Sherman College named school of national service by AmeriCorps

AmeriCorps has named Sherman College a School of National Service in recognition of its involvement in the prestigious program. These institutions offer incentives to students and are able to recruit from AmeriCorps’ pool of driven and civic-minded alumni.

Since 2018, Sherman College has offered a one-time matching scholarship of up to $4,000 for AmeriCorps Education Award recipients, in addition to waiving the application fee, for students admitted to the Doctor of Chiropractic program.

Dawanya Burgess, a 2020 honor graduate of Claflin University, is the latest AmeriCorps alumnus and recipient of the Segal AmeriCorps Education Award Matching Award to join the Sherman College student body. Burgess, who majored in biology and minored in chemistry, was referred to Sherman College by Dr. Tyrone Wallace, ’94, who practices in Lake City, S.C. He enrolled in October 2020.

“AmeriCorps prepared me for the Doctor of Chiropractic program at Sherman by allowing me to provide service to those who needed it,” says Burgess. “Chiropractic is a career that will let me continue to serve others, building relationships while moving toward my goal of changing lives for the better.”

The Schools of National Service program was formally launched in December 2020 as an initiative to help more AmeriCorps alumni achieve their higher education goals and for institutions to attract more AmeriCorps alumni. Because of Sherman College’s existing commitment as a Segal AmeriCorps Education Matching Institution, the college met the qualifications to be part of the program. Sherman is the only chiropractic college to participate in this program.

AmeriCorps engages more than 80,000 young adults in service each year. AmeriCorps members meet pressing community needs and mobilize millions of volunteers while gaining valuable professional, educational and life skills. These individuals are leaders with the determination and skills to succeed.

“AmeriCorps’ students’ dedication to service and their drive for success makes them excellent candidates for careers as Doctors of Chiropractic,” says Director of Financial Aid Chris Roberson. “With Sherman’s on-campus Chiropractic Health Center and our dedication to providing chiropractic care to our community, I could think of no better place for AmeriCorps alumni, with passion for community service, than Sherman College.”

AmeriCorps alumni and other prospective students seeking information about Sherman College’s Segal AmeriCorps Education Matching Award should contact Roberson at 800-849-8771, ext. 334, or email croberson@sherman.edu.

 

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Million-dollar Practice: Top healthcare reimbursement strategies

Tips to take your practice over the $1 million mark with the leading healthcare reimbursement strategies

The doctor I externed with was a great influence over my life and practice. This doctor taught me more about chiropractic practice than I learned from just about anywhere else in life. This is why I give back, having interns and coaching other doctors, especially when it comes to healthcare reimbursement strategies.

This doctor was phenomenally successful by any stretch of the imagination in practice and life. But he always fell just short of a million dollars in collections. He was obsessed and just could not quite get over this hurdle. So, when I started a practice this became a de facto focus of mine, to break $1 million. It took over 10 years to get there, and I never went back below that collections mark. It felt good to get over a million and it is a sign of business success, but it does not mean everything.

Here are some tips to maximize healthcare reimbursement to increase collections, no matter how large of a practice you have:

Insurance analysis

The first step we do on all new patients is a thorough insurance verification. Before we develop a treatment plan with a patient, we want to know exactly what is covered.

Do they have DME coverage, is there a visit limit, do they need pre-authorization? We need to know exactly what is covered up front. I also would rather charge the patient for deductibles and copay up front, rather than try to collect it months later after treatment has ended.

Get the information up front. Some things to check include DME coverage, deductible, copay/co-insurance, visit limit, pre-authorization, out-of-pocket max, etc.

Durable medical equipment

Not all areas of the country have a DME benefit, but many do. A lot of insurance policies cover DME that patients want, will use, and will help them get better and stay better.

DME benefit is usually different from chiropractic benefit. Sometimes we will find that a patient has mediocre chiropractic coverage but has excellent DME coverage. Get some training in this — my biller is a certified DME specialist and I have attended many seminars.

Some DME to look at for a chiropractic clinic include orthotics, back braces, TENS units, knee braces, and wrist and cervical braces.

Healthcare reimbursement and cash services

I do not believe in turning a chiropractic office into the local pharmacy. Has everyone else noticed they seem to sell everything but medications?

I think a chiropractic practice should be about chiropractic. But look for other related areas of revenue. We offer spinal decompression as a cash service, DOT physicals, CBD products, drug testing, breathalyzer testing and more.

Don’t overwhelm your practice, but look for other services you can offer and charge cash for.

Collections — front desk and billing

Again, the key to good collections is a proper verification up front — that solves 90% of collection problems. Other tips include billing daily or weekly, and keeping collections coming.

Review the aging report with your biller weekly. Make the time to do it. Call on delinquent accounts and make sure to keep up on the lawyers. If you are doing PIP, no-fault, workers comp., etc., we all know how shady some lawyers can be.

For my clients and my own clinic, we separate out front-desk collection from insurance collections. Front desk is literally everything that comes across the front desk such as copay, deductible and cash services. Besides adding cash services, we can increase front-desk collections by making sure copay and deductible are handled up front. The majority of our patients will pre-pay for care and deductibles. If they choose to pay as they go, they pay on the way in; no sneaking out after a visit without paying.

dd retention and you’re golden

These are some tips to increase collections. Besides the strategies above, working on retention is a key to getting total collections higher.

