Blog, Chirosecure Live Event September 8, 2021

Increasing Chiropractic Utilization Mark Studin DC

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Hi, I’m Dr. Mark Studin and welcome to today’s presentation. First, I’d like to thank ChiroSecure for the opportunity to be able to share this information with you. And today I am extremely excited to share with you one of my very, very favorite topics. So what I’m going to be looking at and discussing today is increasing chiropractic utilization. You know, that’s the thing, how do we get more patients? But really I look at it globally, not so much your office, but how has the profession itself going to increase its utilization? And unfortunately, I believe we’ve been looking in a lot of the wrong places. We’ve been really letting politics lead us where in fact academia and the literature should lead us. We should go where the science takes us because there is so much science right now, and we’re letting opportunities really go between our fingers.

So if we look at the avenues it’s medicine, physical therapy and case management, if we look at the tools MRI, x-ray digitizing and non-specific back pain, those are the things that we’re looking at and not specific back pain, not so much a tool, but it’s a concept that we need to utilize in order to get where we want to go. And you might say, well, where’s technique in there. Where’s results. That’s what chiropractic is built on for over 125 or 126 years. Why are we relying on that? Here’s your answer? Because over the last 10 years, chiropractic has been teetering on seven to 10%, seven to 10% utilization. We’re only treating seven to 10% of the population with technique with results. Believe me, I don’t minimize or marginalized chiropractic results. They’re incredible, but that’s not. What’s going to bring us to increase. Utilization is a profession medicine currently treats 95% of the population, 95%.

Why wouldn’t you want to tap into that? Because you could say, I’m not a medical doctor. I don’t want to work with them. Drugs kills surgeries, kill blah, blah, blah, blah, blah. Well, that’s great. As you’re sitting in your office all by yourself, treating one patient every hour, look, there are some people that are hugely successful and others that aren’t as in any industry, but even so how come there’s not long lines of waiting lists in our chiropractor college? How come there’s not tens of thousands or hundreds of thousands of more chiropractors in the country. Truthfully, there’s more medical doctors in New York city than the are chiropractors in the whole United States. The reason being is we are not tapping into a system. That’s already there to send patients over to us and I don’t care why a patient gets to my office. I only care that they get to my office and then I get to treat them.

And I get to educate them as to how I want the practice as I choose. And this isn’t about how you choose to practice. This is about increasing utilization, which comes from every single office and how we’re driven. And again, politics and politicians have led the charge throughout our entire or the last 50 years, or at least 40 something years I’ve been involved in car politics cannot drive our profession. It must be science, the evidence academia. That’s what we must do it. And when you start seeing the medical community validating, chiropractic it’s game over because those referrals are going to be a revolving door into your office. So what we look at is what drives referrals. The answer is reputation drives referrals. If you have a good reputation, that medical primary, that medical specialist, that lawyer, the urgent care emergency rooms, the institutions will drive patients to you.

If you have a good reputation, Hey, listen, patient referrals are phenomenal. It’s been the bedrock of our industry, but again, we’re relying wishing in seven to 10% utilization with having predominantly relied on patients and word of mouth, we need to go beyond word of mouth and you can throw all the money and you want, unless you’re willing to own a network TV station where they’re, they’ve got a viewership of a hundred million people, or you could afford to advertise and take out a million dollar per minute out of the super bowl, you’re going to have some issues here, but reputation drives referrals. Now let’s look at how our reputation, uh, um, uh, we try to build on, we try to build our reputation on technique. We try to build it on technique. Aman Ajo adjuster. I’m an AK adjuster. I’m an ABC adjuster. I’m an EFG adjuster.

Um, I do AK. I, uh, come on. When you go to a surgeon, when’s the last time he said, listen, I’m the best surgeon because I used the double Trendelenburg triple Lindy technique of surgery. I mean, you know, no one says that they don’t talk about those things. The second you go into technique, you’ve lost. You’ve lost because you’re supposed to get people. Well, you’re supposed to be an expert. And if you don’t like your technique, change it. I am the only person on the planet earth that knows the best chiropractic technique. You ready here. It is. It’s the one that works best for you. That’s the best chiropractic technique. If you don’t like your results, learn something new, but don’t use that in building your reputation. Don’t use that in your marketing. Don’t use that when you communicate with collaborating physicians, because they don’t care.

