sign out there. Number two, you can send an email out to all of your patient base, letting them know this is what we do. Because I know right now that there’s some doc that’s out there listening to this, that’s saying, “You know what, I’ve experienced that same thing whenever Sally came in, she told me that she had this problem with her wrist and she never ever thought to mention it to me. And then she went someplace else. And I told her, you know, I take care of wrists too like, I can help you with that. And she had no idea right?” So a lot of times it’s just about educating our patient base in our community. So, signs, making sure that you talking with them, emailing, then also you’ve got to get out into your community. So we’ve got to get outside of our four walls to get the message out there to more people. So whether or not that’s through social media, through actually getting out in front of other oral care providers. Like, what are those action steps gonna be in order to make that happen? So if you’d like, I can give you one strategy. And you can use this for temporomandibular joint dysfunction, you can use this for, if you like, taking care of whatever else it is. So you just plug it in, plug and play. So let’s say that you have a patient that comes in and for this example, we’ll say that it’s TMJD.

And you’ve heard me say, TMJD, it’s just temporomandibular joint dysfunction. It’s just a diagnosis and what it looks like. It’s what the patient’s dealing with. And it’s a universal kind of a way of speaking the same language as an oral care provider. So a patient comes in, they mentioned to you somewhere along the way that they have jaw complaints, they have jaw pain, so then you say, “What are you currently doing?” So you’re gonna ask the patient this, you’re gonna say, “What are you currently doing to help with your temporomandibular joint dysfunction or your TMJ issues?” And they’re gonna say, “Oh, I’m seeing Doctor-Dentist.” Okay. And what has Doctor-Dentist done so far? “Well, Doctor-Dentist gave me this splint or this appliance and you know, he’s done some injections or he’s given me this medication to help with it. But it’s still there.”

Okay. Would you mind, because I have training on helping people with TMJD issues, would you mind if I reached out to Doctor-Dentist to find out what he or she is doing to help you and see if there’s a way that he and I can work together to get you the results that you want?

Daniel: That’s a really great strategy. I really like that a lot.

Dr. Vidan: Thank you. And that’s one that just…I’ve never had a single patient. I’ve never heard of a single doc, whenever I’ve posed that to them as something to do, because we all want help, right? Like, if you’ve got a problem, and you’re saying that you’re gonna reach out to my dentist in order to help me. Wow, that’s a huge win for me. So and most patients will say, “You’d would do that for me? Yeah, absolutely I will. I’ll do that. And then we have our strategies to do that too, and how we reach out to them and what we do. So, that’s just kind of one nugget of what you can do and we can go further into it. But I just wanted to give like that’s something that you can do right away whether or not you’re looking at TMJD issues or anything else that you want to focus on.

Daniel: You know, what’s so awesome about this strategy that you’ve explained very succinctly here is that, the problem that DCs have reputation wise in the medical community often stems from cases where a DC has tried to poach another provider’s patient. And so that builds walls of distrust, you know, and when the DC reaches out the forms of collaboration with another member of the healthcare community, you’re starting to build a source of referrals, you’re starting to improve your stature in the community, you’re mainstreaming chira. I mean, it’s just a win-win.

Dr. Vidan: It’s a win across the board. I completely agree. I like to make my conversations very inclusive, not exclusive. And so if I can include other people into that conversation they win because they’re gonna be able to give valuable information. And I win, because I’m gonna give valuable information. And then we’re going to work together in order to get this patient what it is that they want. And, when we think about it from that perspective, that’s what we ultimately all want. Like, we all want to be able to help our community and be able to help people. And if we can work in a team environment to do that, that’s pretty cool, too.

Daniel: Yeah. So, there’s a place where the joint in the jaw kind of fits into the, the socket of the skull, and there’s, I think, like a ligament or tendon there that kind of…

Dr. Vidan: There’s a couple. Yeah, so there’s the condylar head is what you’re talking about, and then it sits within a fossa and so the fossa sits in there and it has a couple of different things that attached to it as well. And so we have a disc that’s in there that creates space in between the condylar and the fossa. And then we also have muscles and ligaments that attach into there directly onto the condylar head as well as on to the disc.

Daniel: Right. And, so when there’s like, I guess what is it inflammation? Is there is that what causes TMJ?

Dr. Vidan: Well there can be. So TMJ can be caused from either an injury, a direct trauma or several micro-traumas overtime. So you mentioned whenever my friends, they have TMJ issues, they go to their oral care provider, and then it really flares up. And it causes a lot of problem for them. Well, there’s usually that there was already an underlying issue that was there that was just made worse by them having to keep their mouth open for a period of time. Now, that may have come from the fact that they had an old injury that happened years ago, OR they got into a car accident and they clinch their jaw whenever they got in that accident, and it caused problems there in their jaw too, and we just kind of low lying, it could also be from micro-trauma. So from the fact that when you’re constantly having what’s called bruxism, that means that you’re clenching your jaw and as you’re constantly clenching that jaw you’re causing tension to happen within that area too. All of those things are things that we can do to help with that, as long as it’s done in a specific way to get the patient the results that they want and it has to be done quickly.

Daniel: What are some ways that a chiropractor can help treat this condition?

Dr. Vidan: Sure. So, what you wanna do is, you wanna make sure that you’re addressing the joint itself. So, the joint meaning, your cervical spine. So, you wanna make sure, hey, look, I’m gonna check and make sure that we’re addressing the subluxations that are there, the fixations that are there as well. Anything else that’s associated with that, in that cervical spine. So in that cervical spine, quite often I see problems that are at C2 and C5 that are associated with TMJ issues. So there’s that.

The other thing is we have to address is, there a problem within the joint within the condylar head that’s not moving and functioning correctly, too. So we have to be able to adjust that. And then we have to be able to look at too, the muscular component. And so when we’re looking at the muscular component, we’ve got to make sure we get that settled down as well. And then we’ve got to look at on the back end, now, what are you doing on a repetitive daily basis in order to… As in the patient, what are they doing on a repetitive daily basis that we’ve got to address there to make sure that this doesn’t keep on coming back around right?

Daniel: Like, if the person’s like grinding their teeth in their sleep or something?

Dr. Vidan: If they’re grinding their teeth, or believe it or not, I’ve had patients that just love to chew gum. And that doesn’t seem to be right whenever you have a jaw problem and you’re constantly…right? But at the time I patients that, look, I don’t do any of that stuff. But my job requires that I’m in sales. So I have to speak all the time. A lot of problems there in my jaw.

Well, then we have to figure out new strategies in order to help them get the results that they want in order to then take care of everything.

Daniel: Wow. So that’s actually a lot of stuff you’re bringing to the table. So you’re looking you’re looking at the adjustment to help, you’re looking at the musculoskeletal system as a whole, you’re looking at environmental, ergonomic factors.

Dr. Vidan: All those things. Yeah. And so the way that I teach docs how to do it, as I say, look, we can do this in 30 to 90 seconds total. And you know, usually it’s closer to 30 seconds on top of what you’re already doing with your adjustment. I realized whenever I say that to people, they’re like, there’s no way. I don’t see how you can do that. But if you’re doing it right, and you’ve got everything just brought right to the meat of it, you can get right to the point rather quickly, right? So you can get valuable information and you can get everything taken care of very, very quickly and not do all the other fluff that isn’t really needed. So, that’s what we do.

Daniel: You know, one thing that I was really impressed by in your background is that you have done this thing that we have been hammering DCs to do in virtually every issue of my magazine. At some place it says, you got to establish yourself as the go to wellness expert. When your local TV station wants, you know, someone to talk about, you know, gardening tips to save your back or backpacks, they come to you. How did you establish that relationship?

Dr. Vidan: Man. So I’ve been doing that over a decade now. And I’ve been very fortunate to get to do it, not only here in the United States, but in other countries as well. I’ve been on the news there too. And so the way that it happened was is that 10 years ago, it was more different getting on the news that it is today. As in it was harder 10 years ago as in the strategies that you have to use. But today, it’s harder because the fact that there’s so much attention there, as in, there’s so many people trying to get on, all right. So, I said a lot there.

But the way that it worked for me was I just kept on coming to them with bringing value to the table. I kept coming to them with trying to bring value and determination. I’m one of those people that’s very persistent. And so I find that persistence pays so I just kept coming to them with valuable information, valuable content that I thought like, man, people have to know this and I had it deep seated into me, my why was really, really big in the fact that the reason I got into chiropractic was because of injuries that I had. And then I found out about chiropractic and I always thought to myself, whenever I become a chiropractor, I’m gonna make sure my entire community and as many people as I can know about this because this stuff is too good not to know.

And, so I love your strategy there too. It’s look, you wanna be the go-to person in your community to ensure that people know like, this is where I’ve got to go and this is what I’ve got… And we have to share our message. Our message is far too important to not be shared all over the place and I find the news as an extremely beneficial distribution channel to do that. Because they’ve already…I look at it this way, is it easier to host the party or is easier show up to the party, right? It’s much easier to show up to the party.

Well, the new station’s already hosting the biggest party in town because they’ve already got the vast mass distribution channel of 100,000, a million whatever it is in your community that people are watching. So, why not be there where the eyeballs are? The eyeballs are there, just be there.

Daniel: Do you get business from that? Do patients show up and say, “Oh, I saw you on TV,” and [inaudible 00:14:43]?

Dr. Vidan: Absolutely, yeah. We get new patients from that from being on the news. We get new patients from how we do everything on the backend of that in order to continually like get the message out there more and more. I mean, we’re constant and I always feel like there’s so much that we’re doing and I feel like man, we just gotta keep on doing it because our message is too powerful. You know, I got a call from Hawaii from somebody that saw one of our things on the news, I got a call from somebody from Germany that reached out to me that saw something on the news that we did. You know, this is all over the place and people are searching, they’re looking, and they’re wondering, where can I go to get what you just talked about.

Daniel: So you can go to any of your local media’s web pages, and you can send an informational sheet to their to the news producers, the directors, the editors is that is that kind of your technique? And then at the bottom, you say, I’m available to talk on this topic.

Dr. Vidan: That’s part of it. So that’s part of it. But the problem is that, they don’t give you, they don’t willfully give you, “Well, these are the people that you need to talk to.” So what they give you on those pages, it’s usually much harder than that. So what they give you on the pages is kind of what I call the black hole. They give you the black hole but guess what? They’re getting pitched to, they’re getting the story ideas to them a thousand times a day, right? Or you know. And so it just goes into a black hole. And whenever it goes into the black hole, nothing stands out. And so you’ve got to make sure like your content has to jump out to them. It has to be sticky. It has to get to the right people that actually need to see it. And there’s a whole backend strategy that I worked really hard on getting docs in order to make that happen. But yeah, I mean, they’re looking for you. They just don’t know that you’re out there because you don’t know how to connect with them. And your community is looking for you. They just don’t know that you’re out there. You’re the best kept secret in town. And that’s the problem. So we’ve got to get you from obscurity into authority. So that then…so that’s my whole thing. My whole thing is built on let’s get you from obscurity into a point of authority so that then you become the go-to chiropractor in your town.

Daniel: Yeah, you know, I think you, you know, you teach techniques along these lines, as well as how to provide specialized treatment for TMJ and an educational website you put together called drtmjd.com.

And you know, is that where any of our listeners should go if they wanna learn more about what you’re doing?

Dr. Vidan: If you want to learn more about the TMJD side, that’s definitely drtmjdcom.com, just like you said, and thank you for that. I definitely appreciate that. If they wanna learn more about…

Daniel: Sounds like you just got way too much to deliver that we can fully unpack today.

Dr. Vidan: Well, and that’s it too, right? So, there’s so many things and I love our profession. I love what we’re doing. I love how we get to help and it is my like, it’s my personal mission to get as many chiropractors out there on the news and help them open up more markets and do those kind of things that are out there so that’s why we have TicTV too. So we’ve got tictv.rocks, if they wanna learn about getting on the news, it’s, T-I-C tv.rocks. And we talked about this is how you get on the news and were getting chiropractors on the news from LA to New York to small markets as well. So, and we love it.

Daniel: Well, fantastic. I mean, if you’re gonna talk the tic, that’s where to do it.

Dr. Vidan: That the place, you’re right. I agree.

Daniel: All right. Well, Dr. Vidan. I wanna thank you so much for spending this time with us today. This has been eye-opening and informative. And you’ve given us an expansive look at “The Future Adjustments.”

I’m Daniel Sosnoski, and we’ll see you next time.

The post The Future Adjustment Podcast Episode 24: The untapped market of TMJ patients appeared first on Chiropractic Economics.

Hannah: Welcome to “The Future Adjustment,” Chiropractic Economics podcast series on what’s new and notable in the world of chiropractic. I’m Hannah Fell, the associate editor of Chiropractic Economics, and our guest today is Bryan Citrin. Bryan is the president and CEO of chiropracticadvertising.com. He manages countless chiropractors around the nation helping grow their practice to capacity using the latest online strategies. His family has a rich chiropractic history with both his parent and uncle being Logan graduates with over 120 years combined of chiropractic experience. His company has been featured on Forbes and he is an active contributor to the Forbes Agency Council. Bryan, thank you so much for joining us today.

Bryan: Thanks so much. So happy to be here.