If a practice can get every patient to come in 2-3 extra visits over time, those visits add up quickly to big numbers for collections. Also, a handful of extra new patients per month can really add to the bottom line.

Do not forget the three metrics to measure in practice:

New patientsPatient visit average (retention)Office visit average (collections)

A 25% increase in all three numbers will double a chiropractic practice. Keep growing and keep measuring.

JAMES R. FEDICH, DC, owns a large multidisciplinary practice in northern New Jersey. He is also the author of “Secrets of a Million Dollar Practice” and host of a popular chiropractic podcast, Dr. J’s Path to Success. To find out more or to contact Dr. J, visit drjamesfedich.com.

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Raise your chiropractic brand profile by becoming a ‘DC in the News’

Developing your brand profile enables you to create a specific feeling when patients think of you, and the ability to garner new patients from your reputation

If your goal is to build or grow your chiropractic practice, many options exist. There’s direct mail, referral marketing, email campaigns, and more to boost a brand profile. Regardless of which one you choose, they all come back to one central concept: strengthening your brand.

What your brand should do for you

Brand is the way your business is perceived by others. It is the feeling that people experience when they hear your name, see your logo, or otherwise think of your services and products.

There are many benefits of creating a strong brand. The first is increased recognition. A prime example of this is when you are driving down the road and see the “Golden Arches.” You don’t have to see the name McDonald’s on the front of the business. You know from that big yellow “M” that hamburgers and fries are just a pitstop away.

The same can apply to your chiropractic brand. By becoming more visible and recognizable, the local community will instantly know that it is you any time they see your logo, hear your slogan, or come across your business name.

Another benefit of developing your brand profile is that it enables you to create a specific feeling when people think of you. Maybe you want them to feel healthy and strong. Or perhaps the feeling you want to elicit when people think of you is enhanced sports performance or decreased pain.

Selecting slogans, logos, or symbols that create these feelings helps patients understand the value that your chiropractic practice provides. It gives them a taste of what you can do for them, making them want your services even more.

Raising your brand profile via the media

You can spend unlimited amounts of money to build your brand via social media ads, Google ads, direct advertising, and more. A lower-cost and often totally free option is to use the power of the media.

Imagine that you are watching the morning news and see a story about a local business owner who donated their time at a charitable event that you also support. Not only will this likely make you stop and take notice, but you’ll probably file that little piece of information away in your mind, telling yourself that if you ever need their products or services, you want to go with them.

This is just a glimpse at the way the media can help raise your brand profile. But how do you become a ‘DC in the News’ and shine a brighter light on your chiropractic practice and services?

Ways to become a ‘DC in the News’

As mentioned, one way to utilize the power of positive press is to become involved in a local charity event that is likely to attract media coverage. If you’re not currently aware of any, a simple Google search will identify a few options. Select one that you’d like to take part in and contact the organization to see how you can help.

Another option is to organize your own event. Pick a cause that you are passionate about and put together a fundraiser or awareness drive. Being an event planner can bolster your brand even more. Be sure to send notice or a simple press release to your local media (TV, radio, newspapers, and local magazines) inviting them to take part, and alert key local media via their social media accounts also.

Some health care providers are getting media attention after going viral online. For example, last year Fox 26 out of Houston published a news report about Sugar Land, Texas, chiropractor Jordan Estrada, who created a Tik Tok video that garnered 17 million views. The focus of that video was how to relieve pain with stretching or some type of exercise.

Similarly, in 2017, Fox 59 out of Indianapolis posted a story about chiropractor Emily Puente after her Facebook video about how to hold a car seat went viral. That particular video had almost four million views in addition to more than 53,000 shares and 19,000 comments.

If these options feel a bit overwhelming, consider a challenge that your community faces and contact local media with your advice about how to help solve it. For example, during the pandemic, more people are working from home. Offer to provide their viewers and/or readers tips on how to make working remotely less of a pain by discussing stretches people can do throughout the day or by providing advice on how to set up an ergonomically correct office space. Or if a large local fundraising event has been cancelled, contact the organizers to see what the two of you can do to raise funds for their charity effort in the interim.

All of these can help you become a “DC in the News.” Be creative. It never hurts to establish relationships with your local news providers and media.

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Use a chiropractic webinar to bolster new patient marketing

chiropractic webinar helps establish you as an expert in the health care field while attracting new customers

Some of the most common forms of digital marketing involve the use of social media, instituting email campaigns, and writing blog posts to increase your website’s search engine rank. Another option to add to this list — and one that can help you increase your number of chiropractic patients — is a chiropractic webinar.

Webinars are used regularly within the educational realm, enabling professionals to receive training on a specific topic without having to appear in person or travel. You can also use them to attract new patients as this particular marketing method offers several advantages.

Benefits of a chiropractic webinar

One of the top benefits of holding a webinar is that it provides a platform for delivering important health-based information to prospective patients. This helps establish you as an expert in the health care field. By providing value, it also positions you as a doctor who truly cares about your patients.

