20 Ways to Re-energize Your Practice, Part One

We all sometimes get bored or discouraged or set in our day-to-day patterns about our practice. It’s easy to rest on our laurels or be satisfied with the size and nature of our practice. But how many practitioners are really thrilled with the size of our practices and the actual work we are doing? If you can answer “I am!” to that question then read no further! If you’d like a little inspiration…here are some ideas you could implement right away to put a shine back on your practice and your mental attitude about it. Good Luck!

1. First, I think it’s important to remember that it’s rarely ever just one thing that we do that keeps us being successful forever. It’s the daily effort of working on our business instead of just working in our business that keeps it growing and continuing to be successful…sort of like a marriage!
2. The Tao Te Ching says, “wealth is the fruit of generosity.” That does not mean giving away your treatments or undercharging for your work. To me it means that we approach our work and our patients with a generosity of spirit and an open heart that our patients will resonate with and be drawn to. It means not being emotionally stingy. It may also mean making as much information as possible available to your patients. It may also mean tithing of your time in some way… such as donating a couple of days per month to a free clinic or volunteering in your community in some other way. What goes around comes around.
3. Have you ever attended a city council or county commissioner meeting and introduced yourself to all the players? Remember that political types have health problems, too, and they talk to lots of people every day.
4. Have you re-considered your front office procedures recently? How I your phone answered? (I hope you are not still answering it yourself all the time). Whoever is answering it, have you written down exactly how, at what speed, and with what tone of voice you want the phone to be answered? For example…have you ever called a company in our industry that you weren’t sure if you got the company you thought you called? You need to make sure that when anyone calls they are immediately
1. Sure of whom they called
2. Know that the person on the phone was happy to answer the phone
3. That the person will help them with whatever reason they called
4. The person or people who answer your phone are the voice of your business! Make sure that your customers will like what they hear. If that person is you, practice with a recording to see if you need to sound more “perky” or speak more slowly.

Finally, have you written specific scripts for your reception person for the four or five most common questions people ask. These are pretty universal questions and you can write out exactly what you want your staff to say in response. Ask them to memorize these simple sentences. If you are the answerer, have a script will help you sound professional and will also help you be clear about what you really want to do say about “how many treatments,” “how much it costs,” “will it hurt,” “can you take my insurance,” and can you treat my ___ (named condition or disease).”

5. If you don’t have any front desk help, what would it take for you to hire someone? I absolutely guarantee that you can make more money with someone to run your front desk that you can by doing it yourself. Think about this…if you pay someone $13-15 per hour, but you are charging $50-60-70 per treatment, would you rather pay yourself the $15 or the $60? There is even a list of 20 other things this person could be doing when the phone is not ringing in Points for Profit (my biz for acupracs book). And, if this person’s presence allowed you to treat 2 extra patients per day on average, you’d more than pay for their services, be able to give someone a job, and make your office more professional at the same time.
6. Create a niche market for yourself. Say you’ve been in practice for three years and you have found that you are attracting patients with diabetes. Why not really study this subject and specialize in it? It could be weight loss, skin care, post-surgery pain reduction, the list is relatively endless. So, as your practice fills, notice what you really enjoy treating. What conditions do you like to hear people say when they call for the first time? What do you fell successful with most of the time? Slowly start to focus your practice in that direction. Why?

It’s easier to get good at treating a few conditions than to get good at everything. Also, it’s easier to avoid burnout and stress when you know you are agood at something and can reliably reproduce patient improvement in a limited sphere of conditions. That type of confidence shows and your patients will fell it, too.

7. Under-promise and over-deliver. If you want your patients to become raving fans, you have to do something more than just a good acupuncture treatment. That seems unfair, doesn’t it? Just remember, a merely satisfied customer will not sing your praises the way a customer that you have given a “wow” experience will do. For example:
1. Do you write down and refer to little things they mentioned about their life the last time they cam to see you (the grandkid who just took the SAT exam, the promotion they were up for, the art show they just exhibited, etc.)
2. Do you always call them during the first 24 hours after the first treatment?
3. Do you send them clippings from articles you find about their condition?
4. Do you provide free hot water and tea in the waiting room?
5. Do you take the mental time to touch them with intentional love and care?
8. Join a club or organization where you ideal patients are members.
1. Do you want to treat sports enthusiasts, join a gym or an active country club with lots of tennis and golf players. Participate in tournaments and other activities these groups sponsor. Join an bicycling or runner club.
2. Do you want lots of well-heeled women patients? Join the Hospital Fundraising Committee, the AAUW, the local Women’s Club, the Breast Cancer 10K Run Steering Committee, you get the idea.
9. Volunteer your services one day per month at a local free clinic, homeless shelter, or other service agency. Everybody else who works there as well is a potential patient. This group may not fill your pocketbook really fast, but it will fill your heart and could become newsworthy at some point, as well as getting your name into the Social Service/Government worker grapevine.
10. Create an acupuncture specialists group, where each member agrees to refer patients to all the others for a specific specialty. Don’t worry about losing patients…it’s likely to work the other way round! Find out in your area who specializes in what and create an active referral base. The person who reaches out to start this type of group becomes and energy nexus around which qi will circulate!