You’re going to lower yourself to the, to the level of a technician. And that’s important. Here’s what else drives your reputation? You like that? The chiropractic bus stop bench. The in the mall, the, the, the, the posture analyzers, um, the cutesy advertisements with the dog sitting there paying gods you down the crooked Ben pens. You know what? It’s almost embarrassing, not almost it’s embarrassing. Let me tell you about my wife. She had cancer three times, three times, and she’s fine now, thankfully, but when I needed to find the right surgeon that I looked for a park bench, a posture analyzer in a mall, acute ad, or a Ben pen. No, I wanted the best of the best. So we’re in the New York area. So I went from Boston to New York, to Philadelphia, to Washington. And if you can’t find a good doctor in that region, you’re not going to find one anywhere.

And I went on to the U S news and world report. I went on and found that the doctors who were highly ranked, I went and I found their curriculum. VTA I found all of this information and what I did. I finally, I spoke to most of these doctors, I spoke to all that I interviewed, and I got them when I, and I found the right one. And it was in Columbia Presbyterian hospital in New York city. And I tried to get an appointment. They said, six months. I said, are you insane? Six months she’d be dead. So I had to play the game. Who do I know where, who do I know in the hospital? Who do I know in the department? Who do I know, who knows someone? It took me two weeks of who do I know? And I got her an appointment and he saved her life.

But what I did was I looked at the guy’s current credentials. I looked at his CV. I looked at all these things, and I ran after that doctor. And 2008 to 2012, it was a five-year period was my journey of helping my wife. And I was totally ensconced in that. But going through that, I kept saying, why don’t does not are our referral sources run after us the same way? Why? And the answer is what makes us special, where a president of our organization, the hell does that mean we’re a good politician. We’re popular what it means. Nothing. Why, why, why? And it always comes down to credentials, credentials, perception, and knowledge base. So what we did was is when we look at perception drives the reality and referral, and I’ve shared this, uh, I think Billy, I believe the last time I presented to there a time before, and it was about getting into a hospital, but it doesn’t matter.

So the doctor that I sent in dress for success, he went into a meeting with a group of chiropractors and a hospital administrators, uh, or it could have been surgeons. It could have been lawyers. It could have been anything. He went and bought an expensive suit. He dressed to the nines. He’s a doctor of chiropractic. He’s got additional qualifications in trauma, MRI, hospital, and primary spine. He’s got all the qualifications he needs. And as a result of that, he came up with a concise business strategy that benefited the recent referral source. It resolved their issues where his competition, which was other chiropractors. What I show you that picture, when you look at that picture on the screen, that’s not sarcasm. That’s how someone actually dressed someone dressed in shorts. You look like a clown act. Someone else came in scrubs that look and came out.

As my grandmother used to say, right out of a pig’s, it was so wrinkle. Isn’t Dr. Carper, I think. And I don’t denigrate that, that credential, but look at the credentials, look at the qualifications, the co he actually made his, um, competition irrelevant. And that’s the goal. And this Cairo had a strategy that benefited the chiropractor. So if you look at that top line, that is your reputation. All of these things are your reputation. And that’s critically important on paper. Let’s look at this doctor’s credentials. And by the way, this is a real CV from a chiropractor on the left. He’s got his name. His business address is education, high school, junior college, college forty-five hours, or pre chiropractic occupation. And then he went to the university, um, uh, chiropractic college. And he was a member of alpha beta Kappa. And I made these he’s a frat boy.

Okay. He’s licensed, which is fine to part one and two. And then his professional summary in my 25 years of experience, I like people and talking to them while caring for them. I bring in my experience as a husband and father and a faith based environment to help guide my patients through their care. That is a bunch of crap. It’s all nonsense. Okay. He gets into technique, upper cervical gods, that AK family status married with two children, affiliations church, um, a food bank, little league, um, girls club. Um, then it gets into hobbies. Let me tell you, you wouldn’t even get a job at a Walmart with this crap. It’s not a CV. It’s a resume on the right. If you look at Dr. Don CAPA ferry, look at his occupational history, okay. He is an adjunct postgraduate faculty member at Cleveland university. He is a clinic director and two different facilities.