This makes you and your practice more appealing from a consumer standpoint. It also enables you to “sell” your services and products in a more indirect way. During the course of your chiropractic webinar, you can provide information that addresses the sales-related objections you face most often. This makes doing business with you a more natural choice.

Another benefit of using webinars is that it gives your audience a chance to get to know you better. The three keys to marketing success involve your target patient base getting to like, know, and trust you and webinars are a great avenue for this purpose. Viewers get to see how you interact with others, giving them a better idea of how you will interact with them.

If you have limited office space, holding an online webinar also enables you to tend to a larger audience than if you were to hold an in-person informational session. It also provides access to more online technologies that can make your webinar more engaging.

Picking your webinar topic

If you are interested in using webinars to bring in new patients, picking the right topic is critical. This will depend largely on what types of patients you’d like to attract.

For example, if you want to build your base of athletic patients, good webinar topics might include stretches or exercises that can help prevent some of the most common sports injuries or which supplements can satisfy an active person’s expanded nutritional needs.

If your target audience is families, you could develop a webinar that shares the benefit of chiropractic at all stages of life — from birth to older age. Another option would be to discuss some ideas of how families can get more physically active together, improving each member’s health and wellness.

Tips for promoting your chiropractic webinar

Once you’ve decided what topic your chiropractic webinar will cover, the next step is to promote it. This is where some of your other digital marketing efforts come into play. Post notifications on your social media pages and send an email to your current patients, encouraging them to pass it along to anyone they know who may be interested.

You can also reach a larger audience by sharing your webinar with other local health care providers. Ask them to promote it to their online followers or request to hang a flyer in their office. This gives you access to people that you don’t currently interact with, whether in person or online.

Getting people to sign up

The next step is to find ways to make prospective patients want to sign up for your webinar. In addition to focusing on a topic that is important to them, this might involve offering some type of incentive, increasing their willingness to attend.

Here are a few ideas to consider:

Promising a special offer to attendees, to be delivered at the conclusion of the webinar, such as a reduced first visit rate or a discount on products discussed during the informational session.Having a big-name guest appear in your webinar who would be compelling to your target audience. This could be an expert on the topic you plan to discuss or an influencer in that topic area who has a large social media following.Providing some type of gift for attending. This doesn’t have to be a high-cost item either. Type up a small informational booklet on the topic and offer that to attendees. Include points that you don’t talk about during the webinar, giving them even more reason to want this gift.

The importance of post-webinar follow-up

After you hold your seminar, don’t forget to follow up with all of those who attended. Let them know that you are there to answer any questions they may have while, at the same time, encouraging them to schedule an appointment.

It’s often said that it takes seven touches to get a prospective consumer to make a buy. Following up on a topic that your target audience cares about is one way to reach that amount. Even if they don’t make an appointment right away, keeping in touch increases the likelihood that they will down the road. It also keeps you at the forefront of their mind, making you the natural choice when they are ready to take action.

For information on hosting your own webinar contact the CE advertising team.

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Foot Levelers announces new orthotic training sessions, speakers

Make custom orthotics a larger part of your practice with the spring Foot Levelers Orthotics Workshop schedule and four new speakers leading collaborative training sessions.

The workshops are led by current Foot Levelers providers who have major success with orthotics and are eager to share their advice, guidance, and best practices. Each half-day session also includes Foot Levelers representatives teaching product training and answering your questions.

Attending a workshop will teach you proven, easily-implemented protocols on how to make custom orthotics a bigger part of your practice. The ultimate goal is improving patient outcomes by restoring proper biomechanics through the use of Foot Levelers custom orthotics.

Workshop sessions are not-for-credit, allowing for open discussion about the benefits of providing custom orthotics. Among the topics covered are:

How to implement orthotics into your protocolImproving/increasing your confidence in providing custom orthoticsGaining more patients for your practiceGetting the best outcomes for your patientsTreating low back pain, knee pain, plantar fasciitis, and more with custom orthoticsProduct overview, patient scripting, and best practicesAny questions you have

The 2021 schedule includes new speakers Dr. Jeff McKinley, Dr. Dennis Buckley, Dr. Alan Smith, and Dr. Kevin Wong. These four current Foot Levelers providers have a combined 65 years of providing custom orthotics.

Returning to the schedule to lead these sessions are Dr. Tim Maggs, Dr. Brian Jensen, and Dr. Mark Charrette. The trio have spoken on behalf of Foot Levelers for many years. In fact, Dr. Charrette recently just taught his 2,000th Chiropractic seminar.

“Doctors who have attended our Foot Levelers Orthotic Workshop sessions are seeing far greater outcomes for their patients, and have near-instant increases in orthotics,” says Jamie Greenawalt, senior vice president of Business Development at Foot Levelers, Inc. “We know our custom orthotics can help with so many conditions like low back pain1, neck pain, and even poor posture. Our hope is to get every chiropractor to a Foot Levelers Orthotics Workshop because the experience is invaluable.”

Attending a workshop session also includes a complimentary dinner the night prior to the event. Travel assistance may be available. To register or for more information, call 800.553.4860 or visit FootLevelers.com/Workshop.