Hannah: Thanks. Now, I understand that you’ve worked with chiropractors in all walks of their practice from the new DC who has been in their practice for months to the DC who’s been in their practice for years and you’ve given them strategies on how to grow their business. Today, how about we talk about one facet chiropractors can use to grow their practice, social media and specifically, let’s focus on how chiropractors can leverage social media for increased audience engagement. For our talk, we are mainly going to focus on Facebook and Instagram since those platforms are some of the most popular for business end users. Bryan, some DCs might not have used social media before in their practice and some might already use it. What do DCs need to pay attention to with social media and why should they use it in their practice if they haven’t already?

Bryan: That’s a great question, Hannah. Thanks so much for asking that. Well, first off, Facebook has over 214 million users in the United States. And Instagram, I read recently, they have over 75 million active daily users and constantly growing. And so, I mean, your patients are on social media. It’s a fact. Your patients are on social media and you need to go where your patients are at. And so, people live on their phones these days. They live in Instagram, they live in Facebook. And so, it’s important to be in front of them because out of sight is out of mind. And it’s still important to be on social media because these days we can be like, right in front of them and you can post an update to your Facebook page, you can actually get right in front of people who are hurting and need your services. When you run an ad through social media, you can target people who are in pain, who need your services, and you can guarantee they actually see your ad. And so, it’s crucial because everybody else is doing it already. And literally, if you don’t…if you’re not on social media, the chiropractor down the street is on social media, they’re utilizing these strategies and people who are hurt and need a chiropractor are gonna go to them. But we want them to go to you instead because you have what they need.

Hannah: Now, I know you talked about some specific strategies just now with having targeted ads on your Facebook pages. What are some other strategies that chiropractors can use with their social media?

Bryan: Sure. And so, what you can do is first off, they have a good content strategy. So for example, you have the ability to go in there and schedule out content. And so, you could say, “All right.” You know, “This week I want to release these three educational articles that I wrote.” And you can actually go in on Sunday night in your…or maybe your CA can go in and actually schedule out so they automatically publish at specific dates, specific times, which is powerful. You can create educational videos where you’re just talking about maybe a specific pain point, maybe you’re talking about neck pain, maybe you’re talking about back pain, and then you’re talking about different exercise people can do from home to alleviate that. And so, you can have educational videos on there. And then another thing you can put on there is patient testimonials which is so powerful. And so, definitely get in the habit of whenever you’re hearing good stories of patients you’re getting well, ask them if they’ll be willing to do a testimonial video, and go ahead and have them sign a full release form so you can go ahead and use that online. But just film that and then you get these different testimonials that you can slowly post on your social media of people who have different ailments that have come to you and are now better, you know.

And I definitely group it by pain type. So for example, maybe go after a bunch of people that have been coming to you for awhile that are now better from back pain and then do that for neck pain, maybe do that for headaches. You know, if you have a neuropathy in your practice, maybe you have some neuropathy testimonials. But then on top of that, try to get testimonials that are gender specific. So say, well, I got mine three to five back pain male testimonials, I got my three to five back pain female testimonials because each testimonials might speak to some person differently. You know, if a guy sees a testimonial of another guy that plays golf and wasn’t able to play golf, but now I can because I saw you, he’s gonna connect better than the mother that was having problems taking care of the kids. Does that make sense?

Hannah: I think so. You know, those are some strategies that you said work really well for chiropractors and that they should really use in their practice. Which strategies would you say that chiropractors should avoid using?

Bryan: I would say a chiropractor should just avoid blindly posting stuff and boosting it without a clear cut desired strategy and I would say, don’t just blindly boost posts. I know, like, I talk to chiropractors all the time and sometimes they say, “Hey, Bryan, we social media, it doesn’t work. We can’t grow our practice. We tried boosting a couple posts, it didn’t do anything.” And whenever you boost a post, you have to have a strategy behind it. And honestly, I wouldn’t even boost posts. Like, you need to run ads on Facebook. Well, you shouldn’t boost them from a Facebook page. You should target them in the ads manager. You can target people who like your Facebook page, but I wouldn’t do it from my boosting area. If you go to business.facebook.com, you can actually have much more control over who’s seen your ads and actually have a better strategy to get in front of the right people.

Hannah: So we talked a little bit about how chiropractors can manage their reputation by responding to reviews on social media platforms and giving patient testimonials. What are some other ways that chiropractors can manage their reputation?

Bryan: I would say, make sure your information is up to date. Make sure that your address is correct. Make sure that your phone number is correct. You’ll be surprised the amount of people that have the wrong hours or the wrong address, or maybe even a wrong phone number on the social media. So, then when a patient goes to call them, it goes to the wrong number and that’s gonna make possibly a bad review or, you know, leave a bad taste in their mouth. So make sure your information is up to date, but also respond to messages in a timely manner. Don’t just respond to negative reviews if someone puts negative review on your page. But also if someone messages you, respond to their messages in a timely manner. And one thing that you can do also is I recommend installing a chatbot on your Facebook page. A chatbot can actually automatically respond to people and then do a variety of really cool things that is really good for chiropractors. Another thing I recommend doing is ask for reviews. Ask your patients when they come in if they’ll review you online. Don’t specifically ask for Yelp reviews because Yelp can actually…they specifically state not to ask for reviews and if a bunch of people will leave you a Yelp review all at once, it could actually hurt you because of Yelp’s algorithm. But tell them to go on Google and tell them to go on Facebook, and to leave a positive review if they had a good experience.

Hannah: So what are some takeaway tips that our listeners can use to help grow their practice?

Bryan: That’s a great question. I’m excited, definitely excited to answer this question specifically. So, each chiropractor needs to have a landing page specific for one purpose. And so, a tip is I’d say either hire somebody or you can do yourself if you’re tech savvy, but separate from your existing website, get some landing page software that each page has a specific purpose. So for example, you can make a page that maybe it has testimonials on it and you’re just, you know, promoting testimonials on there and someone has an opportunity to contact you to come in for a service, for one of your services. But also have like, say, a new patient special landing page, so you can promote a patient’s special and send them there. Maybe have a landing page that promotes a dinner talk or a lunch and learn seminar, and have these different landing pages that literally, whenever they click it, it’s very obvious that the one thing they can do there is put in their name and their e-mail. So it might have an information about the offer and you press a button, and you press the button, it pops a box for them to put in their contact information. And then of course, follow up with those people in a timely manner.

By having those landing pages, then you can run specific ads to those specific landing pages, and then you can literally track and you’ll know if it’s successful or not. You want to say, “Hey, I blindly boosted a Facebook ad and these are my results.” You could say, “Hey, I ran a new page with an offer and then I ran a very targeted ad five miles around my practice targeting women within this age range and of that, X amount of people actually clicked my ad. And of that, I know for a fact because I have their names, numbers, and e-mails from a landing page software that X amount of people actually redeemed my offer.” And so it’s very, very trackable.

So I would say, have an offer, have a landing page for the offer, and run a targeted ad to that. And then monitor it and if it works good, keep doing it. If it doesn’t work, you know, change it. Another practical take away you could do is run an ad that’s specifically in educational nature. I mentioned earlier uploading educational content to your Facebook page, but don’t just upload educational content, but actually run an ad to this educational content. So you would go into the business manager again. So go to business.facebook.com, go in there, upload a video, make sure the video has subtitles. You can edit it yourself or you can have Facebook review it. But that’s very, very important that the video has subtitles. All right? And then maybe have an educational video where you’re talking about back pain and things you can do at home. And then…a lot of doctors don’t know they can do this. But then you can actually go into Facebook and create a custom audience. And in this custom audience, you can actually then target new ads that people that watched a percentage of that video. So you can run an educational video and then you can run another ad that if they watched 25% of that educational video, they’re gonna see a second video or even a ad that has images in it that talks about your offer. And so, but they don’t see the offer until they see the video. So, you already have some clout in their mind because they’ve seen you around and then you can add another ad that if they watch percentages of that video, then they’re seeing testimonials of other doctors, not a doctor, a testimonials of other patients and their success stories. And then you could even…there’s something called the Facebook pixel where you actually install that on your landing page and you track if people actually become a lead or not. And so, if somebody clicks your ad and goes to your landing page, but then doesn’t follow through and get your new patient offer or whatever it is that you’re promoting, you can actually then show them a different ad. So, what you can do is you can have testimonials that are only shown to people that clicked onto your landing page, but never actually became a lead or a patient.

And so, I know that’s a lot of information to share there, but that stuff works really, really good. And every single chiropractor needs to be doing that because we work with countless doctors across the country who are utilizing these strategies and literally, taking their practice the next level. We’ve taken plenty of people to capacity because we were able to utilize these strategies and then you can actually scale. Because once you find out how much it cost for you to generate a new patient lead, you can then allocate that a budget based on how many leads that you wanna get. And from there, you’ll know how many…depending upon your follow through, you’ll know how many new patients you’ll be able to get out of that. And you can pretty much decide how busy you wanna be. You say, “Hey, I wanna have 20 new patients this month,” you can literally put together a budget that’s gonna guarantee that by reverse engineering those things. I know that’s a lot of information, but I know that whoever’s listening, I hope this was super helpful.

Hannah: Great. Is there anything else that you wanted to add?

Bryan: Sure. I know that if you’re tech savvy, you can set this up yourself. I don’t recommend it because as a chiropractor, you’re extremely busy. You don’t have time to monitor the latest trends in social media and the latest changes because they’re constantly changing things. I know that I’m sure you’ve seen Facebook in the news lately and in even in light of Facebook in the news, things are changing. Facebook still works. It’s still the best way to generate new patients, but things are constantly changing. And there’s even new changes rolling out in light of the announcements such as, you’re not gonna have access to target people based on their income or based on their buying behavior anymore. And so, you’re gonna have to know how to constantly change in light of changes in the marketing environment. And because of that, instead of trying to do it yourself, I would recommend hiring someone to do it. But if you did wanna do it yourself, I do have some tools available that you can get access to, some tools that we use as our company. And so, if you go to chiropracticadvertising.com/tools, you’ll have access to landing page software that we use as well as some other tools. If you don’t have time to do this and you don’t have time to constantly monitor latest trends, we’d love to implement these strategies for you. And you can then go to chiropracticadvertising.com, schedule a demo, and we can go through our different programs we have, and then put together a campaign that’s constantly crafted for your practice to help grow you to capacity.

Hannah: Well, thank you so much for spending some time with us today, Bryan. You’ve given us some great tips on how to leverage social media for increased audience engagement for a chiropractic practice. Thank you for giving us a look into “The Future Adjustment.” I’m Hannah Fell and we’ll see you next time.

Bryan: Thanks so much, Hannah.

The post The Future Adjustment Podcast Episode 23: Leveraging social media for your practice appeared first on Chiropractic Economics.

Daniel: Welcome to the, “Future Adjustment Chiropractic Economics” podcast series on what’s new and notable in the world of chiropractic. I’m Daniel Sosnoski, the editor-in-chief of “Chiropractic Economics” and our guest today is James Fedich, DC, who’s notable for his tremendous success in the field. Since launching his practice upon his graduation in 2003, he has grown year on year in scope and in 2015 published a book titled, “Secrets of a Million Dollar Clinic.” Today, he employs two chiropractors, two physical therapists, an acupuncturist, a nutritionist and an MD. He coaches other DC’s who want to model his path to prosperity, while remaining active in daily practice.

Doctor Fedich, welcome to our podcast.

James: Thanks for having me on Dan, I appreciate the time to come on the show.

Daniel: All right, you’re somebody I’ve wanted to talk to for a long time. Can you tell me how you came to start your practice, actually securing office space even before you obtained your diploma?

James: Yeah, it wasn’t the most well thought out plan, now I look back on it 14-years later. But I graduated from NYCC in December, 2003, and signed a lease on a 700-square foot space before I got my board scores back so, if I failed my boards I’d be in big trouble because I already signed a lease. It wasn’t a well thought out plan but it ended up working out really well. A space came up and somebody knew this place and thought it was a good spot to practice and I jumped in probably not knowing as much as I should. If I knew what I knew now I might have not done it but it worked out for the best. I just jumped right in and had very little money in the bank, and just made it work by hustle, sweat. I worked 2-days a week in somebody else’s clinic on the weekend and 5-days a week in my own clinic, you know, 12 hour days and slowly built it on up to where we are now.

Daniel: Wow. How long did it take you to reach profitability in your first clinic?

James: Yeah, I mean it’s tough. It takes some time, you know, people see it now. The first couple years were tough, I was living with my parents for a year or two and commuting on the weekends to another clinic. And barely every dollar really went back to the business for the first couple years and then there was a point where I got myself in trouble using credit cards trying to fund office expenses when we had some slow months. And, so there were quite a few years where it was kinda tough in there and I was floating it on credit cards, all those things you hear about. So you know, it’s a good couple years but it really just you know, grew [inaudible 00:02:24] the first year you do $100,000 and then you grow 20% every year. I just have really grown 15-20% year after year until we really get to the numbers where we’re at today. So, it’s just been a slow steady growth for the first year, yeah, the first four years is pretty tough.

Daniel: That’s what I’ve heard. Normally it takes three to five years before you really start moving into the green and you know, new docs need to be aware of that if they’re going to try to follow your model and launch their own practice as opposed to being an associate, And, it’s interesting that you actually kinda did a hybrid model where you were doing a little work for another practice as well as getting your own off the ground. Hey, you’ve written for “Chiropractic Economics” before and you’ve described something that you call the Practice roller coaster. What is that and how can a D.C. get off of it?

