Blog, Live Events August 7, 2021

Getting MD’s and ER’s to Refer to You

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Hi, I’m Dr. Mark Studin and welcome to today’s presentation. First. I’d like to thank ChiroSecure for providing the forum. Uh, it’s always a pleasure to collaborate with them. And secondly, next week, I’d like to share that Janice Hughes will be on air today. We’re going to be talking about emergency rooms and, uh, and working with MDs and what it takes to break that glass ceiling. So let’s go to the slides. Everything when you deal with MDs is about evidence-based care. And that’s really, really important. And in the academy of chiropractic is which is our, our, our parent organization is we strive towards clinical excellence and we want to break the dogma of DCS versus PTs. Who’s better for spine. We’re not going to talk about lawyers, but the goal is to get lawyers to DCS first and hospitals, to have chiropractic inclusion. That really folks is what primary spine care is.

I want you to become a primary spine care provider and primary spike here means quite simply, you are the first provider for spine. That’s it first referral, but not just MDs hospitals, urgent cares, or emergency rooms, lawyers, everybody, you should be the primary spine care provider and not a physical therapist. We’ll talk about that. Why in a few minutes, but first, what I’d like to do is there was a doctor in Florida who wanted to break into a hospital and his name is Steve Kenyan will, and I’m going to play a little blurb with his permission and an only played the first three minutes of it. Let’s listen.

[inaudible] and mark, how’s it going? Uh, things are going fantastic. So Steve recently, um, you were, uh, you went to a hospital meeting where the hospital wants to have a meeting with chiropractors because, uh, one of the things that I’m realizing around the country is hospitals have overlooked a tremendous resource for utilization and that’s chiropractice and they’re starting to open their eyes. So you were contacted just recently about three weeks ago, I think, or four weeks ago. Yeah, that sounds right. We’re up by one of their marketers to attend a meeting. And could you just share with us just set up what that meeting was like? Yeah. So they had a meeting at a local restaurant there. Um, there’s about, maybe about 15 or so chiropractors there wanting to bridge the gap. They said between the MDs and the Tyros, they wanted to start doing some, uh, basically like continuing education classes having this so we can start building relationships.

So basically referrals, no matter how they are covered with, they want your referrals and they sent their marketing person to get you. Correct. Right. So what happened at this meeting? What was the format like at this meeting and what did you do to prepare? So, first of all, we, we dress for success. Um, I was wearing a suit and tie and my wife was also dressed professionally. Um, most of the chiropractors over and subs jeans. Um, one, I was in shorts and in short, we can’t make this crap up. And the medical director started talking. He was, you know, the other parents are puffing their access. They’re talking about subluxation. Um, one guy was saying, well, you UMD do you do surgery? And I have to fix them. And they just became this like argument back in stores. Um, we went and just sat there, didn’t say a word. And, uh, I told her I needed a leave early anyways, about seven 30. The meeting started at six, so the surgeon can set a time. So, you know, I waited time earlier, came up there, shook his hand, gave me my, a copy of my CV and said, yeah, I’d like to talk further with you. And that was about it.

Okay. And then what happens after that now, by the way you are, you are trauma qualified in hospitals as of the time of that meeting, correct? Yes. Yes. Also the, and you will prepare that was the bottom line you will prepare. Yeah, we’re prepared. So three days later, you know, they reached out to us, the marketing and, uh, she wanted to set another meeting in our office, in our office. We did that. Um, it was great. Uh, we talked about Eric being out in Colorado and then a surgeon he’s off in Utah actually played a video, the neuro surgeon that he works with out there. She’s very impressed. And, um, yeah, she went back to the hospital, they contacted us again and said that they definitely want to work with us. So we’re, we’re working on setting up another meeting with them, with the dots.

So I could, um, uh, the video, the recording’s over. So, um, just, just to segue after that, um, they’ve had two or three meetings there. Uh, one of their medical directors took them out for dinner. And the real question is what was the takeaway from this meeting that brought them there? Well, it’s very simple. They dress for success versus shorts and a t-shirt or even scrubs. And look at the look at the second column. There are a doctor of chiropractic. He was trauma qualified, advanced training and MRI qualification. He’s hospital qualified. Um, if your primary, primary spy care qualified versus just a doctor of chiropractic. And I don’t mean to denigrate just the doctor of chiropractic, but he came up with a concise business strategy that benefits the hospital versus the other 14 people in the room that had a strategy that benefits the chiropractor.