Look at his education. Doctorate chiropractic, doctor chiropractic, um, his internship, uh, additional degrees look at his selective, uh, graduate educational, uh, certifications. The guy on the left. This is his CV or resume one page. Dr. Kappa ferries is 83 pages long literally of citations. Just as you see here, who would you want to work with? It’s your professional reputation on the left is a resume, which we should never have. This is your professional reputation folks equals referrals. You want to talk about utilization of every chiropractic and the, every chiropractor in the industry had a professional CV. It would be all OB the utilization would drop, would jump up at tech. And if you learn how to position it, use it, it can almost be game over. You’re making your competition irrelevant and your competition. Isn’t not just other chiros dressed in clown shorts, it’s orthos, neuros, and neurosurgeons.

That’s your competition folks. They’re being hurt in a myriad of environments financially. So they’re wanting to compete with you. And that’s important. Look at documentation on the left. And this is a real, I just did this about a month ago. I do compliance reviews with every doctor that I start with. That is the some parcel of the doctor’s evaluation on the left. And that’s his report on the left. It’s a joke. It’s a joke on the right is the first of an eight page report, which it has his diagnosis. Um, uh, the patient’s history. Yeah. Then you’ve got into subjective complaints. I mean, again, it goes off to family history, past medical history, um, a review of systems, all of those things are missing beyond committing insurance fraud, for billing, for elements not done. And that’s a whole different conversation, which we’re goat, which we do have, by the way, a documentation seminar coming up, which by the way is free.

And you can email me and I’ll get you that information. Um, think about the reputation. You’re going to be sending this out to an attorney, to a collaborating ortho, neuro neurosurgeon primary in the insurance companies. They’re going to look at this. You’re, you’re going to be bill six runs below that of a physical therapist, which is horrible, which is just horrible. You should be appear with the ortho neuro neurosurgeon. We’ll talk about that later, but your documentation is your professional reputation. And that folks not only is a legal and a fraud issue. It drives your referrals very important. You need to be up on those things. So how do you break in, how do you break into that 95%? Well, it’s real easy. And if you look at my logo and underneath, what does it say? Clinical excellence drives your success. And this is all about clinical excellence.

And by the way, you know, it’s funny, I’m looking at the, at the tagline on top ChiroSecure malpractice insurance. They don’t tell me what to say. I don’t ask them what to say. So whatever I want, but you know, who’s the happiest person right now is ChiroSecure. Because if you don’t want to get sued for malpractice, have good documentation, have good credentials practice within a standard. There’ll be thrilled. Them make more money, but you know, he’ll be even happier. You you’re going to sleep at night. You’re not going to have to go through, you know, the knock on the door, you know, with the, with, with the PR process server, serving you a claimant or a cause of action against you for malpractice, suing you for hurting someone for not practicing within your standard. All of those things per all of the credentials and documentation, everything protects you.

It’s your shield to everybody’s sword. And that’s important. Now the first thing we want to look at and the core of the problem with medical doctors, and you want to get, you want to break into that 95%. You have to tear into that nonspecific back pain. Dogma, dogma means a perpetuated non-truth based upon a false belief. And it’s all theory. Kairos going to hurt someone. You’re going to get a stroke. You’re going to get this. You’re going to get that. There are not, it’s not specific back pain. Why is it non-specific because the medical community, which I thoroughly respect and work with every single day, the medical community treats anatomical problems, fracture, tumor infection. Whereas chiropractors, we treat neuro biomechanical dysfunction. There is another name for that. It’s called Ricky with subluxation. I choose to call it neuro biomechanical dysfunction because it works with collaborating physicians.

It works for insurance companies. It works in a court of law. It gets you reimbursed. It builds your reputation, and it helps you get referrals and take care of people. You can never take care of before holding onto what is that old ball and chain dogma non-specific back pain. You have to make it very specific. Now, how do you get their attention? Well, your current patients and your reports help get their attention. We just discussed that your referrals and those reports back gets their attention recurring non-specific back pain patients when they don’t know what else to do, they end up in your office that gets their attention, your graduate medical education and credentials. Your CV gets their attention. You educating the medical community, gets their attention. And the medical community is frustrated because mid-levels have failed in case management, nurse practitioners and physician’s assistants in, in the world of spine have failed.