James: Yeah, that’s what most docs do when they’re marketing their practice and we’ve all heard of some of the promotions. A patient appreciation day is a good example that has been around for 100 years. You know, we do a patient appreciation day. You get this flood of patients, the practice jumps up 25 to 50 visits a week and you’re processing new patients and you’re so busy treating all these people, we don’t do any marketing in our office for 6 or 8 weeks and you know, that big rush of patients dies down and we end up back at the same number of visits we were seeing seeing before, you know, this rush of new people. So, instead of consistently promoting and growing month over month, you know, we do a promotion, we ride that wave and then it comes back down as we you know, process those patients and then we weren’t marketing in those six to eight weeks that we were treating all those people. So that’s what a whole lot of docs do, they promote, they have a bunch of clients and they treat and then they don’t promote again until things slow down, they have another promotion and then it picks back up again. But, you know, year after year we never get anywhere going up and down that way.

Daniel: That’s right. I have definitely heard that before and I’ve heard that, especially in the newer years of your career, you probably want to do more marketing and regular marketing. And then, you can kinda taper off after you’re, you know, well established and you have more of the referral traffic coming your way. In addition to your book, “The Secrets of a Million Dollar Clinic,” you also lecture on that topic. Can you share a few of those secrets with us?

James: Yes, I’ve lectured on several different topics and one of the things I’ve talked a lot about is internet marketing over the years. But, you know, everybody talks about that as well so we also teach direct mail and we do do all that kind of stuff. But, you know, I’ve done a lot of Facebook ads, and YouTube, and Google, I’ve thought a lot about that ways. But, one of the key things we’ve talked about is getting the marketing calendar just like with a roller coaster, just consistently marketing the practice, and having, you know, an internal event going on all the time and an external event. Like you said, when you’ve been in practice awhile you get more referrals. And I just had a new client, he’s seeing 15-visits a day and he wanted some help bringing on an associate. And I just had a little internal thing and he saw this big jump in patients. Even though he didn’t need it, it was just a small internal thing. So, just always keeping an internal marketing going and external, every single month. And those could be things like direct mail or internet marketing as well as internal events. You’ve gotta kinda do it on both ends is my thoughts.

Daniel: Definitely, and you mentioned direct mail, you know, it kinda sounds old school but there’s a reason why it has traditionally been highly effective and it remains so today. And that’s that certain kinds of marketing, like let’s say, Facebook or other kinds of internet driven campaigns are reaching a potentially wide audience but most chiropractors are probably interested in that area of about 15-square miles around, in a radius around their practice and direct mail allows you to target that demographic with surgical precision, if you will. And, it tends to have a pretty high rate of response as well. I know that e-mail campaigns can be considered effective if you’re getting a 3-5% response rate, that’s great. And, normally you can beat that with direct mail.

James: Yeah, absolutely. I was just reading an article about this. And yeah, the direct mail rates are going up, the percentage of responders, because there’s less mail in the mailbox, your odds are going up of people reading your message and getting the message. And, we all know what’s going on with Facebook, you know kinda, everything about, who’s watching your ads and all that stuff. So yeah, direct mail is still good, I mean, we just did an every-door direct mail, it’s a great program for chiropractors. You get low cost, you can get your whole neighborhood and you can also buy a list, it’s real targeted. We just did a senior mailing where we bought a list of just people, you know, over a certain age, to market to seniors.

Dan: Sure.

James: So yeah, direct mail is still good. I don’t care about the medium, I tell doctors, “Whatever works. If it brings people in, it gets your message out, that’s all that’s important. Whether it’s new or old isn’t important, just get them in the door.”

Daniel: Yeah. Hey, one of the consulting services that you offer is something called a Remote-Practice Assessment, wherein a doc will send you like 3-months worth of statistics on their practice and then you analyze them. What kind of things do you look at and why?

James: Yeah, that’s a great thing. Really, with the practice, statistics never lie. You can really always tell what’s going on with the practice if they show you the numbers. You know, everybody’s got different issues whether it’s not enough new patients, or they’re retention, they’re not keeping people enough not or not collecting enough per visit. If you look those, they’re really new patients, collections, patient retention, office visit average, case visit average, all those metrics. But, if you get all those, you can really see what the problem is of the practice from afar. Those numbers really don’t ever lie, what’s the issue, whether it’s new patients. And, a lot of times docs think they may need more new patients. They add the new patients, but they’re not keeping them long enough or something else. But yeah, the numbers really never lie. You can always figure out what’s going on with the practice. I’m always astonished when doctors do that and they don’t even know their numbers, that’s usually step one is finding out all these numbers and then step two, analyzing them.

Daniel: Yeah, if you’re not measuring it you can’t fix it, is something that I’ve heard before as well. Okay, and you know, just to kinda switch gears, there was something kind of interesting I saw in your story is that, well you know, topical analgesics and chiropractic have been you know, hand-in-hand for 50-years or more because topical therapy is clinically effective, and it’s also a good profit center. And, I understand that you developed your own topical line of products for patients, how did you do that?

James: Yeah, we actually found a laboratory that’ll private label for people without like, a huge order. So, I looked around and saw you know, we were promoting brands that are available in other stories or every chiropractor has them. To, look for something different so I looked all over the country for a years to find a lab that would do them and most of them wanted to provide 10,000 bottles of them. But, we found a lab that, you know, they have a formula and they private label it for you and I think you can order as few as 48-jars or maybe even less than that, 24-jars. So yeah, it’s a company that does it and they private label it for us and some of our clients. But, and this way it, you know, has your logo, your phone number, it’s in their medicine cabinet, people never really throw it away. So, it’s good marketing, and it’s a good formula, you know, similar to a lot of the stuff, Pharmaca and Menthol and all the stuff that most of them have in there but it’s got your name on it instead of promoting another company.

Daniel: Yeah, private labeling, where the D.C. can get their name on supplements, on topicals, that just seems to be good marketing, in general. You know, like publishing a book with your name on it as well. These things just, I think kind of, increase your authority and your legitimacy in the eyes of your clientele. And, I just thought that was just a really clever idea. And, it probably improves your bottom line as well.

James: Yeah, absolutely. And you know, they can’t, if they liked it, they can’t go to the CVS or Walmart and buy it because it’s your name on it. They don’t know what formula it is. You know, so, they can only get it from you and we send it in like a new patient welcome box to everybody. So, it’s in their house, it’s in their door. So it’s already in their house. Everybody gets a free jar so, you know, my name’s in their medicine cabinet for, you know, probably years I would think, for most people unless they use it up and then they come buy more.

Daniel: Got it. Hey, before I let you go, do you have any new initiatives or things you’re working on, symposiums coming up? Any new…

James: Yeah, we’ve always got…

Daniel: Yeah, go ahead.

James: We’ve always got new stuff going on, I mean, obviously the podcast is out. We have two new episodes a week. I just did an interview with Doctor John Demartini, who is obviously well known in our profession.

Daniel: Oh, yeah.

James: There’s always free tips and tricks on our podcast, you know, we have like 50-60 episodes, we do 2 a week, there’s always something going on there. We talked a little bit before now, we have a free audio program on, “Ways to get New Patients,” available on our website at drjamesfedich.com. That’s F-E-D-I-C-H. You can download a free audio of, “The Top 10-Ways to Get New Patients in 2018.” Yeah, I do some speaking here and there and we’re always around at chiropractic conventions, but a whole lot of it we do remotely because I’m still in practice. But, there’s always stuff available and the podcast has always got some new great tips for you.

Daniel: Okay, well, you’re a thought leader and you definitely have your finger on the pulse of the profession. So, we’ll try to get you back in the magazine as fast as we can and…

James: Thanks Dan, I appreciate it.

Daniel: All right, well hey, Dr. Fedich, thank you so much for spending this time with us. It has been highly informative and you’ve given us a million dollar look at the “Future Adjustment.” I’m Daniel Sosnoski, we’ll see you next time.

The post The Future Adjustment Podcast Episode 22: Building a million dollar clinic appeared first on Chiropractic Economics.

Daniel: Welcome to “The Future Adjustment,” Chiropractic Economics podcast series on what’s new and notable in the world of chiropractic. I’m Daniel Sosnoski, the Editor-in-Chief of “Chiropractic Economics,” and our guest today is Madeleine Silva, who’s found remarkable success in the highly competitive arena of healthcare business coaching, particularly for complementary and holistic providers. She’s also the co-founder of The Empowered Healthcare Revolution. She understands that disruption is happening in healthcare just as it is in nearly every other industry. And she’s a renowned speaker to audiences who want to stay ahead of the curve. Madeleine Silva, It’s a pleasure to welcome you to our podcast.

Madeleine: Thank you so much, Daniel, I’m thrilled to be here.

Daniel: Okay, well, you have your finger on the pulse of so many interesting things, so let’s just get to them. Your knowledge of disruption and the shifting business landscape is more than academic, you confronted it in your own business. Can you tell us a little about your backstory?

Madeleine: Yeah, absolutely, so about 16 years ago, I started a insurance billing and practice management consulting company, primarily working with chiropractors. And, you know, I quickly grew it and it was very successful, I had some really powerful partners in that business and it was really fun, I loved it. And then big changes, big industry changes happened in the insurance industry and anybody who’s dealt with insurance knows what a headache it can be.

And all of a sudden, I lost 35% of my profit margin just like that. And up to that point, I was working many hours, I was working maybe 50, 60 hours a week, the typical, you know, small business owner. And the silver lining of all of that was that I had a really good cash flow. And then when that shift happened and that was taken away, too, it was really, incredibly stressful and I tried to tweak. I mean, working with the insurance industry, things are always changing so you’re always pivoting and trying to move with the economy, but the little tweaks I was making was just not making a difference. And pretty quickly, because I now had lost my main income source, and like many women these days, I think 29% of all women these days, I was the sole breadwinner of my family and so without my income, we pretty quickly spiraled downward.

And by just pure luck, I think, we were able to sell our home, our house that we owned, and get out before we actually lost that to the banks. We were starting to get pre-foreclosure paperwork from the banks. And so we had, you know, so there I was middle of the night, lying in bed, sleepless, staring at the ceiling, really stressed out. And we have made a little bit of money from the sale of the house. And so as I was staring there in our little rental, I was like, “Okay, I have to make this work, I have to commit,” and I made that commitment, put my stake in the future and said, “I’m gonna turn my business around.”

I mean, I didn’t have a lot a lot of choice, really, right?. So the next day, I sat my husband down and I said, “Listen, I want to take half of what we made from the business. I mean, from the sale of our house and invest it into my then failing business. And that would leave us, you know, a tiny bit of money left over that would if we stretched it out, we might be able to live off for the next six months and then we would run out of money again.”

And so he was, you know, amazing guy, he actually said yes, and so I started, you know, I went back to my office and I still didn’t really know what I needed to do, or what I need to change. And a couple of days later, I received a letter in the mail that totally changed everything and it was a letter from a business broker.

And he was specialized in selling businesses like mine, insurance, recurring insurance billing services, recurring businesses. And so I reached out to him and he gave me three things that I needed to have in place in order to sell my business at the price that I wanted, that I made up. And he said, you know, I had to be able to run the business from anywhere and I needed to have X-dollar profit margin and it needed to be able to run without me.

And at the time, I had an expensive office lease, I had eight full-time local employees. I had, you know, not making…I was making good money and our revenue was really good, but I wasn’t making any profit anymore, right? And so at that time, I just started really looking and I feel like I did a paradigm leap in my own mind and started looking at my business from a completely different point of view. Because, like I said, I was working 50 or 60 hours work weeks that I wasn’t really sure how the business was gonna be able to run without me.

And so I started making some really radical changes and really looking at the business differently and within the next six months, I worked myself out of a job and ended up with an eight-hour work week. And I ended up with a 65% profit margin and I went primarily from a brick and mortar business into a virtual business. And I did that and then we’re able to sell it for the exact dollar amount actually that I gave that broker that day.

Daniel: Hey, a happy ending.

Madeleine: I know, a really happy ending, and so I understand the challenges of today’s brick and mortar businesses and I understand the challenges of disruption that happens outside of your control. I mean, these decisions in the insurance industry was made way above my pay grade, right? At government levels, so I understand what the chiropractor in today’s, you know, office… And yeah, and I might not be able to go virtual, but there’s lots of really creative ways of looking at the business. And I also think, you can no longer rely on making minor tweaks in your practice, you need to make that paradigm leap. A different way of practicing.

Daniel: Yes, let’s explore some of that in a second. I just wanted to say that from some of the things that you were saying, you reminded me of that series of books called “The E-Myth Revisited.”

Madeleine: Yes.

Daniel: Yeah, that doctors of chiropractic are vulnerable to this problem because often the practice is driven by the personality of the owner. And the practice never develops these systems in place that would allow the practice to be sold as a turnkey operation because it’s really built around the personality and the popularity, and the charisma, of the founding doctor. And so it seems like you’ve kind of put your finger on the importance of establishing systems so that the practice can run whether you’re there or not. And there’s no question that the doctor-patient relationship is undergoing some changes now. It used to be the doctor was sort of the premier authority and the patients had to be extremely deferential. And that seems to be changing because of the internet. Do you have any thoughts on that for us?

Madeleine: Yeah, absolutely, and I’m so glad that you’re actually acknowledging that the patient-doctor relationship is really changing. Because I think a lot of times when we talk about healthcare disruption, we overlook that part. We talk primarily about innovation and technology and online marketing, but I think that biggest piece is actually that the doctor-patient relationship that’s just changing. And what I’m noticing is really patients are changing in five key ways, one, that I think they’re more skeptical than ever before. Now getting bombarded with offers and sales online and, you know, being promised the sky and the stars.