That’s the formula for success. And we’re going to really dig into that strategy as we move on, because if nothing else, I am a strategic business strategist. I have worked with hospitals all over the country, large medical groups. I consult not just for chiropractors, but for MDs. Um, and it’s very easy with what they want. So this is important. You’ve got to prepare if you want to work with the medical community, whether it’s an individual doctor or it’s an entire community, you’ve gotta be prepared. And those six P’s matter, proper planning prevents poor performance, and that’s critically important. But one of the things that I’ve done is espionage for referrals. And I started this back in 1996, where I paid $106,000 for a company to infiltrate the top spine related MD specialist in my region. And I learned a tremendous amount, those secrets equal referrals, you know, we’re talking decades ago and that same holds true today.

What are they doing? What do they need? What do they want? And the bottom line is what are the trends? So my job is to find out the trends and the here’s the trend for chiropractic. You’re going to see advertisement on benches. You’re going to see spinal. What are those units, posture units, uh, advertisements that acute where the dog is there and bed pens. You still see a lot of that stuff out there. Look at this cancer surgeon, Dr. Jamie landman. You know how I know him? My wife had cancer three times, three times. If you think that I’ve looked for the person who had a park bench as a cancer surgeon, you’re out of your mind. I went and scoured and found this guy. I looked at his CV. He was incredible. You know, it took me six weeks to get an appointment with this guy.

Actually, that’s not true. It took me three weeks. I had to run after him. I need a favor after a favor, after a favor. And this was in 2008. And when I was going through that in the middle of the process and my wife is fine to me. I said, why don’t people run after chiropractors while there was a reason for that? And the reason for that comes to a strategy, a mindset, and what is considered usual customer in our profession. And I am looking to change what’s usual and customary because it’s about credentials. If you are the best of the best through clinical excellence, which has nothing to do with your ability to adjust, they’ll come after you. It’s about case management. Remember the movie field of dreams with Kevin Costner, build it, and they will come. And they do. I ran after that surgeon and I can share with you as of this morning, um, in the past nine years, we were able to get 1 million, 360,000 additional new cases to chiropractors.

We’ll talk about that later on. So we get into that, but what’s the strategy. It’s very easy. We start in the bottom, left with infrastructure. You’ve got to build an infrastructure of case management and how to understand that. Then you move up and you have to have documentation. That’s pristine and compliant. Then you need tools and you need credentials. And that’s critical. Then you build your relationships. You get into the top of that pyramid. Then you start getting some referrals, start from MDs and lawyers. Then you become the solution to their cases. Now you move over to the inverted pyramid on the top, and you’re working with MDs and lawyers. And when you’re the solution, not just to their case, but for their practice, because you’re taking, um, issues away from them. Now they start to pay attention and you could do plaintiff, IMS, or second opinions for those lawyers or get peer relationships.

When you collaborate with the MDs and then you start teaching them because you need to understand the latest literature in relation to spine. That’s what a specialist does. That’s what a primary spine care provider does. And you need access to that literature and education. Then you start, when you become their teacher, you get exclusive referrals. It’ll be really hard to break that relationship. Once you do that, they become your advocate for inclusion. They bring you in ERs and primary cares and medical schools, specialty practices, trial, or embar associations, you’re game over you win. This formula has been working like the chart to make it simple. The first thing you need to do, infrastructures, credential and strategy, then you can communicate. Then you can look at reports and educational programs at case collaboration and business solutions for them. But your business model is upside down. It’s not enough just to help people to turn on life, to adjust them.

It’s not enough because that’s brought us at best to about 7%, um, uh, utilization in our industry. Maybe it’s bumped up to eight or nine, but we’re not much, much beyond that. Just think of primary care medical doctors, they see 95 to 97% of the population. So we don’t, and we shouldn’t be seeing a lot more than we do, but let’s, let’s look at how this, where the problem is. And this is the core of the problem. The core of the problem is dogma. According to Montero, et Al accordingly, chronic low back pain and neck pain are considered nonspecific and a large majority of cases, meaning the pain cannot be attributed to a specific origin or to a pathway detectable with imaging methods. That is nonsense. That is not true. That is steep than dogma. We have another name for dogma in New York. It’s called BS.