And what we do is we go out to the medical community and medical academia in conjunction with chiropractic academia. And you get credentials in that, through medical school. And in this case, I have the state university of New York at Buffalo Jacobs school of medicine and biomedical sciences get credentials in that we’ve credited relationships with them. We’ve cut our relationships with Cleveland university, Kansas city chiropractic, and in health sciences. We’ve Coker dental people because without the additional credentials, your second, that you’re a secondary technician below the, you know what, in the shoe of the physical therapist, according to your referral sources. And that’s important when we look at this and you’re going to educate and have a relationship with the collaborating physicians, you have to look at the month and the kid’s demonstrable, meaning you could show it, show and tell just like an elementary school show, Dell potential pain generators.

And we look at potential pain generators. You have to be able to show it because if you can’t, they’re not going to believe you. It’s all theory in theory goes back to dogma, which goes back to non-specific back pain. You’ve got spinal cord, fecal SAC. You’ve got, um, uh, recurrent meningeal nerve through the desk. You’ve got myeloma Malaysia, nerve root compression, Fossette and capsule, connective tissue pathology. You got all these things going on, which you can demonstrably show, and you must show them. And then what you must do is put it in a, in a, in a report or in a graph form where it’s all laid out. It’s all here in front of me. Here. It is because if you don’t lay it out and you’re not able to show it to them, here’s what occurs. And I’ve showed you this before, and I’m going to do it again.

It starts at number one, the physician writes a prescription for a number two drugs failed. Then you go to the ortho, neuro neurosurgeon, 92% are mechanic, or non-specific back pain. They’re not doing surgery. Then they send them to the PT. Number four, PT fails as the first provider is fine. There’s a 313% incident of increased secondary disability. If PT treats them first, then you know, they failed PT. They go back to the ortho or the primary, and they are back to their muscle relaxes steroids, painkillers, or opiates doesn’t work. And you know what happens? They start the cycle. They go back for a second, um, course of physical therapy or ortho. It goes a circle full number six in the middle of the final solution, pain management, legalized drug addiction. Cause they don’t know what to do. And that is failed. It’s a failed system, trillions of dollars a year being spent on a failed system because spinal related pain is the fifth most prevalent diagnosis in primary care or the emergency rooms.

And it goes in circles because no one can identify where the lesion is. Let’s identify non-specific back pain. This is a x-ray digitizing from a technology called SIM Virta and it’s a simple flection extension x-ray. And by the way, we discussed the last time about x-ray and, and, and creating wise decisions to take a, not to take. Let me just reiterate briefly. The literature is abundant with evidence that unless there is a hundred Millis serves of radiation and the Miller servers or radiological absorbable dose, and it’s all over the science, all it’s it’s everywhere, except perhaps with the American board of internal medicine in our organizations, unless you breach a hundred millimeters per incident because x-rays not cumulative. There has been no evidence, zero zip, zilch that x-ray is harmed people. In fact, there’s evidence that it helped people in creating, um, uh, other, uh, preventative issues, but let’s not get into that right now.

If you breach a hundred mil of serves between 100,000 and 1 million people, um, I believe it’s one in 100,000 to one in 1 million do have a side effects of radiation, a lumbar x-ray, which is the most radiation we do on an x-ray on a patient has eight millimeter or 6.2 millimeters, I believe 6.2. Um, so you divide 6.21 a hundred. How many x-rays is that? Well, you know, you just do the math, you know? No, are we taking, so let’s do a hundred doing a calculator on the side divided by 6.2. You’d have to take 16 lumbar x-rays to even get into the one in 100,000 to one of the million. We don’t do that. I don’t know anyone that takes 16 lumbar x-rays and it’s like 30 cervical x-rays we’re not doing that. So there is no possibility of hurting your patient. So if you do a simple flection extension and you’re looking for two things, bones that slide back and forth and bones that tilt forward and back you measure it in angles of degrees or millimeters on the left of that bar graph, you will see a green line, according to the evidence in the scientific literature, which has been out for over 20 years, that green line is the amount of millimeters that a vertebra has to slide in order for the ligament to be pathological, which then creates bone on nerve.