And I think that they really are looking to know, like, and trust somebody before they’re actually willing to come in and see you. And I think even with referrals, it’s harder to convert people. And I also think that they’re way more demanding than ever before, meaning that they’re really looking to be empowered and get knowledge. And they want somebody that’s gonna partner with them in their healthcare, and they are way more educated than before. They ask more questions because with the digital disruption, they have now access to all of this amazing information online. 80% of adults are now researching online before they seek out a provider. 94% read online reviews and they consider online reviews just as credible as a direct referral from a family member.

So, you know, they are highly educated and they’re hanging out on hubs online looking at solutions for healthcare. So they walk into your practice pretty much right with a folder underneath their arm ready, armed with knowledge and with lots of questions. And I also think they way more holistically focused, so, I mean, obviously, this is a fantastic thing for chiropractors, right? But I think that they really waking up that medications and surgery is not the solution, it’s definitely not a long-term solution. And that they’re really looking to find different answers to health concerns. And I also believe that patients are more than ever want to participate in their own healing, they don’t want things so much done to them, they don’t want to be fixed as much as they actually want to be engaged. And better understand and learn from the healthcare provider they’re working with.

Daniel: Yeah, I’ve gone into the doctor’s office with a folder under my arm, like, so guilty as charged.

Madeleine: Right?

Daniel: Right, and, of course, there are the online review tools, as well. A dissatisfied patient has a lot more power nowadays. Because he or she doesn’t just, you know, tell their friends about an experience they had, but they can get online and tell the whole world about it. So that’s definitely changing things there. One problem that is common to most doctors of chiropractic is just a hard limit on the number of patients they can see in a day. How can they get…give me tips on how they can get beyond a linear growth pattern and experience the kind of exponential growth that you talk about in your seminars?

Madeleine: Yeah, absolutely. I mean, you kind of touched on it earlier when you were talking about how the chiropractor, and I also said this for years that I think that chiropractic is in a very unique position because other, if you look at other six or seven-figure or even eight-figure business owners, none of them are actually responsible for the day to day promises of their businesses anymore, right? But a chiropractor is there face to face with a patient adjusting and that’s the main promise of that practice. So I think that the long-term goal is to step out of that role of being the center of your practice and, like you said, personality-driven practicing and rely on other people to take some of those pieces. Now how do you do that well? So one of the things that I’m talking a lot and teaching some of my clients is, really, you have to figure out a membership-style practice and I’m not talking about the joint or discounting your chiropractic services.

So obviously, if you discount your face to face services, you are quickly not gonna be able to create exponential growth, but you quickly actually gonna now just discounting your services. So that’s not the solution, but just like I talked about before, patients are really looking for education and resources and community-based online networks and I believe that chiropractors should create online communities. And they can simply monetize those, as well, and create memberships as a business model that actually covers your basic overhead expenses. So imagine if your overhead was covered by recurring membership income by people, a community of people that you establish yourself as the expert and leader of. And it also becomes, very quickly, a place where you are the expert and obviously, the leader of that community which positions you and gives you a tremendous amount of social proof. New patients are definitely gonna seek you out from that community and you’re gonna get way more referrals because you’re now a key influencer. And it opens doors to other speaking gigs, and podcast interviews and just local influencers are gonna start reaching out to you. It creates this place where people find you and get to know you better.

Daniel: Yes, and for our listeners out there who may be, like, thinking, “Well, that sounds kind of like a wild idea,” actually, there are some doctors out there right now who are doing exactly what you’re describing, they’re building a strong online community. They develop a fan base, if you will, and they’ve created the spaces for patients to come together and share their own insights and knowledge. And it’s a very powerful technique and it is definitely doable and there are people who are very good at it. Dr. Axe comes to mind. There’s a few more.

But this does lead us to the kind of another topic I wanted to ask you about quickly because it’s something that you’re apparently pretty good at. You offer consulting services to help doctors to get better at new patient marketing and acquisition. Could you just share a couple of offhand tips with us to give us an idea of the kind of things that you teach?

Madeleine: Yeah, absolutely, so I basically take people through a three-step system. And the number one system is really to clarify your marketing message, and so most chiropractors, right, when somebody asks you what you do, you say, “I’m a chiropractor,” And what happens immediately to patient or the person in front of you that’s hearing that, they immediately jump to assumptions about what chiropractors are based on their own experience and what they heard. And they’ll probably pretty quickly cross you off the list of somebody that they need or might need help with. And so if you actually answer it in a different way, that question becomes really powerful. One way is, you know, you know how teenagers are four times more likely to commit suicide than actually die from cancer because of anxiety and depression? And, well, what I do is to help teenager regain their happy or maybe teach them how to cope, and so they can live a long and fulfilling life. So that’s another way of answering that question, “What do you do?” It’s a much more engaging way of answering it, it’s a much more specific way of answering it. And actually gets people leaning in and curious about what you do.

And so, you know, you can come up with your own version of that depending on what you want to focus on. I think the biggest misconception when it comes to clarifying your marketing messages is that, “Oh, if I do it that way, then I’m gonna push away all these other people that I can help.” And we all know if somebody has a spine, they need to see a chiropractor, right? I’ve been getting adjusted for 27 years, so I get it. But I actually think when you’re really targeting your marketing message, people who you’re speaking to, when they hear your message, they feel that you’re speaking directly to them. And they get much more likely to take action and move closer to you and get to know what you do.

And so that is one of the powers of doing it, and so one of my clients, she was just doing this and she actually did focus on specifically what we’re talking about here. She focused on teenage anxiety, and we had this shooting down in Florida, right? A couple of months ago and she did a Facebook Live where she had a TV screen behind her with a picture of the shooter, and she was very emotional. You know, she’s a mom, she has teenagers. And she had printed out the printouts of the side effects of the drugs, the psychotropic drugs that these kids often are on. And she was reading the side effects of those drugs right from the sheet, from the printout and it was just very impactful, and she encouraged people to go and check it out. And within a couple of hours, that video went mini-viral on Facebook and thousands of people got it shared. And thousands and thousands of people started seeing it, and about 2:00 am that morning, a father reached out to her via private messaging and just said, “Listen, can you help my daughter? She’s talking about hurting herself and others and I don’t know what to do. She is on those drugs, she lost her mom and I’m at a loss. Can you help me? Can you help us?” And this chiropractor was then able to actually help this family get out of that situation, and I think that that’s the power of having a clear marketing message.

Daniel: I couldn’t agree more. In my work here at the magazine, I run across very, very frequently a business owner, or a company employee, who does not clearly understand the nature of their own business. They can’t concretely explain it in clear and simple terms. And chiropractors have a great deal of leeway. They can say, “I want to focus on spine health,” or, “I want to focus on helping people optimize their nervous system,” or, “I want people to have lives free from the dangers of drugs and their side effects.” Many different ways that that value proposition could be stated. And I hope our listeners will take a little time today and think about their own core marketing message if there might be other ways to say it in more compelling terms.

Madeleine: Yeah, and I know we have a little bit, limited time here, Daniel, today, so if they want the [inaudible 00:18:13], I can go over the steps or they can also download the e-book that I have. And we’ll give them the link to that before the end of today.

Daniel: Yeah, for people who’d like to follow-up and learn a little bit more about you and the work that you’re doing, where can they go online?

Madeleine: Yeah, they can go on to freedomswitch.com/danielsosnoski. Did I pronounce that right, Daniel?

Daniel: Daniel Sosnoski, that’s me.

Madeleine: That’s you, right? So yeah, so basically, you know, we have created a very special page specifically for your listeners and where they can find both my Facebook group, a link to my Facebook group, “Healthcare Heroes.” And they can join for free and, obviously, I give away tons of information in there. They can also download my free e-book, which basically helps them attract patients on Facebook and how to do that effectively without wasting a bunch of money on ads or spending tons of time in front of the computer. And also taken a five-part, if you want to engage even more with people and create a community to really do the unknown to experts five-day course. It’s a free e-course and I’m only offering your podcast listeners, so they should check it out.

Daniel: Oh, that’s a great

Madeleine: That’s all on one page. Yeah.

Daniel: Okay, well, I’ve just been doing a little reading over the past couple of days just about your thoughts, and the work that you’re doing. You are a fascinating individual, you’re doing excellent work. And anybody who wants to follow up and learn a bit more from you, I think, will be extremely thrilled at the outcome. I want to thank you very much, Madeleine, for spending this time with us today. It’s been extremely informative and you’ve given us a revolutionary look at “The Future Adjustment.” I’m Daniel Sosnoski, I’ll see you next time.

The post The Future Adjustment Podcast Episode 21: Staying ahead of the healthcare curve appeared first on Chiropractic Economics.

Hannah: Welcome to “The Future Adjustment Chiropractic Economics” podcast series on what’s new and notable in the world of chiropractic. I’m Hannah Fell, the associate editor of Chiropractic Economics, and our guest today is Karla Wolford. She is the owner of EHP CrossFit, and Elevate Human Potential in Moorhead, Minnesota. Her practice offers sports chiropractic and rehabilitation, group training, personalized coaching, one-on-one nutrition, and more. She graduated with high honors from Palmer College of Chiropractic-West and summa cum laude from Logan University with a Master’s Degree in Sports Science and Rehabilitation.

Dr. Karla appreciates working with people who may be overcoming an old injury and finding ways to teach them how to move differently and more effectively to avoid future injuries.

Karla, thank you so much for joining us today.

Karla: You’re welcome.

Hannah: So, I was reading about you online, and I understand that you got into CrossFit because you wanted to treat CrossFit athletes for a sports chiropractic job that you’re working at the time, and the gym said that you could treat those athletes if you tried CrossFit out for a week. What was that experience like?

Karla: Well, it was a bit humbling. I was a college athlete. I was a Division III college athlete. I played multiple sports and I was actually pretty scared for a few reasons. I had a pretty significant snowboarding injury that resulted in a broken lumbar spine with a ruptured disc, so I was pretty conservative in the fact that, like, I lifted weights. I just didn’t pull a lot from the floor at that time, because I had a lot of low back pain. And, I just tentatively and hesitantly said, “Okay, I guess I’ll come for a week.” And the rest was pretty much history.

Hannah: So, did you gain a lot from that experience of being CrossFit and did that kind of shape your direction with where you wanted to go with chiropractic and then you decided you wanted to treat CrossFit athletes?

Karla: Yeah, I mean I always like treating athletes of all varieties; basically anybody who has ambition to go somewhere and do something. And, CrossFit just happens to incorporate a lot of different things into one. So, CrossFit athletes tend to be quite complex as far as, like, treating them. The good news is, in my practice, unless you’re really down and out, I’m always going to encourage you to modify your activity and keep moving. And I guess the nice thing is coming from a world where I worked with a ton of runners…if you take a runner out of their sport for too long, mentally they start deteriorating. You know, the good news is, if I have a CrossFitter with an ongoing shoulder thing, I can say, “All right, do this instead of that. Do this instead of that.” And mentally I can help them through it and say, like, you know, “This is what we’re gonna gain. In the next three weeks, we’re not going to be able to do, you know, your snaps or your kipping, but this is what you’re gonna gain in that time.”

So, it’s difficult because we’re complex athletes, but it’s easier because you can always give a modification and help people get better in a different way.

Hannah: What kind of challenges have you seen in your practice in treating athletes?

Karla: Well, you know, I’ve been all over the country and all over the world treating different athletes of different calibers. And, there’s so many different challenges, I guess. I would say younger in my profession, it was to get athletes to adhere to, like, out-of-office, like, education, modification of whatever activities they were doing. Somehow nine years in now, and somehow I don’t know if I say it meaner or what I do, but people tend to really pay attention and really take it to heart. Like, what I ask them to do when they’re not in the office, because in all actuality I teach a lot of people how to treat themselves so they don’t have to come see me as much.

Hannah: So, do you think that being a CrossFit athlete yourself has kind of given you this ability to I guess understand what it might be like to have an injury and how to best treat that?

Karla: Well, yeah, I’ve had my fair share of injuries throughout things that I’ve done whether it be college basketball, or volleyball, snowboarding were probably my worst injuries. You know, and not to say that CrossFit doesn’t have injuries because all sports have injuries. I’ve actually been fairly lucky at the level that I’ve competed at in CrossFit. I did have a meniscus injury that I had fixed, and I had a pretty severe ankle injury. I was not even jumping, I was stepping off a box. And in the last couple years, actually my dog ran into me and took me out and took out my ACL, which I chose to not surgically fix.

And so I’ve gotten my fair share of injuries, so empathy is…I get it. I get when people are injured and struggling. So, when they’re in my office…I just had a gal the other week. She’s got some, like, thoracic disc degeneration, and we’re cotreating with another provider. And I just said, “At this time, you’re not gonna get better at your front squat or your back squat, but this is what you are gonna get better at. So let’s take and restructure your goals on what you wanna achieve in the next three months based upon where your body’s at.” So, sometimes it’s just letting people know that you get it and having them meet them where they’re at is half of treating my patients I guess.

Hannah: Yeah, so I was looking around on your website and I saw that you also encourage your patients to engage in a healthy lifestyle which extends to the food they eat. How much of a role does nutrition play in your practice in treating your patients?