Here is a look at the 2021 workshop schedule:

March 11 – Columbia, SC – Dr. Brian Jensen

March 11 – Phoenix, AZ – Dr. Dennis Buckley

April 16 – Minneapolis, MN – Dr. Brian Jensen

April 24 – Greensboro, NC – Dr. Alan Smith

May 8 – Seattle, WA – Dr. Kevin Wong

June 3 – Chicago, IL – Dr. Tim Maggs

June 4 – Newark, NJ – Dr. Mark Charrette

 

Foot Levelers, Inc.

Foot Levelers, Inc., the world’s premiere provider of custom orthotics and other therapeutic products, has been serving health care professionals for nearly 70 years. Foot Levelers supports every step patients take to enjoy fuller and happier lives at work, home, or play. Visit FootLevelers.com, like us on Facebook, and follow us on Twitter (@FootLevelers) and Instagram (@FootLevelers) to learn more about Foot Levelers.

Cambron, J. A., Dexheimer, J. M., Duarte, M, & Freels, S 2017, Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Trial. The Archives of Physical Medicine and Rehabilitation, viewed 18 August 2020, https://www.archives-pmr.org/article/S0003-9993(17)30262-9/pdf

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New Mentor Program for Black Hemp Farmers Announced by CBD Leader Charlotte’s Web

In keeping with its ‘Ten Commitments to Black Lives’ announced in June, 2020, Charlotte’s Web, Inc. (“Charlotte’ Web”), a certified B Corp and trusted hemp brand, is launching today “Seeding Our Future, Together,” an mentorship program for Black hemp farmers and leaders.

Charlotte’s Web is partnering with 40-acre Cooperative, a growing organization with over 50 farmer members in seven states. 40 Acres Cooperative is the first national cooperative to serve Black farmers launched in over a hundred years. The goal of the partnership is to begin to reverse the woeful underrepresentation of Black farmers, businesspeople, scientists, and leaders in the hemp industry.

“Greater diversity in our company and in the hemp industry may not happen swiftly, but working together with the 40-acre Co-op on our new ‘Seeding Our Future, Together’ mentor program is a way to move forward by sharing our knowledge, our science, and our cultivation expertise with Black farmers and other agricultural leaders in the Black community,” said Deanie Elsner, president and CEO of Charlotte’s Web.

In 1920, there were nearly a million Black farmers in the United States. Today the number is 45,508, and that accounts for just 1.3% of the nearly 3.4 million farmers in the country, according to a 2017 census by the U.S. Department of Agriculture (USDA).  Those troubling statistics inspired Angela Dawson, a hemp farmer, to take societal change into her own hands to reverse those numbers. She founded the Minneapolis-based co-op in 2019.

 “This is the beginning of an important shift in the industry and we intend to use this momentum to create lasting and impactful change,” said Dawson, founder and president of the 40-acre Cooperative.

The 40-acre Cooperative (FAC) will advise on the expertise most relevant and timely for their cooperative members and staff.  FAC will also educate Charlotte’s Web employees and leadership team on challenges and opportunities for the Black hemp farming and manufacturing community beginning with a Charlotte’s Web employee Lunch and Learn with Angela Dawson on Feb. 26, 2021. 

The 40-acre Cooperative is a swiftly growing and entrepreneurial organization whose mission aligns with the Charlotte’s Web’s vision of a healthier planet for everyone.  As part of “Growing Our Future, Together” Charlotte’s Web will donate some of its U.S. patented Lindorea hemp seed to 40-acre Cooperative farmers for the 2021 growing season planting.

“This collaboration is important for our entire hemp industry so it may achieve a wider potential for innovation through diversity. Our Charlotte’s Web Cultivation Team is excited to share our knowledge of organic hemp farming, and we know we will also gain knowledge from our work with the 40-acre Cooperative and its farming members,” said Jared Stanley, chief cultivation officer for Charlotte’s Web and co-founder. 

About The 40-acre Cooperative:  

Founded in 2019, 40-acre Cooperative is a Minnesota-based and farmer-owned cooperative focusing on bringing equity and innovation to Black, Indigenous and other farmers with a mission to promote agricultural development and economic equity for socially disadvantaged farmers. The co-op provides training, supplies and leadership specifically focusing on resource gaps with its members in seven states. 

About Charlotte’s Web Holdings, Inc.

Charlotte’s Web Holdings, Inc., a Certified B Corporation headquartered in Boulder, Col., is the market leader in the production and distribution of innovative hemp-derived cannabidiol (“CBD”) wellness products under a family of brands which includes Charlotte’s Web

, CBD Medic

, CBD Clinic

, and Harmony Hemp. The Ccmpany’s premium quality products start with proprietary hemp genetics that are 100% American farm grown and manufactured into whole-plant hemp extracts containing a full spectrum of naturally occurring phytocannabinoids including CBD, CBC, CBG, terpenes, flavonoids and other beneficial hemp compounds.  Charlotte’s Web product categories include CBD oil tinctures (liquid products), CBD gummies (sleep, stress, inflammation recovery), CBD capsules, CBD topical creams and lotions, as well as CBD pet products for dogs. Charlotte’s Web is the number one CBD brand in the USA and distributed through more than 22,000 retail locations, select distributors and online through the Company’s website at http://www.CharlottesWeb.com.  