New Jersey it’s even worse, but dogma is a false belief that MDs hold onto. Because if it’s not an anatomical problem, fracture, tumor infection, they don’t know what to do with it. We do it is very specific. And I’ll show you that later on, but what you need in dealing with them. And these is they want the evidence. They want the evidence in the literature and they want to work with peers. They don’t want to work with a lowly therapist, a PT, or even worse than Chiro below the PT. They want a peer. So when we look at how it works, let’s look at number one on the top left patient goes to their primary care provider. They complain of back pain. Doctor thinks it’s nonspecific. Number two, it gives them drugs, muscle relaxes, Metro dose pack, steroids, painkillers, or opiates. None of those work fail treatment.

Often. Number three, to the surgeon. Now only 8% of surgery. A surgeon has to see a hundred cases for eight surgeries, say 8% needs surgery. Let’s talk about the other 92%. They don’t need surgery. Now they’re going to the PT. They’re going to number four, that’s going to fail. And we’ll talk about that in a minute. Then when it fails, they go back to their primary care or their ortho back for another course of therapy, a physical, another course of physical therapy, which is going to fail again. And then it goes back the final solution, which is pain management, which is legalized drug addiction. That’s where people are and live, which is fuel the opiate issue in our problem. But let’s tear this apart. Let’s look at where the issues are. Let’s look at MD primary care triage in a recent article written by Humphreys, et cetera.

In 2000 and 2007, they stated in the United States upwards, approximately 25% of all primary care doctors are from musculo skeletal complaints. And it’s been estimated that less than 5% of the undergraduate and graduate medical curriculum in United States. And 2.2, 6% of Canadian medical schools devote to MSK treatment. Now there was a paper, a basic competency on MSK where the passing score was 73% recent medical graduates. Only 18% had basic competency, medical students, residents, and staff physicians, board certified internist, family practitioners, 20.7% osteopathy, 29.6%. Now, if that’s in basic competency, um, most respondents in another article in 2006, 92% of them said their recent, their, their ethic, their education from musculoskeletal issues were not sufficient. Then we go even further. Uh, we’ve met Al reported in 2013, that average annual charges for filling an opiate prescription with 74% lower with chiropractic care. They also reported the adjusted likelihood of filling a prescription for opiates was 50%, 55% lower with chiropractic than with no chiropractic care.

So now we know we help with the opiates. Now we go into surgery again, only 8% get surgery. Where do the other 92% go on the Cleveland clinic’s website? It says the about non-specific back pain. These patients may be best served through prompt access to PT or a nurse practitioner at the entry level. When pain persists, then you go to a spine specialist or a surgeon or behavioral problem. The Mayo clinic says physical therapy is the cornerstone of back pain. A physical therapist can apply treatments, et cetera, et cetera, to reduce pain. Now I want to focus on those other 92%. What do they do? It’s very, very simple. They go into physical therapy. Now watch physical therapy is best suited for all rehab as the first provider, except spine. Now, according to Humphreys again, where pet for physio for musculoskeletal conditions were 70%, uh, greater as the passing score, a physical therapist at the master’s level, uh, and the doctoral level, by the way, masters level, 21%, 26% at the doctorate level, a chiropractic student was 64%, just simple.

So we’re so much better. And I think that number is way low 64%, but that’s what they came up with. So it’s just about triple of any of our competitive, uh, treatments and physical therapy certainly is a failed entity in musculoskeletal care. Why? Because if we go to Marist college and look at its contemporary doctor of physical therapy program, they’re not learning to be doctors and diagnosis and case management, just more of what they do. They get to credits and diagnostic imaging and not how to interpret, just to understand what it is. Three credits in cardiopulmonary management. In other words, how to manage cases who have cardiac issues with therapy, their programs are never intended to train physical therapists to be any type of primary care provider or enter your portal of health into the healthcare system. And by the way, all of this is evidence-based the scope of a primary of a primary care provider.