Karla: Well, nutrition should honestly be, I think, the biggest foundation of what we do. Is it the whole foundation of what I do and practice? No. I won’t say that I don’t plant those seeds in people. We talk about diet, we talk about nutrition, and I will plant little seeds into people’s lives about, like, “All right, like, you know, I know that you think what you’re doing is healthy but it’s not.” And, a lot of times people come to this crossroad of, “Okay, like, I really want to, like, learn, and I really want to dig in.” So I do individual, like, nutrition plans for people and anywhere from two months to a year based on chronic diseases, or performance, or weight loss, or whatever their goals are.

And then also, because I own a gym, we also run a body transformation challenge which brings a group of 8 to 12 people together, and we basically teach you how to meal prep. We teach you what healthy food is. We take you on grocery store tours. We have a really comprehensive eight-week program that shows to increase some body muscle and decrease a lot of fat mass.

But most importantly through this and all the things that we’ve studied over the past two years is eating healthier things improves people’s quality of life scale and happiness scale. We’ve had them test the World Health Organization scales. So, it really is the cornerstone of what we do. You know, when somebody comes in with a sprained ankle, they don’t want to hear me talk about nutrition but I still do it. It’s pretty much the foundation of where we should start.

Hannah: That’s good. So, I guess that’s all I have to talk about with you for today. Thank you so much for spending some time with us and helping us understand that, you know, CrossFit, and nutrition, all that you do, and how to specialize in that as a CrossFit athlete and as a chiropractor. Thank you for giving us a look into The Future Adjustment. I’m Hannah Fell and we’ll see you next time.

The post The Future Adjustment Podcast Episode 20: CrossFit + Chiropractic appeared first on Chiropractic Economics.

Daniel: Welcome to “The Future Adjustment,” Chiropractic Economics podcast series on what’s new and notable in the world of chiropractic. I’m Daniel Sosnoski, the editor-in-chief of “Chiropractic Economics,” and our guest today is Ryan Comeau, DC. He’s the CEO and Co-Founder of Kinetisense, a technology and software firm that’s been gaining significant attention. And you may have seen their Parker 3D Booth at this year’s Parker Seminars Las Vegas 2018 conference. Dr. Comeau is a graduate of Southern California University of Health Sciences, where during his studies, he realized the need for more objective and precise movement and analysis tools.

Dr. Comeau, thank you for joining us today. To set the stage, can you tell us a little bit about the state of biomechanical assessment as you saw it prior to the founding of Kinetisense?

Dr. Comeau: Absolutely. And Daniel, I’d like to thank you for having me on this podcast, it’s truly an honor. Currently, the state of biomechanical assessment in the clinical setting is really one of subjectivity and the lack of efficiency.

We find that, in the clinical setting, we really do lack the tools to be able to gather proper information on our patients and to be able to see progress that we make as practitioners. And what happens is this leads to, obviously, a subjectivity in assessment where we’re often left with having to eyeball the patient or having to have difficulties with looking at their progression over time.

The other issue that we see is a lack of efficiency. Many of the tools that we do have require having to put on wearable systems or require extra time of the practitioner with the patient. And in a clinical setting, this can be very, very difficult for the practitioner. And oftentimes, practitioners will get caught in this tradeoff between the efficiency and the objectivity and choose to simply eyeball their assessments or use some of the more archaic tools that we’ve had in our profession for hundreds of years, like the goniometer and inclinometer.

And really, this results in the patient satisfaction being affected. This results in patient compliance being affected, as the patient really is not engaged in the process of the assessment and in the process of rehabilitation. The patient is not able to see the changes that we’re making, the powerful changes that we make as practitioners with adjustments with the different clinical tools that we use.

The other important thing too is the ability to collect data to be able to make our practitioners movement scientists. This is a very important concept because when we start to look at, as a profession even, the changes that the adjustment makes to the neuromuscular system, neuromusculoskeletal system, we’re able to now see which techniques, which different modalities are making the best changes for the different symptoms or issues that our patient has.

The other advantage of this is that we can expand one’s clinic walls, we can expand the practitioner’s walls of their clinic and allow them to have a portable tool that they can go out in the community and really showcase chiropractic to the masses.

Daniel: Right. Okay, let me pause right here. For listeners who aren’t familiar with what Kinetisense is about, let’s dial in and describe it a little bit, because when we’re talking about range-of-motion measurement, posture measurement, any kind of biomechanical measurement, there’s really two paradigms that we have in the chiropractic space.

First, we have the really old-school analog tools. Like if you’re gonna measure, you know, how far an elbow can bend, you have something that basically looks like a mechanical protractor and, you know, you basically just dial in the angle that you’re registering and you write that down on the intake form.

And then you have a newer wave of tools that are often handheld and Bluetooth. And they have, you know, motion sensors, and those transmit to a computer screen, and you can get fairly good readings off of that.

Kinetisense is like going off way into the third dimension in the future using a device…I think, right now it’s based off the Microsoft Kinect system, is that right?

Dr. Comeau: Yeah that’s correct.

Daniel: Right. And so, it’s a series of intelligent cameras that actually focuses on the patient, and it basically can just read and assess their movement completely through software, and records that data directly to a computer, and gives you readouts.

Dr. Comeau: Correct.

Daniel: Right. And this company, your company, you founded it back in 2012. Can you tell me, kind of, like, what…You’ve described it as being the first markerless motion capture analysis system. Can you explain your thinking and what that means?

Dr. Comeau: Yeah, absolutely. Yes. So, definitely, you know, with these other systems that you’ve mentioned, you know, if you’re looking at, let’s say, range-of-motion with the handheld tools that we have. This involves having the practitioner, you know, placing these tools on the body, which really does have an effect on the overall motion of the patient. But also, when we’re looking at assessing joints, let’s say we’re assessing a shoulder and abduction, for instance. The body can compensate, and the other joints of the body can compensate. Sometimes the patient will go into a little bit of a lean or sometimes the patient will rotate slightly.

The beautiful thing about Kinetisense is with the 3D motion camera that does not require wearables, it simply picks up the joints automatically, reproducibly every single time, we can get true joint values. And that’s a very important concept because let’s say, you know, in assessing shoulder abduction, if the patient does lean, the system will automatically calculate that lean into the range-of-motion of the shoulder. So we’re getting pure joint range-of-motion, specifically of that joint, because the algorithms will remove any other motions of any other joints of the body or any other joint planes of the body. So this becomes the most accurate joint assessment that we have and the joint, obviously, just being one of our modules.

And so, with the camera, and this is, it’s the Kinect camera, you’re correct, this camera is able to locate the joints of the body based on three different systems that it has built within. So, one of those being the ability to pick up infrared, so the heat distribution of the body. There’s also a sonar component which picks up depth, and this does a topographical representation of the body line for the reproducible placing of the joints, and also gives us the transverse view, the overhead view. So we’re able to look at compensation patterns of movement in all three planes. We have the frontal view, we have the sagittal view, and then we also have the transverse view. So we can look at compensation, we can look at muscle firing patterns that occur with all the different ranges of motion.

And then the system will automatically take this data and write it out into SOAP note form for our practitioners, so they can simply API that into their charting, they can copy and paste that into their charting, saving the practitioner even more time.

Daniel: Well, that’s really amazing. And when I attended Parker Seminars earlier this year, I was able to take a demonstration of the system myself and it was amazing. All I had to do was just walk in front of the Kinetisense unit, and immediately, it was tracking me, it was placing points of measurement automatically on my body. And the person at the booth who was demonstrating the system just asked me to turn 90 degrees and raise my arm. And it was all happening in real-time.

There’s been talk about the future of healthcare intersecting with augmented reality, and it’s no longer in the future, you’ve actually brought that to us right here, right now, and it’s immediately available.

You mentioned modules. In addition to Range-of-Motion, for example, how far an arm or how far a person can bend over with their torso, what other modules are available with Kinetisense?

Dr. Comeau: Yes. So, Kinetisense is a module-based system. And really, when we started Kinetisense back in 2014, the first module that we developed was Range-of-Motion. So, being able to replace, you know, systems like the goniometer, inclinometer, and being able to do joint by joint assessment. With our technology, with the Range-of-Motion component, we’re able to do assessments such as cervical rotation, different rotations in a standing position. So, being able to really get insight as to what’s happening with the muscles in that support of position.

We then transitioned into posture, and we created 3D Posture. And 3D Posture is the only system in the world that gives the transverse view, that overhead view of assessment with a single front-facing camera.

We then progressed into 3D Balance, 3D Balance Assessment, where there’s no need to have a balance platform. And what it does is it actually will calculate the amount of sway that occurs at each segment of the body, unlike a force plate that only gives you information on the foot. So we’re able to figure out what part of the body is lacking proprioceptive input or stability, whether it’s the hip, the knee, the shoulder, and exactly in what plane.

We then moved into the 3D Functional Movement component. So this is a movement module where you can do any type of movement, whether it’s a golf swing or whether you want someone to do a box jump or have someone reach overhead. And it calculates all of the joints of the body in real-time, and the practitioner can take data captures of the video of the patient doing whatever movement they’re going through.

We then transitioned into what is called as KAMS. And this was the product that we launched at the Parker Seminars in Vegas. And we’re very, very excited about this module because KAMS is a workflow of 12 different movements that are science-based movements, that give insight into compensations of the body. So, movements such as the overhead squat, the inline lunge, we do a modification of posture with the posture software.

And this system will calculate all the different data points and find the compensations and which joints, which planes are rotating or shifting, or how that patient is trying to find ways to accommodate the movement and whether it’s efficient, and actually scores their function, which is a huge change to what is currently being done with some of the more visual functional movement assessments that we have that take, can take 20 to 30 minutes. This is done in three minutes, and automatically is reported. So, very excited about that.

Daniel: Yeah, we’re talking right now about measurements, but I understand that because, you know, what you’re describing right now is dynamic movement, you’re not simply, you know, measuring a single action but you can actually look at the body in motion and make some assessments from that. And I understand this can also be used for risk analysis?

Dr. Comeau: Yeah, that’s correct. So, with the modules and specifically with Balance, for instance, our Balance module is being used in concussion baselining, and then reassessment after a concussion. So it’s being used by a bunch of different sports organizations, professional teams, for that. Also, risk of fall in the geriatric population.

We’re actually able to look at the numbers, you know, that we get from balance. We’re actually able to look at trends with our patients and see if they’re trending in a positive way or a negative way and be able to get insight as to, “Okay, when is it time to intervene? You know, what changes do we have to make to prevent further injury to occur?”

We’re also doing this with KAMS, so our functional movement screen where we’re starting to work with different universities with research looking at, “Okay, what is the amount of injury that a volleyball player will have over the course of a season or a team? And how does assessment and intervention before injury occur? How well does that work?” And we’re getting some very promising results early on. So, being able to assess risk of injury really is at the forefront of what we’re doing with the data capture.

Daniel: Yeah. Although on this podcast, we don’t often go into proprietary technology and patented items, we’re definitely making an exception today, because it’s definitely our assessment that Kinetisense isn’t simply a tool, but it allows the practitioner to open new doorways into new types of practice. And you’ve made things possible that have simply not been possible in the past. It’s a real game changer. And, I think, really, the best way for our listeners to understand what a game changer this is is to take a look at it themselves. How can people see Kinetisense in action? Is there a place they can go online?

Dr. Comeau: Absolutely, yeah. The best place for the listeners to get more information on Kinetisense would be to go to our website, that’s www.kinetisense.com. And, on the website, we have a lot of different information there on the different modules, the different groups that are using the product. And then, on our website, you can actually book an online demo, a free online demo, with our team. And our sales team and our kinesiology team will take you through every single step of the product to be able to, you know, learn some more information about the clinic that you have, and not only, you know, how to integrate, but different strategies on how you can use the system both in your clinic and in your community.

Daniel: Well, we’ll have a link to that directly on this web page, and I urge anybody with interest to take a look at it.

Dr. Comeau, you have been a font of information this morning and I wanna thank you for being with me today.

And the emerging technologies in the realm of augmented reality always have just seemed to be around the corner, but you’ve made them available for practitioners to use right now, and for that we’re thankful. And thank you, for giving us a three-dimensional look at the future adjustment.

I’m Daniel Sosnoski, and we’ll see you next time.

The post The Future Adjustment Podcast Episode 19: State of biomechanical assessments appeared first on Chiropractic Economics.

Dan Sosnoski: Welcome to “The Future Adjustment,” Chiropractic Economics podcast series on what’s new and notable in the world of chiropractic. I am Dan Sosnoski, the editor-in-chief of “Chiropractic Economics,” and our guest today is Ty Talcott , DC. He is the president of HIPAA Compliance Services. And he’s a certified HIPAA privacy and security expert. He’s consulted with thousands of health care practices related to business development, and protection strategies. And Dr. Ty is here today to talk to us about some of the threats and risks facing today’s health care practices and how you might go about mitigating them and remaining compliant with regulations. Dr. Ty, welcome to our show.

Dr. Ty Talcott: Thank you so much.

Dan Sosnoski: All right. Well, just to kind of get going here, in your experience, what are some of the major threats facing practices from a security standpoint? Is the risk mainly digital?

Dr. Ty Talcott: Well, that is kind of a yes and no answer. The most serious thing is digital because that would be your ransomware attacks that completely shut down your business, hacking attacks that steal your data from your electronic devices, but, realistically, actually I just returned from the Washington, D.C. Cyber Security Conference, boy, there’s a snoozer, two days with those folks. But, anyway, I learned a lot of information, and as of now 39% of the risk that you run is still direct theft, people stealing your laptop computer out of Starbucks when you set it on the table and go to the bathroom. People breaking into offices and physically stealing, and only about 17% of attacks that are happening are hacks, you know, electronically coming in to your electronic digital devices. But the point there is that just a couple of years ago it was only 2%. So that’s the growth industry, the cyber-attacks, the electronic hacking into digital items, the ransomware attacks.

these are the things that are just raising…causing havoc in chiropractic offices and of course nationwide in all types of businesses, and that’s the growth industry. If you want to look at what’s the growth industry in attacking data, that’s it. That’s it.