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Relevant rehabilitation therapy and how to go big in chiropractic

Education is key — this isn’t your father’s physical or rehabilitation therapy

Chiropractic physical rehabilitation therapy is big. Regardless of your practice style, incorporating chiropractic physical rehabilitation (rehab) therapy into your practice has big returns for your patients and your bottom line, regardless of your practice style.

Whether it is low- or high-tech, properly applied rehab improves outcomes, patient satisfaction, referrals and is an additional service your office can provide. However, the main reason chiropractic rehab is big is because of the exceptional outcomes it achieves.

How chiropractic rehabilitation therapy is different

Chiropractic rehabilitation therapy is not physical therapy, personal training, group training, myofascial release or athletic/performance training. These disciplines are beneficial and address faulty movement patterns and muscular imbalances between tight and weak muscles (length-tension relationships) and expect joint mechanics to normalize along the way.

Chiropractic rehab is different: We treat and assess the entire body, adjust the hypomobile joints (local as well as within the entire kinetic chain), and then address the soft tissue imbalances, faulty movement patterns and altered muscular length-tension relationships to enhance the effects of chiropractic manipulative therapy (CMT).

Finally, we discuss lifestyle and nutrition to fully restore homeostasis. This approach is the reason chiropractic rehab is big in creating superior outcomes.

Begin with the basics

NFL Hall of Fame coach Vince Lombardi started every season by holding up a football and announcing to the team, “Gentlemen, this is a football.”

Therefore, regardless of if you have no experience with rehab or are in an interdisciplinary facility with the newest rehab equipment, let’s start with the basics and build your practice to where you feel comfortable.

Sharpen your spinal and extremity adjusting This is essential in correcting kinetic chain imbalances. Also, as patients recognize your office is big in rehab, they will expect you to treat more than just the spine.Havea go-to soft tissue plan Be ready to address soft tissue issues with manual, instrument-assisted or even high-tech modalities — be proficient in at least one.Startinyourcurrenttreatment Elastic resistance bands, physioball, balance discs and a foam roller can all be used effectively in your current treatment rooms with excellent results for the acute, sub-acute and corrective phases of care. There is no need for a dedicated rehab suite to go big in rehab.Learnlow-backandneckexercises for mobility, stability and These will be the most common conditions that will arrive in your office.

Building on the foundation

Thoughtful rehab is a process that incorporates CMT, soft tissue work, active and passive exercises, taping/bracing, nutrition and lifestyle advice. Exercise principles need to address both the local stabilizer muscles as well as the global prime movers.

Exercises must also address mobility and symmetry between left and right as well as front and back. Anyone can look up exercises on the internet; however, as a chiropractic rehab provider you need to know which exercises are appropriate and correct technique. Improper technique is simply not acceptable for optimal results.

Take courses and get hands-on experience in exercise prescriptions for spinal and extremity Start with the most common extremities: shoulder, knee and hip. Consider starting a study group with other local colleagues to sharpen your skills.BepreparedtoaddresstheTop3 common postural distortions of tech neck (forward head posture), lower crossed distortion (hyperlordosis with anterior pelvic tilt), and pronation.Apply all exercises in proper alignment and strong Use postural correction as the transition from treating the patient’s “pain” to a corrective “non-pain” model of care.LearntoassessandcorrectfaultymovementVideoyourpatient’sexercises on their own phone — video exercise software programs are also available.Create a professional referral base for patients when they get to return to sport and higher levels of activity. This phase of rehab is time-consuming and requires more extensive equipment and space. Patients still remain under care for adjustments, soft tissue work and oversight. This is a triple win: The patient, the local gym and your office all benefit at this stage of rehab.

Growing to the next level

Active care takes time and it may affect your appointment scheduling. Be prepared to add “rehab slots” to your appointment book for patients to learn and review exercise prescriptions.

As your rehabilitation therapy practice grows and your patients tell others you “do more than just give adjustments and heat,” the decision needs to be made on expansion. You may need additional space at this time and/or additional providers.

Movingtoanopen-conceptadjustingroom can make the space for your rehab suite right in front of This will enable you to adjust patients while observing other patients performing active care. Caveat: If you are billing insurance carriers for exercise therapy, you need to have one-on-one patient contact. However, it does not have to be continuous, so you can intersperse exercise instruction between adjustments.Hire another professional to oversee your rehab. Depending on your state’s laws and scope of practice, it could be an ATC, licensed chiropractic assistant, PT, PTA, RN, DC, OT, personal trainer, exercise physiologist or massage Again, be sure to check with your local licensing board on the requirements.Consider higher-tech machines to add to your menu of services. These offer services you can prescribe but do not have to oversee directly. Many of these novel therapies do not have CPT codes and are a cash service, which helps cash flow.

Growing into the interdisciplinary model

The interdisciplinary model for rehab is effective and profitable; however, it can change the focus of treatment.

Often the intake physician is a DC and they schedule the patient for the appropriate care with the other providers in the office. This offloads the DC greatly; however, it is important the team has weekly clinical rounds to assure the patient is progressing as well as maintaining their treatment schedule.

Remember, the hallmark of success in chiropractic rehab is the whole-body approach we use with a foundation of the chiropractic adjustment. Multi-disciplinary clinics can fall into a reductionistic model.