If you look at PT, Texas is a typical state. You’ve got to have a prescription from an MD. It’s just simple. They may provide, if you look at number beat or two B PT may provide instruction who is asymptomatic related to the instructions, be given with that, a referral to promote health, wellness, health, wellness, fitness, but certainly they cannot work independently and Texas actually better, right? There are some states that allow direct access to physical therapists without a prescription. And I believe that’s a public health risk, but with the general genre or, or care path with physical therapist after MDs in 2013, Matthew McCarthy and Davis, and Landon reported that physical therapy back pain treatment from 1999 to 2010 represented 440 million visits and revealed an increase of opiates from 19 to 29%. During the same time with continual referrals to the same failed treatment path, according to blanche it 2016, medical care ended spinal related compensation, 12% longer than chiropractic and physical therapy required 239% more time to end full compensation than chiropractic regarding partial compensation.

Medical care was 20% longer and physical therapy was 313% longer. It’s incredible. So, so point days reported the 32% decrease in average weekly cost of medical expense compared to physical therapy, which is better PT as well. And the is a little bit better, but here it is the cost for managing low back pain, just managing and not fix anything was $106 billion, 106 billion and 20 billion in lost productivity. So you look at what’s going on in a failed care path. So if we look at, um, low velocity manipulation, which PTs do okay, and arthrokinematics studies and osteokinematics principles, it doesn’t affect the release of substance P, which is an oral peptide, which helps analgesia, which promotes healing, which does a lot of things. But chiropractic adjustment does that coroner reported that a high velocity, low amplitude adjustment causes significant higher changes in pain sensitivity. In other words, up into the brain, okay.

Where low velocity or, or, uh, physical therapy, um, joint mobilization doesn’t work, uh, Reed found that high velocity, low amplitude thrust, the chiropractic spinal adjustment revealed unilateral bilateral and multilevel hyperalgesia, uh, because of central nervous system changes. Physical therapy does not. Those are the things we’re looking at. [inaudible] reported chiropractic at a 250% decrease in disability duration during the first episode compared to an MD’s care, they Al reported that 82% of fourth year, uh, Harvard medical students. And that’s another one failed basic medical competency, um, and musculoskeletal aptitude and devotion revealed that 87% of the chiropractic patients were helped exhibited decreased the pain where 82% of fourth year medical students can be come up with a diagnosis. We’re helping 87% of the people. Um, and I could go on and on and on adjust. Doesn’t adjust folks. It just doesn’t end. Well, just as a side note, everything I just shared with you are in these two volumes called the science of chiropractic.

So if you want that research and more of these two volumes have those, you can email me, you know, we can offer you a discount. You go to Everyone’s always looking, where did you get those references? Where did you get those references? This is where you can get those references. And we’ve done the work for you when it’s simple and it’s wonderful, but the outcome, the outcome of this, of this is a failed care path, fail care path. So what’s going to happen is, is you have perpetual pain. You’ll live in drugs. Wolff’s law is going to come into effect, which is arthritis, which is degeneration, which is epidemic in our society. Now, you know why? Because it’s a perpetual failed care path medicine doesn’t have it, right? And we need to educate them. But unless you’re educated, they’re not going to be educated.

And it’s really that simple. So to shift referrals, the MD needs the evidence. They need demonstrative proof, and that’s critically important. We’ll get to that in a moment. They need peers for case management and need people with credentials in order to work with that’s. Those are the four keys that you need to March, without appearing to March and getting them to understand what you need to do. Now, here’s another thing. And let’s just look at the second paragraph. Um, the estimated total expenditure for neck and back pain between 2018 and 2027 is 4.6, $5 trillion to a health care delivery system. The estimated savings if chiropractic treated first would be 1.6, $5 trillion. It’s just simple. It’s just simple, but that’s the reason why you’re not getting the referrals because they’ll lose the money. And they want to keep that in the system because too many MDs on too many PT practices, too many drug companies want to perpetuate these things.