Dan Sosnoski: I’ve read in some of the security literature that medical records tend to be among the most valuable on the black market. Is that correct?

Dr. Ty Talcott: That’s correct. You can get about $5 per name on the black market for identify theft type information, name, social security number, etc. You can get almost $500 per file for a full health care file because of all the information and data that it contains and the information we gain from our patients. What we gather and collect, it is just…it’s so massive that it’s worth a lot more on the market. And you know what they do with this information? The reason these people keep stealing it and they get all this money, they do identity theft, they make insurance cards and ship them overseas. People buy these insurance cards and come get care on your group policy.

And you don’t know that they are getting care on it until you get the EOBs that come in. I’ve never been to this doctor. By then they are back out of the country. The other thing they do is they take all your patient’s information and they file their tax returns. And if they have a refund coming, they collect those tax refunds.

Dan Sosnoski: Yes.

Dr. Ty Talcott: And that’s where they make their big money on this stuff. And that’s why this stuff is so valuable and sometimes people go, “You know, why do they care about my stuff? I am not sure they are really so interested in my data. I don’t know that I’m at risk.” No, they want your data because they can make lots of money on your data.

Dan Sosnoski: That’s the point I really wanted to make very clear to our listeners today, that if you’re running a medical practice, you are the whale in the water. You are the target that they are coming for, so that’s why you want to be really careful. Hey, Dr. Ty, you mentioned a term just a little while ago, you mentioned ransomware. That is a particularly nasty kind of attack. There was a hospital that got hit in California. They had to pay the cyber criminals something on the order of $17,000 in bitcoins to get their data back. How can a doctor defend against this if even a large hospital couldn’t?

Dr. Ty Talcott: Well, the reason…I mean, it’s actually harder for hospitals. They’ve got hundreds of staff, people running around that can get in that data, share that data, share their passwords with other people, who then get in and you don’t know who was in there and who wasn’t. They have way more devices than the typical office that they have to protect and keep everything updated, the patches and the firewalls, and all the things that they have to do. And they have more exposure because they have more data transferring back and forth and going everywhere. It’s actually easier for a typical doctor’s office to protect that than it is for a hospital to protect it. It’s a massive thing. I mean, I have a video interviewing a woman who…a small chiropractic practice in the Pennsylvania mountains, who was hit by ransomware.

A screen pops up on your computer and says, “We have your data. You’ve got five hours to pay us $5,000. If you don’t, you’ve got five more hours to pay us $25,000. If you don’t, we’re going to sell or, you know, expose your data on the Dark Web. We’re going to weaponize and destroy your computer. You will never get your data back again.” They even have worms that can go backwards into your backup data so your data is completely gone. You’re shut. Now, that is also a HIPAA violation so you have to report it to HIPAA. Now you get fined by HIPAA, probably a minimum of a $50,000 fine for what’s called willful neglect. And then you have to turn around and monitor the credit of every patient who was exposed for a period of at least one year, about $10 per patient per month, and so the chiropractor that got hit in Kentucky had 5,000 patients or $50,000 a month.

That can be a practice shutting issue. This is a huge, huge problem, and what you have to do in an office to protect against ransomware, is you have to have an entire HIPAA program in place. By putting in a HIPAA program, getting it in place and then following your own policies and procedures under that program, it’s a de facto thing. You can’t be hit by ransomware, you are protected. That is why if you get hit by ransomware, it is automatically a HIPAA fine. So the solution is to get a HIPAA program put in place, make sure all of the factors of the HIPAA program are covered and implemented and then you both guard against ransomware. You also guard against those fines if you were to be struck.

So it’s a…this particular woman actually shared information which you can’t get people to do because under federal investigation it could affect your license, your PPO contracts, all this different stuff. And the world changed last year on May 20th. The WannaCry virus hit a 115 countries at once, and this ransomware disproportionately hit health care. Health care was at the top of the list of what got hit, and so the world changed. The Industrial Revolution, the invention of electricity, the invention of the Internet, these are all world-changing effects. Well, now there is one that goes with it called Cyber Attacks. And it is a world-changing event, so you’ve got to change or you’re going to get left behind or swallowed up by the world.

Dan Sosnoski: Right.

Dr. Ty Talcott: It’s a major change.

Dan Sosnoski: And a little bit earlier you’d mentioned that even though that is a significant risk, and we can all see that it is, that just direct human theft can still be a problem, and another risk to a practice just involves the staff members, the people who are working for you. They can be vulnerable to what’s called a human engineering attack. Are you familiar with that? Can you tell us a little about how a practice can avoid that kind of problem?

Dr. Ty Talcott: Well, in fact, under the laws of HIPAA, you have to do at least an annual training. You have to document who was at that training. Not just that, you have to document the topics you covered, because if you get hit in a certain way with an attack and you can’t prove to the government when they investigate that you trained your people how to not do or do the things they are supposed to do, then you have full liability. They will give you no slack at all.

Dan Sosnoski: That’s right.

Dr. Ty Talcott: That’s why you’re required to issue periodic security reminders to your work force that have to do with things that are in the current news of potential attacks, and if you don’t do that, you have to do that at least on a monthly basis. That was the opinion of the cyber security symposium, is the law says you have to issue periodic. Nobody knew what that meant. They came out and said that they felt that the typical physician’s office had to be issuing these once a month to their people and documenting they received the information that they agreed to read, understand and abide by the information. It goes on and on. And this is to prevent things such as having your staff untrained so that they open emails that are inappropriate where people were doing phishing attacks trying to get into your computer, into your data.

Dan Sosnoski: Right.

Dr. Ty Talcott: Telling people information over the phone that’s inappropriate. Doing workarounds where your staff might go, “Well, we’ve got this anti-virus or this block or this firewall, but we shut that down because it slows things down and we have to get work done or whatever, and they work around these things that have been put in place. They share passwords. This is a big problem. Sometimes they use bootleg software. They don’t have new software that has the automatic updates. So it is not updated. They click on the wrong pop-up, you know, it comes up on the computer. There’s just all kinds of things that can happen where outside individuals design these attacks to come into your computer and disguise themselves as email addresses of people you know.

And so you click on it because you’re confident. Don’t click on one unless you’re expecting an email from someone. I mean, not just that you know them, and, “Oh, that’s their address,” but you’re actually expecting them to email you something. Because they’ve gotten so good now, they can make it look like it came exactly from the person that you know. And the person you know doesn’t even know it’s happened. It gets crazy, but they’re very good at what they do.

Dan Sosnoski: Right. That technique is what they call “address spoofing.” And it can be very pernicious because we get those attacks periodically here at Chiropractic Economics. I don’t know why but people sometimes just try to sneak into our system that way. And so everybody gets periodic reminders to not click on emails that are unexpected, exactly as you say. The other common weak link can just be a direct phone call. Someone calls up your CA and says “Hi, this is Scott with your software vendor. And we need to check something on your system. What’s your password?” And if your staff are not trained, they might fall for that and just give the attacker the log-in credentials right over the phone.

Dr. Ty Talcott: Absolutely. It happens all the time.

Dan Sosnoski: Happens all the time. So, Dr. Ty, one of your areas of particular expertise is HIPAA compliance. Could you just give us like just a brief topline overview of what HIPAA wants to see in a security and privacy program?

Dr. Ty Talcott: They want to see that you have a compliance officer that has a job description and knows all of the different types of notifications that are required to be issued to your patients. They want to know that you have a notice of patient privacy policy that is updated from 2013 Omnibus Rules, and that you’re issuing a copy of that to every new patient, that you’re getting a signed authorization from the patient that they received it, and that you have those copies available in the office. They’re looking to have an accounting log that shows everywhere that you send anyone’s private information out of your office. They’re looking for your business associate contracts to be in place. You’re required to have a contract with anyone who stores, transmits, or you’ve given access to your data. You have to have an actual contract, an agreement in place with them. It was created in the Omnibus Rules of 2013.

They’re looking for your staff training in-services, what you train on, the fact that they’ve agreed to abide by it. They’re looking for a physical plant audit done at least once a year where you’ve looked to see if your computer screens are visible and all that. Most importantly, they are looking for a complete and total risk analysis, which is really a risk analyses because it is a risk analysis done of each of your electronic devices that goes together and you put all those risk analyses together into one giant risk analysis. They’re looking for what are called periodic ISARs. That stands for Information System Activity Review. This is where you’re checking audit logs on your computer to see who accessed the data when, and did they actually delete, alter, or simply observed data and who were they, when were they there and what were they doing.

You’re required to do a once a year A to Z HIPAA program audit and evaluation. You’re required to have what has typically becomes over a 100 pages of just policies, just to cover the required policies in a chiropractic office, typically takes around 100 pages. It has to be customized to your office. This is why you can’t buy a book from somebody that says, “This is a HIPAA compliance manual with 500 pages in it,” five years ago, and you set it on a shelf to collect dust. You actually made the government’s case if they walk in the door and say, “What’s going on with your HIPAA program? You’ve had a breach. We’re investigating,” you point to some book on a shelf.

A lot of the time they blow the dust off of that book, you’re toast, because it has to be active, dynamic and it has to be customized to your office, and you made their case for willful neglect. And that’s a minimum of $50,000 fine, willful neglect, up to $1.5 million. You’re required to have an equipment maintenance log on every electronic device, who worked on it, what they did. You’re supposed to have…of course, you have to have model releases in place for testimonial use, and there are about a dozen audits, evaluations, re-audits, re-evaluations, or analysis audits that you have to do on an annual or more frequent basis, or your program is not current.

And if you have a program, but your program is not current, you’ve just made their case as well. Because putting the program in place means you know it had to be kept up, and if you didn’t keep it up and that caused a breach, because it wasn’t current, then they are going to nail you to the wall on that as well. And there’s your 100,000 foot overview in two minutes.

Dan Sosnoski: Right, and, of course, you know, disaster can strike but at least if you do wind up getting audited after a problem and you’ve got a well-documented, well-implemented HIPAA compliance program, that tells the auditors that you made every good faith effort to make your practice as hardened as possible. And that goes a long way.

Dr. Ty Talcott: It’s interesting that you said the word, some type of a disaster because one of the things I didn’t mention, you’re also supposed to have a required contingency plan that consists of two parts, a data recovery plan and an emergency mode operation of how you operate and protect information during the disaster, like a tornado or whatever. What you said is absolutely correct, and it’s absolutely critical. And that is one of the things that came up at the Cyber Security Symposium this year that I’ve never heard them say in seven years that I’ve been attending the Cyber Security and HIPAA programs in Washington, D.C. to stay on top of this stuff. They’ve finally said, and some of this is because of Trump and he doesn’t like regulation, but he knows this has to be regulated because we have to stop the ransomware attacks.

But what he did sort of put in place and what’s out there now, they stated that if you can show that you have documented…this doesn’t mean that you just, “Oh, yeah, we do that,” and somebody says, “We do that in the office.” No. You documented a good faith effort to cover every one of those regulations that I’ve talked about. In other words, 100 pages of policies, that is what it takes to make sure you’ve covered every one of those regulations with a good faith effort. They say that they are now, for the first time in seven years that I’ve been doing this, they say they are more inclined to assist you if you have a problem if you can document that you’ve done good faith in all areas.

However, and that’s the first encouraging thing I’ve ever heard, however, there is a however, if you have failed to document even one area of requirement, then there’s no mercy.

Dan Sosnoski: Well, that’s the name of the game, and it’s important for all health care providers of all stripes to be very careful with security, with protected health information, and, you know, experts like yourself, Dr. Ty, are doing a very valuable service in trying to make sure that nobody goes unaware of the challenges, and nobody lacks the tools they need to get compliant. Well, that’ll be a wrap for our talk today. I want to thank you so much for spending some time with us, Dr. Ty. This has been extremely informative, and you’ve given us a bulletproof look at The Future Adjustment. I’m Dan Sosnoski, and we’ll see you next time. Thank you, Dr. Ty. That was excellent.

Dr. Ty Talcott: Thank you so much. I appreciate it.

The post The Future Adjustment Podcast Episode 18: Protecting your practice in a digital age appeared first on Chiropractic Economics.

Daniel: Welcome to, “The Future Adjustment – Chiropractic Economics Podcast Series,” on what’s new and notable in the world of chiropractic. I’m Daniel Sosnoski, the Editor-in-Chief of Chiropractic Economics. And our guest today is Stuart Oberman. He’s the principal of the Oberman Law Firm, a prominent practice in Georgia, and he’s a specialist in medical law. He has particular expertise in the chiropractic field and has contributed articles and blogs to Chiropractic Economics.

Stuart Oberman, thank you so much for joining us today. As everybody in our audience is aware, the medical field is tightly entwined with the legal arena. But not every legal firm works the medical space. So what led you to focus on this area specifically chiropractic and dentistry?