And yes, there’s bone on nerve. And I think I did that a few months ago. Bone on nerve is at the nociceptors it’s at the joint capsule, which feeds into the lateral horn, goes up the spinal thalamic track, hits the thalamus and pigpens off of five or six different disparate areas of the brain that goes, he apparently not necessarily the area of lesion, but the other parts to create homeostasis, which is a whole different conversation. The red line, which is on the right side of the graph is an impairment rating, which is an administrative determination, all duration of motion, segment integrity. And you can prorate it based upon the AMA guides, the evaluation, permanent Pam and fifth and sixth additions. So now you’re looking at, I’m sitting with a surgeon and say, listen, doc, there’s no fracture, tumor infection herniation. There is nothing for you to operate on.

You can send them to a physical therapist all day long to relax the muscles, put them in joint mobility. They’re going to have a 313% increase incident of disability. Here are your lesions. Look at C six or C5. Look at C five. Look how far out that goes. There is your neuropathic biomechanical lesion. And I have, I know how to manage this case. I work with not fix, not treat. I know how to manage this case. I am managing this case. I’ll do it in conjunction with you. I’ll send it back, but this is what we do. This is our wheelhouse. You know, those 92% that don’t need surgery right here is how we diagnose that. And it’s demonstrative and it show and tell. And this goes back to your reason. Number six of those six pain generators, which is Fossette injury, connective tissue pathology, your joint disorders, neuropathic, biomechanical dysfunction.

There’s also a problem at C two or three. We can manage that as well. We’ve got, it’s just easy. It’s in our wheelhouse. So this is show and tell. This is showing them what to do. Then we get into MRI and you’re dealing with surgeons. And according to spine journal in 2017, there is a 43.6% error rate in general, radiologists reporting this methodology, meaning they get it wrong. According to Dr. Peiser, who’s a Harvard trained neuroradiologist. He thinks general radiologists, get it wrong. 95%. I find an error rate of 85%. And Dr. Shadi, who’s a neurotrauma fellow neurosurgeon says, and I quote, he doesn’t even waste his time reading the report to the general radiologist. They get it wrong. Look at that right image in the yellow line. Let’s just circle that yellow line, just so you see on the right image. And if we look at that, look at the angle of the disc in the vertebra, can you see the front of that yellow line going through the vertebra?

It’s going through the inferior anterior portion of that vertebra. It shouldn’t touch the vertebra. That is your, that is your slice. It should only go through the disc, but because it’s angled through the vertebra as well, you’re being you’re, you’re, uh, obliterated or creating, um, a shadow of bone and you’re not able to see pathology, but radiologists are accepting this and you’re getting, you’re getting an error rate that it’s at best 43.6%. But in reality, between 80 and a hundred percent wrong, and myself and the doctors, I train on this and my doctors are MRI qualified trial qualified. Then I had to interpret image. We send that back to the radiologist, 99% of the time. You know what the radiologist says, oh my goodness, thank you so much. I miss that. I’m going to make an addendum almost all the time. They’re thanking us. If we look at an MRI, you see that red arrow on the left, that’s pointing to a huge extrusion, huge it’s superior.

And through your extrusion, if you go down four or five levels of look at the back of the vertebra, there’s nothing sticking out. It’s flat. This was erroneous leash report. It is a concentric bulge. This is pretty much a surgical lesion. So this is something you’re going to treat and not know if you look on the left at that light area, that’s a compression fracture that was erroneously reported as a disc osteophyte complex. It’s a compression fracture, and this is my favorite one coming up. You see those hours on the left, the vertebra, that’s an acute Schmorl’s node. It broke right through and a fracture, the implants. And then you’ve got a significant end plate spurring. All that was reported was employed spring. They missed the fracture of the vertebra, and you’re going to treat those cases. These cases don’t need to be treated. They need to be managed.

We need to know what’s going on because you’re under deliver a high velocity thrust into this patient and potentially damage the quarter of a quantity, potentially damaging different, not, not this one, but the spinal cord or the nerve root or increase the patient’s level of disability because you haven’t looked, you don’t know. And it’s erroneously reported by the radiological community. And the issue is, is when you look at this stuff and you’d go through this, you’re starting to now learn, or you appear, are you managing these cases? Or are you a technician talking technique treatment? You want to be a appear, start educating the MD primaries. I had someone yesterday called me up and said, doc, I just met with 50 MD primaries. The, you know, not one knows how to order an MRI properly. Do you know one doesn’t know anything about slice thickness or slice placement?