That’s what you’re fighting against. It’s a multi-trillion dollar business now with hospitals and chiropractic inclusion, Hey folks, just like Tony soprano said, it’s not business. It’s just business. It’s nothing personal. It’s just business. That’s the key. So when we look at, in the past, what we tried to do with hospitals is we tried to say chiropractic additive, sir, I’m going to refer to your MRI. I’m going to refer to you in neurology, pain management, electronic diagnostics, physical therapy. It’s a failed strategy. We tried it because the hospitals are going to get very small dollars. Let’s just the bottom line. What’s big dollars. This is easy. You’re ready. Here’s big dollars folks. One spine surgery, a two-level fusion on long island is $365,000. That’s what hospitals want. They want procedures and it’s plain and simple. You want to get them procedures. So let’s look at this again.

The spine surgeon performs a hundred examinations, eight surgeries. It takes three clinical days to create that. And then two days of surgery. Now, the malpractice rates in New York for a surgeon is $365,000 a year for a spine surgeon. And if he has two cases against them even found innocent, it goes to $600,000. What our doctors do. And I do with doctors. Who’s trained them to be neurosurgeons without a scalpel. And it’s about management. It’s about diagnosis, about triage. So the DC screen’s the same hundred and refers 12 for the eight surgeries. Cause we pre-screen them. Now the surgeon or the hospital can have one clinical day and they lose money on evaluations and four surgical days. Instead of two folks, it’s always about the money. You’ve doubled their time. Because for me, it’s not about the surgeries. I’m not trying to prevent surgeries. Even though I’d like to, you need surgery, you need surgery.

I’m getting out of the way. I’m looking. I’m not looking at that 8%. I’m not donkey. Hodie fighting against the windmill. I am focusing on the other 92 patients, where are they going to go? I want them in my office. If they’re not in your office, your philosophy doesn’t mean a hill of beans. What your beliefs are means nothing. You’ll be talking to the wall and a mirror. I want those 92 patients in my office so I can manage those cases so I can get them adjusted and do whatever I want. Because when you start getting hospitals and surgeons and MD’s to understand that you are the solution to their problem, they will start working with you. And if you are credentialed, just like Steven Florida shared with you, he gave him the CV. It had pages and pages of courses, which were meaningful, which worked because it showed them that he was a peer it’s peer to peer.

And what shows your peer-to-peer is your current UNM reports, your referrals, reading your documentation. When they look at recurring non-specific back pain patients, they don’t know what to do with them. You are graduate medical education and credentials, where I train a doctor, you get co credential, not just through chiropractic academia, but also through the state university of New York at Buffalo Jacobs school of medicine and biomedical sciences. I’ve worked for almost a decade to secure that credential because now when you’re talking with an and you say, Hey, I referred that MRI over and there is, and there’s a two and a half millimeter slice, no gap. And I’m getting two to three clean slices through the desk. And I want to make sure there’s a T1 T2 and a stir view to make sure when I fax a precedent, I see what we’re doing. You know, occasionally we’re going to need a, um, a, um, a proton density view.

They’re going to say you’re a chiropractor. Yeah. Where’d you learn that? Oh, through the state university of New York of Buffalo Jacobs school of medicine and biomedical sciences. Now you just became a peer. You went from being a lowly therapist below the dog, poop on the shoe of a PT to appear there in lies the secret to referrals, because it’s about reputation. And it’s about being a true spine specialist. That is the core reason why my doctor’s gotten 1,000,300 and plus thousand additional referrals into their offices over the last nine years. And it works like a charm. And Steve [inaudible] was in that room with 15 other doctors. He was the only one that got a knock on the door the next day. And when they came to him, they said, oh, who else in your region is credentialed? Like you are? And the answer is nobody.

It’s really that simple. So when we look at this there’s things you’re going to have to learn to document, and I’m going to go through this really fast. It just give you a quick overview. You have to be able to document common. And the word is demonstrably pain, potential pain generators. Whether it be the spinal cord, the fecal SAC, the recurrent laryngeal nerve myeloma, Malaysia nerve root compression and abutment and Fossette and connective tissue pathology. And by the way, car currently lives in connective tissue pathology. You’ve got to put it in a way. That’s easy to understand that a report where you have demonstrative pain generators, where it’s all late, this is what they consider non-specific back pain. Here. It is nonspecific. You’ve got to understand this. You’re going to have to go through a little bit of training to get there because the worst thing you could do, the very worst thing you could do is get into a hospital or having an MD referred to you.