Stuart: Well, when I first started out, I was actually in-house counsel for a Fortune 500 company. And I’m also a claims adjuster. And so I naturally just sort of gravitated to the medical field. And to me, it’s just a fascinating field. The doctors are so individual-based more so than the physician side. They are more entrepreneurial in spirit and they are just great to work with. They’re very easygoing, is client-based, and the medical side is fantastic on the chiro. So just sort of naturally somewhere we just gravitated to. And we’ve been doing it for, you know, 20-25 years and I love it. I love our doctors. I love being involved in the industry. It’s a pleasure to serve these guys.

Daniel: Yeah. And the articles that you’ve written for Chiro Eco have been very authoritative. They really show that you are very familiar with this particular subset of the medical field and their needs. And I tend to agree with you. I find that doctors of chiropractic are quite a bit more easygoing than some of the type A surgeons and whatnot that you need.

Stuart: That is true. That is true.

Daniel: One of the things that you have some particular expertise in is in the area of medical practices need for cybersecurity. And we know that’s an especially difficult problem because cyber thieves, cyber criminals they find that medical records are some of the most valuable bit of information that you can hack. Those medical records allow for identity theft because they tend to contain things like well, you know, protected health information, social security numbers and that sort of thing. What are some of the threats out there and how can doctors of chiropractic defend themselves against it?

Stuart: The biggest threat, are employees. A substantial part of the breaches, are employee-based. It’s that they got to know how to handle the emails before you get into the encryption and we have like a cybersecurity checklist that we would be glad to provide your listeners. But majority of the problems are with staff, not knowing how to handle incoming emails, not knowing what is a threat, what is not a threat, how to handle certain protocols as far as where they should be surfing on the internet, where their inner cookies are being, you know, found on the internet, their footprints, and then honestly, their IT guys. We find a substantial part of the, “IT guys,” that these offices have, have no idea how to protect against ransomware.

Daniel: Really?

Stuart: Yeah. It’s amazing. We’ll send these and we have like a certain checklist, that we have maybe 8 or 10, 12 topics. And only that would probably have like maybe five to seven areas that there should be a checklist on, “Do I have this? Do I have this?” And we get calls all the time and my IT guy doesn’t know what to do or is not sure of this, “What do I need to do?” I figure you need to get another IT guy or hire a specialist.

Ransomware is probably the biggest hit right now, where it has become so pervasive that they now have customer service departments for ransomware. So not only do they hijack your information, they now have customer service representatives to help you get your information supposedly back without being breached. But we all know that it is an absolute HIPAA Breach that the cybersecurity occurs. But it’s ransomware that’s the biggest threat right now, phishing and what to do.

Daniel: Well, hey, Stuart. If I can just get you to pause on there for our listeners who aren’t familiar with what ransomware is. Could you just give us a really quick overview of what that is?

Stuart: Yeah. Yeah. That’s like I’d say a four-hour topic but it’s really amazing. So what happens is, is that once you’ve been breached and you may not know you’ve been breached for four, five six months eventually some point comes up on your screen that basically, “Your computer has been hijacked.” And they’ll give you instructions on how to get your software and data back, to get control of your computer. So they literally, have a virus, that control your computer, you know, from Lord knows what country or where.

And then, you don’t get that back or control of it until you send Bitcoin currency through international wires. And then once it hits you get your information back or access to it. You never really know where it goes once that information is hijacked. But it’s basically this is it’s a lockdown system, where somebody else has the key to your computer and you got to pay to get it back.

Daniel: Yeah. You mentioned phishing and then I know another area that’s difficult, it’s what they call a human engineering attack. Are you familiar with that?

Stuart: Vaguely, vaguely as far as that goes. And it has, like, a lot of different names. But depends on the topic of, “Oh, we’re right on that,” but…

Daniel: Well, generally speaking, it’s not that a hacker is using a, you know, sophisticated software to get past your defenses, they just call your secretary up on the phone and say, “Hey,” you know, “I’m with your IT department and I got locked out. What’s your password?” And, you know, there you go.

Stuart: Interesting. For a couple of hundred bucks, you can buy software to hack a computer on the Black Net. It’s actually pretty easy. Then one of the things is that there’s a lot of disguised emails where you are from a billing department or from a bank it made you just easily give away information from the office. That’s where the staff has got to be trained like some most of the breaches come from the staff.

Daniel: Yeah. Well, you know earlier this year in January, a chiropractor was in the news because he had to shutter his practice. His business partner was embezzling funds out of the practice, you know, doing the keeping two sets of books. And by the time that this was discovered, it was way too late. There was no way to recover the funds. And this is certainly not unheard of. What kind of steps could a practice take to mitigate that particular risk?

Stuart: You know, it’s a maze in the industry probably 40% to 60% of all practices are probably embezzled. And then the IRAs embezzlement is in excess of $100,000. It doesn’t take one shot, it takes years to do. And I always say this, is that at some point, a doctor realizes something is not right, something is just not right. Maybe collections have slowed. Maybe they’re not getting financial information in a timely manner. Maybe they can’t explain adjustments for certain patient charts.

My recommendation is an internal review probably 15 to 20 charts every month. Track your EOBs, track your credit card authorizations, track your cash payments, track your incoming, your invoices, and map along what your day sheets to show what you did that day, determine what you did. It won’t take you that long to do an audit. But at some point, we’ve got, you know, or an employee refuses to take vacation, not that they really love you, it’s because when they’re gone, that’s when things blow up, and they find out what’s going on. So it’s just internal controls.

Well, some of our manuals now we’re running where employees have to take vacations mandatory. There’s no question about it. And then it’s amazing what you find out when they’re when you’re gone. But again, there are certain signs and doctors get so busy, you know, day-to-day and adjustments in running, you’re running this department, you’re running that department, they lose track of what they’re doing practice-wise.

Daniel: For sure.

Stuart: It’s not easy. It’s not hard to do for our doctors.

Daniel: Well, I really like your suggestion of making that a monthly activity because if you’re doing that on an annual basis, it could be way too late by the time you find out that something.

Stuart: Yeah. I mean there’s always something to look at. And again, you sort of connect the dots what happened before. It’s hard to connect to going forward obviously. But you’ll see the signs and our doctors will ignore them, they’re like, “Oh, you know I knew that…I knew something right or something wasn’t right.” But, I mean, now you got staff members opening up fake bank accounts, diverting your insurance checks, taking cash. I mean honestly, I would be glad to provide the readers with a embezzlement checklist. And I think it’s almost like two or three pages. One thing is just to take a look at it and what to look for and how to, you know, what the signs are.

Daniel: Interesting.

Stuart: There are signs. It’s just that doctors ignore them.

Daniel: Let’s talk a little bit later about it. Maybe we can talk later about possibly putting together an article on that subject because that could be a lifesaver.

Stuart: Oh, yeah, absolutely. Yeah. Oh, yeah. I mean it’s a lot, you know, we’ve got to practice that, they got hit pretty hard. And they tend to either decide whether or not they’re going to keep you on or shut it down.

Daniel: Yeah.

Stuart: Yeah. When you get partners in embezzling, you get employees that embezzle, you know, thousands of thousands of thousands. It hurts and it hurts. I’d be glad to do that for you for sure.

Daniel: I’ve heard that one way that like one first line of defense is to avoid a situation, where a single employee is handling the money, either collecting the mail alone or going to the bank with deposits alone and that you should try to make [inaudible 00:11:33] their activities. Is that on your radar as a possible solution or one of the steps to take?

Stuart: That’s a great suggestion. And yeah, cross-training across disciplines of the office and switching things around every couple of years or you know, monitoring cross-referencing, cross-reviews. Yeah, that not giving the one employee, too much control is key and honestly, I do a lot of talking on embezzlement and I will not give an embezzlement speech to an office manager association.

Daniel: Right.

Stuart: I mean we get those offers all the time. And I just will not do it because that’s leading the fox to the. And it’s just a recipe for disaster. But then that’s a great suggestion is have two controls when it’s tough to verify.

Daniel: Well, you know, what we’ve been talking about for the last few minutes here really has just been a conversation about risk management and risk mitigation, in general. And I know that you have actually said that risk management is a process. Could you explain what you mean by that in a little more detail?

Stuart: Yeah. I have my top 10 list of mistakes that chiropractors make. But it is a process, “Do you have your employee manuals in place? Are you doing the background checks on your employees? Are you doing the things necessary, new hires? Are you giving the reviews? Are you recognizing problem patients? Are you sending patients to collections?” which is a recipe for disaster.

Daniel: Oh, yeah.

Stuart: “Are you checking your notes? Who’s writing your notes? Who’s doing your charts? What’s your HR policy? Do you have OSHA in place? Do you have HIPAA in place?” you know, or, “Do you have a social media policy? What are you going to do when all of a sudden you got negative comments in the chart because one of your employees put something in there and appears on the Facebook page?”

Daniel: Wow, yeah.

Stuart: You’re dead in the water. You stay out of water, “Do you have an internet policy where your employees are restricted in certain areas? Do you have a software policy? We got to take a people who would or staff members recording conversations now? Staff meetings?” You know, there’s a lot of stuff that are privacy breaches. You know, “Are you getting rid of the problem patients that you just can’t help?” There are just some patients you’re just not going to help. And if you don’t learn how to get rid of those, they’re a recipe for disaster.

So, all those things make up the process, from the beginning to the end. And I know a lot of our doctors do not understand how to fire an employee. I mean they could say that but they don’t understand that at a certain stage, you got to file separation notices, you got to file stuff for the State, “And what are you going to do if you got a Federal audit for U.S. Department of Labor matter because one employee complained to U.S. Department of Labor you weren’t paying overtime?” [crosstalk 00:14:54] text messages, emails. So it’s all apposite[SP]. It’s having that control over what you’re doing day-to-day. And to stop me control, where somebody doesn’t have control over it, it is a recipe for disaster.

Daniel: Got you.

Stuart: That’s a lot of information.

Daniel: Yeah, I know and insanely good…

Stuart: That’s a lot of information.

Daniel: …at your fingertips. Hey, are there any other areas that you see DCs having trouble within the legal area?

Stuart: Compliance is the biggest part. I think well, in Medco, I’d say compliance, and employment law, and doctors don’t understand it. They don’t understand what’s required if you have a employee, who is expecting a child four or five months from now. They don’t understand the hiring process. They don’t understand the firing process. They don’t understand what compliance is or how they should be in compliance, what their cybersecurity is.

But I think by and large, the biggest problem is employment law that they don’t understand it. And things change so much. It’s so hard to keep track of. It goes down to the basics to me, you know, “Are you doing things you need to hire the employees correctly? Monitoring the employees? Are your internal controls? Are you good with OSHA? Are you good with HIPAA? How’s your HR? Are you doing things right for the employees? Do you have your employee manual?” without an employee manual, you will never win a labor dispute. It’s just not the way this…that’s not going to happen.

Daniel: Right.

Stuart: Then, “Are you going onto the internet and getting a six-page manual? Content access to your information the technology side? Do they have disassociate agreements? Are those secured?” And, you know, and then honestly, one of the areas is, “How do you respond to a board complaint?” Our guys don’t know how…they don’t know how to respond to a board complaint. They let it go. They blow it off. They don’t properly respond. And next, you know they’re getting on probation or getting suspended for a while.

Daniel: Oh, yeah.

Stuart: And then Medicaid is a huge issue right now.

Daniel: It is, yeah.

Stuart: That’s coding. That’s a huge issue and how to deal with the Medicaid audit. That’s just an area they just don’t understand and they’re afraid to ask for help.

Daniel: Well, you know if I can just teach you to pause right there. I just wanted, well, I just would like to say that if there was a subtitle for our talk today, I would have to say it’s, “Things change so much,” which is what you just said. That all of the things we are talking about today would be what I would call moving targets. They aren’t a, “Set it and forget it,” with arrangement. The compliance law threats to a practice, these things are constantly evolving. And that’s why we run articles often on the same topic throughout the year because we want to stay abreast of the changes and we know that the regulatory and legal picture facing practices is constantly in motion.

Stuart: Well, you guys do a great job on a publication basis on covering things. If you look at like a 12-month subscription to your magazine all the areas you cover. You cover the clinical side, the practice side, the billing side, the accounting side, the audit side, client side.

Daniel: Yeah.

Stuart: And my God, there’s not much more you guys can cover on a monthly basis, as much you guys cover. So I mean you guys do a fantastic job getting the word out to the industry. And there’s not many publications frankly that do that. And most are just they’re not very informative, they’re just sort of filling space but honestly, I think you guys do a fantastic job doing that. And that’s why I’m so proud to be on this podcast and can contribute to what you guys are doing because you guys do a fantastic job doing that.

Daniel: Well, hey, thank you so much. And I really appreciate that. Hey, I just wanted just to thank you again for spending this time with us. Today Stuart the legal challenges facing the modern medical practice are varied and complex. Thanks for making them easier to understand. You’ve given us a judicious look at, “The Future Adjustment.” I’m Daniel Sosnoski. See you next time.

The post The Future Adjustment Podcast Episode 17: The legality of the medical field appeared first on Chiropractic Economics.

Daniel: Welcome to The Future Adjustment: Chiropractic Economics Podcast Series on what’s new and notable in the world of chiropractic. I’m Dan Sosnoski, the Editor-in-Chief of Chiropractic Economics. And our guests today hardly need an introduction.

They are two of the most famous names in chiropractic. First, let me welcome Dr. Arlan Fuhr, inventor of the Activator Adjusting Instrument and President of Activator International. We’re also pleased to welcome Dr. James Cox, the creator of the Cox Technic. Dr. Fuhr, welcome to our show.