Do you know that don’t even know what motor changes are? I said, of course, I know that, you know, what’s even scarier the chiropractor. Who’s delivering a high velocity thrust knowingly that there was an 80 to 100% upwards of an 80% error or 80 to 100% error rate, delivering high velocity, thrust in clueless and talking only technique. Whether they’re dealing with surgeons, you’re on the right side of the equation. You’re subservient to, they’re laughing about you. They bring your reports into their meetings and banter them around. You’re the joke. And I mean that sincerely, this happens all the time. I have friends who are surgeons or those neuro nurse. I work with all they say, mark, how come they can’t be like you or the doctors you train. So you’ve got to become a peer. You got to educate them. You’ve got to get educated yourself and get into case management.

Now I’ve shared this with you before. I’m going to do it very briefly. How do you get there? How do you get every place I’m telling you? Well, you start in the left and the bottom of the base, you build an infrastructure. You’ve got to learn how to do documentation. You’ve got to learn all these things. Then you have to determine, and you’ve got to be compliant. Then you’ve got to work your way up and you’ve got to get credentials and you’ve got to get tools. Then you build your relationships and start getting your referral. You become a solution to a case. Why don’t you become the solution too many cases, you’re morphed over to the inverted pyramid and you become the solution for their practices. Then they start as a peer sending second opinions over to you, the handle, their tough cases. Then you start getting their easy cases and all their cases, and you’re teaching them and sharing literature.

Then you get exclusive referrals. Now they’re your advocate for inclusion into hospitals, urgent cares, emergency rooms, trial, or as associations game over folks for the rest of your career. It works like that. And it’s easy. But in order to get there, you’ve got to understand the literature and let’s look at the, the second one down. I quoted that twice regarding partial compensation, medical care required 20 times more than chiropractic and physical therapy, 313% more than, than chiropractic. So Puente’s reported that there’s a third, the third one, the 32% increase or decrease average weekly cost of medical expenses during disability with chiropractic versus physical therapy, I can go on and on and on. If you go to these two books called the science of chiropractic, which you can Um, the science of chiropractic one volume, one and two, all of this in there is hundreds and hundreds of evidence-based articles.

As I just shared with you, what’s all in there. It’s all in there. You go to, put my name. You can get it. Um, chiropractic colleges are starting to teach us. You’ve got to keep up with it. It’s all there. You don’t have to reinvent the wheel. Your business strategy is upside down. It starts with infrastructure credentials, and then get a strategy to communicate. That is the way to increase utilization in our profession. You need real. Prudentials in both chiropractic and medical academia. It’s not enough to have only chiropractic credentials and I’m not denigrating that, but you have to be considered a bit. Doc, where were you trained? You know, so much about MRI through the state university of New York at Buffalo school of medicine and biomedical sciences. Hey, if I’m talking to another Chiro, Cleveland university, Kansas city, that’s fine. But if I want to have a peer relationship with an MD, I’ve got to tell him I’m trained at a similar institution than they are because perception drives reality.

And then you get additional qualifications. We’ve got qualifying programs that are recognized through both medical and chiropractic academia. You get incredible credentials. Your CV is robust. Perception drives reality. And that’s the cake you want to learn this stuff. Call me up, go to the academy of We’ve got online programs that are free, um, academic courses that are free for a lot of free stuff. We have stuff that you pay for. We have the consulting program. Your journey started should start with the consulting side. I’m happy to do that with you. It’ll be my pleasure. Give me a call. I’ll share that with you. What does case management look like? Our average doctor gets 15 to 25 cases per month. No advertising, no marketing, just like that. Cancer surgeon with my wife, we went after them. Our average doctor’s take home. Pay goes up 61% after taxes, purely on clinical excellence folks on Dr. Mark student. And as always, it is my absolute pleasure to share this information. Increasing utilization in our profession is my passion. More people need to get onto chiropractic and off of drugs and that’s critically important. Um, our next presenter will be Janice Hughes. That’s coming up. Um, I urge you to go listen or watch. She’s just incredible. Again. I’d like to thank ChiroSecure for the opportunity, um, to present and share this on their platform. Thank you. And I’ll catch you next time.