Conductweeklyclinicalrounds with the entire team to ensure patient response and compliance.As the DC on the team, be aware of the active care being provided. Understand the exercise prescriptions the other providers are incorporating.Bemindfulthatthereisa difference between “churning” the patient and comprehensive care — patients know the difference.Monthlyre-examsandprogressreports are integral to compliance.Thepatientcanalwaysbegina postural correction program once they are pain-free.

Chiropractic rehab is big

Expanding rehab in your practice is supported by research and patient demand. Numerous studies indicate a multi-modal approach to musculoskeletal pain that incorporates active care is the current paradigm.

In addition, patients are looking for active care solutions and desire to be independent. They appreciate the knowledge of a provider who can counsel them to attain their health goals and embrace technology that demonstrates postural and muscle imbalances, faulty movement patterns and physical limitations.

Finally, as mentioned above, active care is a reimbursable code for insurance carriers.

Make sure patients are scheduled for a mini report of findings to review the results of any movement, postural or kinetic Simply emailing the results is not enough.Whenbillingforactivecare, be sure to bill and code Active care can be billed under several allowable codes, both individual and group. Take a course or speak with a coding/billing specialist to ensure compliance.Perhaps the easiest code to document for one-on-one active care is 97110, Therapeutic The code 97110 is billed based on the outcome of the intended procedure, not the procedure itself. Therefore, if the goal is to increase range of motion (ROM), any technique (other than CMT) designed to increase ROM to that region can be applied.Dependingonyourstate’sscopeof practiceandlaws, patients may be able to pay directly for a personal trainer in your office to oversee their rehab. Since this is not billed to the insurance, it is direct pay.

Chiropractic rehabilitation therapy adds an exciting dimension to your practice. For doctors interested in adding rehab to their practice, start with the steps outlined above. You can use low tech in your current treatment rooms and address the conditions that currently present to your office.

Develop your rehab assessment and exercise skills and then decide if you want to take it to the next level. For doctors looking to expand, you can keep it “chiro-centric” or grow into an interdisciplinary model. Both models allow for appropriately coded reimbursement from insurance carriers. However, active care and non-billable high-tech machines can be direct-pay cash services, too.

ligning chiropractic rehab

Chiropractic rehab is effective because it is different than generic rehab. It is a corrective procedure that centers around the adjustment and the patient’s individual goals.

Our approach is to first restore joint motion to hypomobile areas (CMT), then proceed to restore soft tissue compliance before strengthening weak muscles and correcting faulty movement patterns. Performing strengthening exercises before joint mechanics and soft tissue compliance are restored simply reinforces the underlying pathomechanics.

Finally, reinforce strong posture and proper joint alignment with every exercise to improve outcomes and to transition the patient to postural correction, beyond pain control. Incorporating chiropractic rehab into your practice from low-tech to multi-disciplinary and high-tech will have big rewards for your patients and your practice.

NOTE: Check your state laws and regulations on billing for active care and follow appropriate documentation guidelines before incorporating the steps outlined in this article.

DONALD C. DEFABIO, DC, DACRB, DACBSP, DABCO, teaches Relevant Rehab with virtual and hands-on seminars throughout the US. His e-book, “The Six Keys to In Office Rehab,” is available free on his website, DeFabioDifference.com; exercise protocols can be found on his YouTube channel, which has over 32,000 subscribers. He can be reached at DeFabioChiropractic@gmail.com to schedule him as a speaker or register for his workshops.

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The status of chiropractic maintenance care

The latest studies give insight into the followed yet ill-defined approach to chiropractic maintenance care

Many patients, and doctors of chiropractic, rely on chiropractic maintenance care to maintain holistic health — “a traditional chiropractic approach, whereby patients continue treatment after optimum benefit is reached,” according to the research paper “Chiropractic maintenance care — what’s new? A systematic review of the literature,” published in November 2019 by authors Iben Axén, Lise Hestbaek and Charlotte Leboeuf-Yde.

The paper followed two prior reviews in 1996 and 2008, both of which “concluded that evidence behind this therapeutic strategy was lacking.” But since then, a systematic research program in Nordic countries, involving some U.S. doctors of chiropractic, was undertaken to “uncover the definition, indications, prevalence of use and beliefs regarding maintenance care to make it possible to investigate its clinical usefulness and cost-effectiveness.”

Method and results

The team included 14 original research articles in their review, where maintenance care was defined as “a secondary/ tertiary preventive approach, recommended to patients with previous pain episodes, who respond well to chiropractic care. Maintenance care is applied to approximately 30% of Scandinavian chiropractic patients.

“Only one of these studies utilized all the existing evidence when selecting study subjects and found that maintenance care patients experienced fewer days with low-back pain compared to patients invited to contact their chiropractor ‘when needed.’ No studies were found on the cost- effectiveness of maintenance care.”

Defining maintenance care

The authors note that new evidence regarding the natural course of spinal pain should lead to a shift in treatment approaches from cure of the condition to management of pain trajectories with maintenance care.

“The acute episode of spinal pain, similarly to an episode of asthma, may be short-lived, but the condition is often, as for asthma, life-long,” the authors wrote, noting that chiropractors appear to have been in the forefront in this domain.