I understand that you’ve known Jim Cox for more than 30 years. – [Dr. Fuhr] About 40 now, I believe.

– Okay. Is it true that he was one of your inspirations in becoming an evidence-based chiropractor?

– Yeah. He probably doesn’t remember this. But it was at a seminar several years ago. And he got up and did a presentation, doing articles from the literature. And I was sitting in the room, and I said to myself, “Oh my gosh, we’re behind. We have to get going here because Jim has got the right idea in putting out his material in an evidence-based style.”

So he was an inspiration to me.

– Yes. We’ve seen that the whole industry is heading in that direction but we still do need, you know, leaders such as yourselves to, you know, really kind of blaze the trail and show other people, you know, how vital and important it is to work with the science on your side. I know, Dr. Fuhr, you’ve referred to yourself a number of times as being an evidence-based vitalist. Can you explain that in a little more detail?

– Yes. I wrote an article here in Karwika, as a matter of fact, to the students talking about vitalism versus mechanism. And I made it clear that when I started the article that I was an evidence-based vitalist. And what I mean by that is I have a saying that the data always wins.

And that goes no matter if you’re in a court situation, or if you’re in a research setting, or if you’re in a government meeting, or if you’re before a Board of Examiners. The data will always carry you and win the day. And so, that’s what I meant by being an evidence-based vitalist.

– Absolutely. Very good. Well, Dr. Cox, welcome to our show. Looking at spine care today, could you give us your assessment of the status of spinal manipulation? – [Dr. Cox] Thank you. Yes. If you go back in chiropractic 50 years ago, we did not see the research, the clinical evidence-based outcomes that we have today. Who would have dreamt 50 years ago that you can see the Journal of the American Medical Association, the American Pain Society, the American College of Physicians, Harvard Medical School, and others say that the first line of care for back pain is spinal manipulation and chiropractic.

Now, that’s based upon research and clinical evidence out base studies. If it wasn’t for that, we wouldn’t see, for instance, VA hospitals having chiropractors on staff. We wouldn’t see all of the hospitals today having chiropractors serve as the primary care doctor seen my back pain patients who then direct and triage the treatment of that patient.

So, I see that chiropractic has a tremendous future that we didn’t appreciate 50 years ago, namely that if we are seeing and depending on who you quote, we’re seeing anywhere from 8.6% of the public to a third of the public.

Well, just imagine what will happen when the public learns of what we can do in chiropractic. In the treatment of the most expensive ailment, the second most common ailment, the people who go to a doctor for spine and radicular pain. So the future of chiropractic is great, though the big problem we have is dissemination of true literature outcomes that is that the public…remember, sometimes they say it takes 17 years for a new concept to filter down the common knowledge.

And so we have education to do, and I think that’s taking place. So I think that the future of chiropractic is very, very bright.

– It definitely is. And in addition to the studies and trends that you just referred to in terms of the college of physicians and other MD groups are now issuing guidelines about back pain management and urging the conservative approach dispersed.

The congress has passed and enacted into law something called the Care for our Heroes Act, which effectively authorizes DCs to provide upper tier testing in the VA system where they could not do that before. And as you know, a lot of MDs get their training and residency in the VA system.

And we anticipate that as they see chiropractors working as co-equal colleagues side by side, that’s going to have a very good trend towards MD to DC referrals. It’s still important.

– Well, that’s true. That’s true. But think about this. We say that chiropractic is first-line care of spine and radicular component. But think about this. It is, today, last-line care. If you think of the number of spine surgeries done, and look at some of the papers that 50%of the people will have the same or worse pain afterward, it’s only after that chiropractic becomes involved.

And there are studies done that we showed that 70% of people had well over 50% relief in postsurgical continued pain patients. So, these facts will not only take care of people with then back surgery, they will stimulate people to have a stronger chiropractic component before the surgery.

– That’s true.

– Yeah. This is what I was alluding to. Before, that data always wins. I’m a fully credentialed VA physician. I started the chiropractic service in the Phoenix VA. And, you know, the problems that the VA hospital been having, chiropractic wasn’t one of them. We have a three-month waiting list for our service in the VA and we had people there that had been through every medical procedure.

And when we came there, we were looked upon very, very… where people were hands-off. After we were there for six months, the head of orthopedics came up to me and said, “Boy, we’re glad you guys are here because we are sending the stuff that we can’t help you.” And I said, “So where you’re dumping grounds?” And they said, “You might say that.” And I said, “Well, let me ask you a question. How are they doing?”

He said, “Well, that’s a surprising part. They’re getting better.” I just did a paper…What you just said, Arlan, is so true. Just this morning in my PubMed search, I got a paper and Bart Green’s on the paper, pointing out that they did a study of women in the military with neck pain. How pleased they were, how successful they were.

And I think it was only in two visits going to chiropractors in the VA system. So we’re making a mark and that willl continue to grow.

– Yeah. And also, while we’re on this topic, Dr. Cox, the Cox Technique seems to involve manipulation, physical hands-on adjustment and manipulation in conjunction with the table offering of flexion distraction.

You know what, flexion distraction has been kind of a cyclic item in the chiropractic field. Where do we stand today with that modality?

– I started this technique in 1964. And the reasons for its institution was I never ever intended to be in research or in the lecture circuit. I graduated from National College in ’63, I wanted to go back to Fort Wayne and live a very quiet life.

But it happened that I had a patient who I gave a lumbar roll to. And I found out that I’m not the only one this has happened to. They gave the lumbar roll and the girl went to surgery the next day. And I said, “There’s got to be a better way.” And my stepfather who was a DC and a DO said, “Son, you may well be in way of learning.”

And so I studied osteopathy and chiropractic. And I put together the two systems of spinal manipulation. And in the last few decades, this has grown to the point that all schools, but one, teaching in some fashion, the New Keiser University, which is the first university in the United States that I know of that now has its school of chiropractic, are using my work.

They have two of our certified doctors teaching the technique there, and it is growing. We’re having certified doctors, and national are now using it, Palmer are looking to make it core curriculum. So, to answer your question, the acceptance has been great. And then the question is why.

Why? Well, and the answer to that is that every patient cannot tolerate high-velocity, low amplitude trust. Now, when you look at the age of people and we are dealing today with spinal stenosis and people over 50 has probably, in my opinion, the greatest challenge to chiropractic today.

That is spinal stenosis with or without degenerative scoliosis. These people can’t tolerate high-velocity adjusting. So to me, it’s up to the chiropractic profession to consistently be supervising and improvement the quality of spinal manipulation because, let’s face it, the public expect us to be the conservative care of spine pain.

So we consistently learn. Now, Arlan has a technique, which is certainly not high-velocity, mine isn’t. Certainly, there are many other techniques that don’t involve high-velocity technique. And let’s face it, there are conditions like advanced degenerative disc disease, spinal stenosis, ankylosing spondylitis. They can’t tolerate that.

So it’s up to our profession to serve the public and develop these new techniques. That’s why I develop my technique because it works, it gets cavitation when nothing else work off times. And now, today, we see that that technique is really gaining a foothold and making a very strong footprint in chiropractic manipulation based upon the fact, like it or not, that you see physical therapists using it consistently as writing papers on it today.

– Yeah. And to look at it from the other side as well, one problem that chiropractors face is the high-amplitude. Thrusts can lead to repetitive motion injuries and truncate an, otherwise, promising career and Activator Method and Cox Technic both I think offer DCs a way to practice a lot longer themselves because it’s gentler around the spine.

– Yeah. I think Jim is right about this. What we’re serving right now a huge geriatric population. And in Activator, we did a study and it’s coming out of the University of Madrid in Spain on osteoporosis. Is it safe to adjust osteoporotic patients? Well, once in a while in research, you get lucky.

And the researchers, they are found not only was it safe to adjust something with osteoporosis, but also we can regenerate osteoporosis, the trabeculum in the actual bones. And so, think about that. And I’ve seen it clinically, but didn’t understand it that we’d have somebody come in that was elderly person on a walker. And three months later, they’d be walking on their own.

Now, we’re finding out that we actually have bone growth taking place. And that’s a big thing because of that geriatric population. The other thing is we just had another webinar here the other night. And NCMIC, the largest, you know, company that when chair chiropractors said the number one thing that they have for a complaint is a cervical adjustment.

They said that’s where they pay the most money. Well, in Activator, we keep them in a neutral position, we don’t turn their head, and we just don’t have that problem. So what I think we’re doing in these techniques is adapting so the patient is the beneficiary.

– Very good.

– No, that’s absolutely right. If we don’t adapt spinal manipulation, somebody else will. In the chiropractic profession, the public think of us we are branded, good branded as spinal conservative non-surgical treatment. We must build on that as a profession, and we will only increase in our patient loads, our clinical outcome studies, and the success of the chiropractic profession.

And Arlan mentioned osteoporosis. Well, I’ll tell you, you don’t thrust on these osteoporotic people, and many of them have fractures, whether detected or not, and you have to have some alternative form of spinal manipulation to treat them. And that’s what Arlan is talking about, that’s what I’m talking about. We’ll even demonstrate it this week in our conference here in Hawaii.

It’s a tough detail. We’re here in Hawaii doing this. But we’ll demonstrate the treatment of fractures, and osteoporosis, and conditions that there’s no way that you can deliver high-velocity for us, too.

– Well, hey, since you bring it up, yeah, you’re both speaking with me from the island of Maui, I believe. And you’re going to hold a joint seminar tomorrow. Can you give us a quick overview of what you’re planning on talking about?

– Well, I can start. We’ve got a mixed group here. We’ve got Cox people and Activator people. And I mentioned to Jim that the last time I remember a couple of technique developers getting together was when I was invited as a kid, you go to Japan with Klay Thompson. And it was Gonstead, Thompson, and DJ Arnett.

I mean, that was the major force in chiropractic. And so, here was Activator, but I was just a beginner. But I learned from those guys many things in what they thought and what they did. And what Jim said before, how far we’ve advanced. Activator has over 150 peer-reviewed papers, 26 clinical trials. And somebody said, “Well, that’s not hard.”

They said, “No, it only took us 30 years to get 26 clinical trials.” Those things take time too.

– Yeah, they do. Go ahead.

– Yeah. We’ll have a joint seminar. And Arlan mentioned Major Dejarnette and Clay Thompson, I knew, I’m so old. I knew both of these gentlemen. I’ve learned from them so much in my life time and respected them.

And today, we’re doing a combined technique. And I suppose many people are shocked to death. I’m not shocked by it. How else are we going to advance if we don’t share ideas, you know? I think it’s great.

– Yeah. The attendees, there are definitely in for a treat. And I’m sure they’re going to be talking about this later on in their careers. But how lucky they were to hear you both talk. And Dr.Cox, you said that competition in the medical world of spine care demands expertise. What is this competition?

And how do DCs best compete with it?

– Look at this fact to begin with. Of all the people who have spine or radicular pain, arm and leg pain, 1% of them really go to surgery, about 2% to 3%.

That means that over 95% of these people are wanting non-surgical, the best conservative care. That’s the chiropractic contribution. We will build on that to continually increasing our clinical outcome studies. Now, you talked about competition.

You rest assured there’s competition in treating spine pain because depending upon who you talk about, I remember Stover Snook, Senior Analyst with Liberty Mutual Insurance, Tony who said, “Can low back pain cost more than the national debt?” Well, it’s not nice to say, but you’ve got both pain and expense, and back pain.

And so the agencies, the insurance companies, the third-party payers, the Federal Government are going to be interested in how do we get the best bang for a buck. And chiropractic stands at the threshold of answering that question. And that’s why the research is important.

Arlan mentioned the research papers. In my, staff I’ve been very happy and I never dreamt that I would see today the federally funded research that we see in our profession. In 1992, the Federal Government said they would fund chiropractic research as long as it’s done in combination with a medical and osteopathic school.

And at that time, Dr. Ram Gudavalli came to National (University of Health Sciences), and John Triano was the head of research at the time, and we were doing my work there. Well, Ram came from University of Cincinnati to National, we applied and got one of the first three grants from the Federal Government.

And very interestingly, to carry your question just one step further, the first thing that Shannon Mulroney from Health Resources and Services Administration…and Bill Clinton was President then, and Donna Shalala was the head of HHS. You know what? The first question….yeah. The first thing they said to us was, “We want you to show us what happens when you do this spinal manipulation.”

We were all taken aback by that, but they wanted to see what happens in the human spine when you manipulate. And so, our first study done from 1994 to 1997 was a funded health resources and services administration from the Department of HHS study to show that. And we found that five things happen when we use Cox Technique in treating spine pain.

That led to another study because the Federal Government said, interestingly, they said, “We wanted to do a study comparing this form of manipulation to medical care for chronic low back pain,” which is the most expensive ailment treated between 20 and 50 in this country today. And so, we did that and our clinical results were about 250% better than exercise and physical therapy in treating radicular patients.

That led to a third study on cervical spine. And these have all been published papers in refereed journals like European Spine Journal, Trials, all published papers. And for me, that’s what our profession needs. Arlan mentioned the papers he did.

I’ve mentioned the papers we’ve done. This is what the world of medicine reads. That’s who the knowers are going to look to, to lead and pay for spinal manipulation.

– All right. Well, very good. Dr. Fuhr and Dr. Cox, I want to thank you so much for spending this time with us today. You’ve brought up some excellent points reflecting your long careers in the field.

And you’ve given us an evidence-based perspective on the future adjustment. I’m Dan Sosnoski, we’ll see you next time.

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