And then they understand you don’t know anything. And the next thing you know is you’re a one and done. They’ll never work with you again. And that is the worst place for you to be as a one and done. And I mean that sincerely. So when we look at making it the monster bubble, there is a piece of technology called SIM Virta and it’s x-ray digitize it. And what, if you look at their spine, we digitize the spine takes about a minute and a half to digitize, and it gives you a graph. There’s a green line and a red line on that graph. The green line shows pathology. The red line shows the maximum impairment rating. When I work with the MDs and I sit with them, I say, listen, you see this, this is your non-specific back pain. You couldn’t find fracture tumor infection.

So you just want to give them an analgesic. You want to drug them up. But look here, look at C five. Look how far that, that, that segment is, aberrantly moving. And it’s all evidence-based in. The literature goes way back to Panjabi and white and 75. And there’s tons of literature now, but you can make what we do demonstrable. And when they look at that, they go, holy crap, most neurosurgeons and ortho surgeons who do spine and neurologists and pain management and physiatrists. When they look at this and primary care, you know what they say, I want this on every patient. How can I get this in my office? They all see it PTs. Aren’t going to know what to do with it. It’s critical. You have the tools in order to be able to get this done. So what we do when we look at this stuff again, demonstrative, do you understand how to explain an MRI?

Can you look at a herniation versus the fecal SAC versus the spinal cord, which of the three slices we have here? These are the things that it takes, not a lot of training, but it takes a little bit of training for you to become a peer and work at the peer level for knowledge. And that’s the key. So when we look at this again, it’s credentials, I’m credentialing you through not only SUNY Buffalo medical school, you’re, you’re, you’re a board certified chiropractor. We work the Federation of chiropractic licensing boards. I work right now with Cleveland university, Kansas city chiropractic and health sciences. So you’re getting tons of credentials. You got to show that you’re working both sides of the fence and you get what they need. That is incredibly important to understand these are the various qualifying programs and things are changing in our industry.

So being trauma qualified is the new minimum. And on the bottom bottom, right, is MRI interpretation review qualified. And by the way, that was just approved through the ACCR the accreditation, um, the academy of, um, chiropractic ACC, our academy of chiropractic credentialing and radiology. It just flew out of my head. I’m sorry. So, uh, and also the credentialing board for doc bars. So the ACCR is approved the language. Um, uh, the universities are approved this language within our, with our academia. It’s taken a lot to get here, hospital qualify. You got to check that box because hospitals need doctors to be qualified, not through Jayco, that re that they require, but we’re meeting a requirement that they have. These are the levels of things you need to become primary spine care qualified to be the first refer. And this is real education. I mean, you’re being taught by Harvard trained neuroradiologists by Albert Einstein, college of medicine, trained double boarded, a vascular neurologist by neurosurgeons from the state university of New York, at Stony Brook and on and on and on in conjunction with the head of people, uh, you know, in chiropractic and everything is academic based.

So this gives you, once you get qualified, it lasts you the rest of your life. It never goes away. This is what makes your competition irrelevant and your competition or not other chiropractors down the block. I mean, they’re clueless. Your competition or ortho neuro is a neurosurgeon and primaries. MPTs this makes your competition irrelevant and allows you to work at a peer level. Here’s where your journey starts. If you want to learn more, just go to the academy of You’re going to learn how to build your infrastructure, develop a strategic business plan, and then get the tools because clinical excellence will drive your success. And here’s what it looks like. Folks. Remember I said that 1.6 million, 1.3 million new referrals. Our average doctors get between 15 and 25 new cases a month, mostly pie, and they are take home. Pay after taxes goes home. It goes up about 61%.

That’s across the board and I don’t care what state you’re in. So listen, I’m pretty much done. I’d like to thank you. I’m a little bit over my time. If you have any questions, please email me. This is my email address. Call me. I love this stuff. I’m happy to chat with you. I’m happy to talk with you. You want to learn more, go to the Uh, call me whatever you like folks. Again. I’d like to thank you so much. Uh, you’ll see, Janis Hughes next time. And again, thank you. ChiroSecure.