Some chiropractors recommend maintenance care as a form of precaution, the authors said, while other DCs “seem to have used it to ‘keep patients going,’ when they had chronic or recurring problems.” The authors note that the term “maintenance care” has been used for decades but remains without an official definition.

Based on recommendations for further study, a research project called “The Nordic Maintenance Care Program” was launched with the aim to increase knowledge regarding maintenance care, utilizing chiropractors in Denmark, Sweden, Finland and Norway.

Review objectives and data

The objectives of the systematic review of studies were:

To define the concept of maintenance care and the indications for its use.To describe chiropractors’ belief in maintenance care and patients’ acceptance of it.To establish the prevalence with which chiropractors use maintenance care and possible characteristics of the chiropractors associated with its use.To determine its efficacy and cost-effectiveness for various types of conditions.

The 14 articles/studies included  were published between 2008-2018 and included ones from Canada, the U.S. and Egypt.

“There was a mixture of qualitative (focus groups and interviews) and quantitative studies (surveys, observational studies and randomized controlled trials),” the authors wrote. “One study was described as a structured workshop, but it was designed like a focus group discussion with a resulting qualitative summary. Eight studies collected their data from chiropractors who either estimated their responses or consulted their patient files, four studies collected their data from patients, in one study data were collected from both chiropractors and their patients, and one study used workers’ compensation claims data.”

Patients and DCs on maintenance care

One study specifically investigated the patient perspective of maintenance care; patients were interviewed and asked to explain why they would visit their chiropractor on a regular basis. Patients stated that:

The purpose was to prevent recurrences (78%);The purpose was to remain pain-free (68%);The purpose was maintenance care as a wellness approach (17%).

By contrast, the prevalence with which chiropractors use maintenance care in studies saw that “some studies investigated the frequency of use of maintenance care from simply asking chiropractors to estimate their use of maintenance care the previous week (mean estimate 22%), to have them check the proportion on a typical clinic day (reported in two studies to be 28 and 35%, respectively), or actually observing in clinic and counting (reported in two studies to be 26 and 41%, respectively). Thus, the mean proportion of patients seen on a maintenance care regimen by Scandinavian chiropractors was around 22–41%, with large individual variations ranging from 0 to 100%.”

Regarding the spacing of maintenance care treatments, most visits were scheduled by patients within a range of 1-3 months.

merican DCs and maintenance care

In one survey the majority of chiropractors from the given countries (98%) stated they believed that “maintenance care could be used as a preventive tool, at least sometimes.”

In an interview study it was found that some chiropractors “favored a universal approach, claiming that maintenance care was always beneficial and would prevent disease.”

In regard to American chiropractors, “One study conducted in Denmark investigated chiropractic factors associated with maintenance care use and found that it was more common among experienced chiropractors, clinic owners, and those who received their chiropractic degree in the U.S.”

At the time of the particular study, “the older chiropractors were almost all trained in the U.S., whereas the younger chiropractors were primarily educated in Denmark. Therefore, it is not known, if it is age (experience) or educational background that guided the use of maintenance care among these chiropractors.”

Further defining the term and use

Across the Nordic countries in the study, approximately 30% of chiropractic patients are maintenance care patients. Visits were usually between 1-3 months for these patients, with DCs emphasizing a full-spine approach.

As the authors note, “Clinical indications vary, but patients suitable for maintenance care are commonly thought to be those with persistent or episodic pain, who react well to the initial treatment.”

Three trials dealt with the clinical usefulness of maintenance care. “In one, patients who received maintenance care had better outcome than those who received short-term treatment or short-term sham treatment. The other two studies compared two types of maintenance care (with or without exercises, or different length of the follow-up treatments) and found no difference of outcomes between groups.”

The study concluded in part, “Presently, maintenance care can be considered an evidence-based method to perform secondary or tertiary prevention in patients with previous episodes of low back pain, who report a good outcome from the initial treatments. However, these results should not be interpreted as an indication for maintenance care on all patients, who receive chiropractic treatment.”

The full study is available at chiromt.biomedcentral. com/articles/10.1186/s12998-019-0283-6#citeas.

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Can the ginger plant help treat patient autoimmune disorders?

The ginger plant or root has varied uses as an herbal medicine, used to treat conditions affecting the nervous, respiratory, digestive, and immune systems

Like many other herbal medicines, the ginger plant root (Zingiber officinale) has a long history of use as a culinary ingredient. Powdered ginger is a common spice for both savory and sweet dishes throughout the world.

Fresh, sliced, peeled ginger root is used like a vegetable to lend a sharp, peppery taste to Asian stir fry dishes. Pickled ginger is a traditional condiment for Japanese sushi. Dried, candied ginger is a common sweet treat throughout Asia.

However, the ginger plant has even more varied uses as an herbal medicine. Within traditional Asian herbal medicine, ginger root has been used to treat a wide variety of conditions, including those affecting the nervous, respiratory, digestive, respiratory, and immune systems.1,2 Treating conditions affecting the immune system, such as autoimmune disorders, can be particularly difficult, as many symptoms may appear to fit into some of the other disease categories that ginger root often treats.

Fortunately, recent animal research into using ginger root to treat lupus, a common autoimmune disorder, may be an important step toward effective treatment of such disorders in humans. Read further to discover how ginger root can help break the inflammation cycle that is often the hallmark of autoimmune disorders.

Mechanism of autoimmune disorders

Before we get into how the ginger plant and root can help treat autoimmune disorders, such as lupus, we must first understand the actual mechanism behind how such disorders actually attack the body.

Under normal circumstances, the body’s immune system activates only for a short period of time to fight off harmful antigens, such as viruses or bacteria, or protect against an injury such as a cut to the skin. White blood cells produce antibody proteins to protect the body via acute inflammation to seal off affected tissue from the rest of the body. When the body is no longer in danger, the immune system stops the inflammation process and no longer produces antibodies.

In the case of autoimmune disorders the immune system fails to stop producing antibodies, as it cannot differentiate between diseased and healthy tissue. As a result the acute inflammation process becomes chronic, causing swelling, pain, and tissue damage throughout the body. This chronic inflammation can affect many areas of the body, including the skin, joints, lungs, kidneys, and heart, or a combination of these.

The ginger plant and the inflammation process

An article from February in the journal JCI Insight reported on the results of a study to test the effects of 6-gingerol, the main bioactive compound in the ginger plant root, on lab mice with either lupus or antiphospholipid syndrome, a similar autoimmune condition.3

Specifically, the researchers were interested in the connection between 6 gingerol and neutrophil extracellular traps, which come from a type of white blood cell known as a neutrophil. These extracellular traps are associated with lupus and antiphospholipid syndrome progression, as well as large-vein thrombosis and antibody formation.

The researchers found that 6-gingerol lowered neutrophil extracellular trap levels, reduced the tendency for blood to clot, and slowed antibody formation.3 They speculated: “Future studies might administer ginger supplements to individuals at high risk for autoimmune conditions and/or cardiovascular disease (for example, individuals with autoantibodies who have yet to have clinical events or patients with cardiovascular risk factors). In such scenarios, its antineutrophil properties might prove protective against disease emergence.”3

Diagnosing autoimmune disorders, such as lupus, can be particularly tricky, as symptoms can often seem to be associated with other conditions or may flare and recede. Although the next step in this research will require human testing, it may represent a major breakthrough in treating patients with autoimmune disorders.

References

Khodaie L, Sadeghpoor O. Ginger from ancient times to the new outlook. Jundishapur Journal of Natural Pharmaceutical Products. 2015;10(1):e18402. Published 2015 Jan 17. doi:10.17795/jjnpp-18402Mashhadi NS, Ghiasvand R, Askari G, et al. Anti-oxidative and anti-inflammatory effects of ginger in health and physical activity: Review of current evidence. International Journal of Preventive Medicine. 2013;4(Suppl 1):S36-S42.Ali RA, Gandhi AA, Dai L, et al. Antineutrophil properties of natural gingerols in models of lupus. JCI Insight. 2021 Feb 8;6(3):138385.

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Salonpas Launches Arthritis Pain Relief Gel After OTC Approval

Salonpas® has announced the launch of Salonpas® Arthritis Pain Relief Gel, which features the most-prescribed topical pain medicine clinically proven to relieve arthritis pain in major joints. That medicine is prescription-strength diclofenac, which was approved by the FDA for over-the-counter (OTC) use in 2020.

The Salonpas® line of pain-relieving products is manufacturer by Hisamitsu America, a division of Hisamitsu Pharmaceutical Co., Inc.

“Salonpas® has a long history of driving growth through our scientific approach to pain relief which includes providing the first FDA-approved OTC topical pain reliever to the public in 2008,” said John Incledon, president and CEO, Hisamitsu America. “Our science-based approach is critical to our support of the Salonpas® Arthritis Pain Relief Gel, as diclofenac is a globally important NSAID drug which is clinically proven to reduce arthritis pain in major joints — foot, ankle, knee, elbow, wrist, hand — and safe to use for up to 21 days.”

Solely focused on topical pain relief, the brand is the top-selling external pain relief brand in the United States according to IRI panel data for 52 weeks ending Jan. 24, 2021. Hisamitsu America recently released the results of its latest clinical trial, bolstering the case for topical pain relievers as a first-line treatment for pain. Hisamitsu Pharmaceuticals, the parent company of Hisamitsu America, is a global leader in transdermal drug delivery and manages the best-selling diclofenac brand in its home country of Japan.

Salonpas® Arthritis Pain Relief Gel is a non-greasy gel that reduces inflammation and delivers relief right at the site of pain. Once only available as a prescription, diclofenac sodium 1% gel is now an FDA-approved over-the-counter medicine.

The new Salonpas® Arthritis Pain Relief Gel is available at retailers nationwide.

About Hisamitsu America
Hisamitsu America is the U.S. division of Hisamitsu Pharmaceutical Co., Inc., founded in 1847, which has specialized in transdermal drug delivery system technology since the introduction of its Salonpas® line of patches in 1934. The Salonpas product line, which gained early acceptance in Asia and is now registered in over 30 countries, has pioneered the development of transdermal patches to relieve pain. Since 2010, Salonpas has become one of the fastest-growing OTC brands in the USA. Salonpas became the most popular pain relief brand on Facebook in 2020. For more information go to us.hisamitsu.

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