So that’s part one of this blog. I’ll cover ten more re-energizing ideas in part two next week! Thanks for being a reader and I hope there’s at least one idea here that you can jump on today.

If you have other ideas for me to share to help everyone in our profession, send them to me at honora@bluepoppy.com. Thanks for reading and feel free to share my blog with friends!

Handling Difficult Communications with Patients

My friend and colleague Nancy Bilello wrote a book for us a number of years ago that I have always liked. We titled it, perhaps inauspiciously, Understanding the Difficult Patient. It is all about problematic patient communication, dealing with all those moments where you don't know how to handle a patient: when they are angry, non-compliant, needy, overly-familiar, seductive, don't show up or don't pay, or all the other weird moments that we hate as practitioners but which do happen. It's a wonderful book but it never got the attention we thought it deserved. We are now making it available as an ebook for a very reasonable price and here is the first chapter for those of you who actually have experienced these problems and know that any advice we can get for these is hugely helpful! difficult patient-chapter1.pdf

Please enjoy.

Shoulda, coulda, woulda...what records you REALLY need to keep on your patients!

by Honora Lee Wolfe

One of the things that many acupuncturists struggle with is what records they should keep on their patients and for how long. It’s actually quite a list and I can tell you that I think it's all a total pain in the ***, but has to be done! My first advice: digital record keeping may make this more automated, but either way create a system so that you always repeat these procedures the same way every time...it's less like to make you crazy that way, and more likely to actually get done for every patient!

Below I’ve written the basics of what you need, whether digital or hard copy. If anyone thinks of something that should be on this list, I hope you send it to me! I’ve given a short rationale for each of these, unless it’s so obvious as to not need explanation. If you use digital files, some of these instructions could change or be less relevant, which I will discuss as I go through these.

• The patient name should appear on all pages. While digital record-keepers could have the patients name connected with each relevant file, in paper files it’s best if the patient name is somewhere on each physical page. While there is no reason to think that you will mix up one chart with another…you never know. What if your moving guys were moving large file cabinet drawers and they dropped one?

• All pages in paper files secured into the treatment folder. It’s easy to purchase file folders with metal clasps or tabs that hold all the papers at the top of the file (Smeed Classic Fastener folders #14537). Both sides have the fasteners, so you can separate money/legal papers from treatment papers. Then, even if the clumsy moving guy drops the cabinet drawer, the papers are all secure inside!

• Organized chronologically (most recent date on top). This makes it easy for you to track what you did from one week to the next. This will be automatic with digital record keeping systems.

• Write legibly, be consistent, clear and concise. Easier said than done, but important. When your patient moves to New York and asks to have their chart sent to a new practitioner, it’s nice if you can be proud of what you are sending. Will what you have done and why you did it be clear and easy to understand?

• Maintain record in ink, use the same pen for each entry on the same day. This is important if your charts are ever subpoenaed in a legal case. If you are using only digital records, the software will know when entries were made.

• Do not alter the records, do not erase, use correction fluid, or use adhesive labels to cover up anything. If you made a mistake or need to make a correction, reference where it goes in the chart relevant to which date, and simply put it into the chart from where you are. Or, clip or staple a page onto the page that needs to be changed and reference the specifics.

• Fill in all blanks, do no skip lines or leave spaces, line through large blocks of space. In addition to conserving trees, which is certainly worthy enough, this rule keeps you or someone else from being able to go back and easily add erroneous information or change things in that day’s entries.

• Do not “squeeze in” notes and do not indent… same thing as above.

• Make additions and changes appropriately, on the page where you are, reference the page you want to change and why, or add a clipped note to the page that needs to be amended. In digital files, date any changes or additions to another day’s notes.
• Record all patient contact of every type
a. Missed appointments are documented
b. Telephone messages are documented
c. Entries dated, timed and initialed by you
d. Patient non-compliance is documented
e. Faxes, emails are documented

• Initial all externally generated reports (X-ray, lab, diagnostic, consultant) before filing them

• Dictation and correspondence and reports proofread, initialed by you before filing. Keep dated copies of any item that you send anywhere for or about a patient.

• Maintain a legend for any codes or abbreviations used. This list should be in your employee manual, or procedures manual, or kept somewhere that employees can reference it if necessary or copy it to be mailed with any records that have to be sent anywhere.

• Document the reason for the visit. This should be done every time the patient comes in, even if it is just a short visit to reconfirm a diagnosis or an acupuncture follow up visit with no further diagnostic assessments.

• Document any unusual events. If the patient does or says anything unusual or alarming, or if there is a strange interaction between a patient and any staff member, this should be in absolute detail in the chart notes.

• Avoid or explain contradictions. If something about what you wrote some other visit is for any reason no longer correct, explain why this happened. If you take a complete u-turn in your treatment modalities with a patient, explain why. If you did something that you now think was wrong, explain why and what you will now do about that.

• Clinical findings (positive/negative) documented and the problem or complaint list is kept current. Don’t leave out diagnostic details, but be as concise as possible.

• Treatment plan documented. This is both the short term (today) and long term (series of treatments) treatment plan. This can and will change throughout the overall course of treatment.

• Entries are objective; do not get personal beyond what’s necessary to write up the case and what you did about it.

• Never criticize other providers or their treatment methods. You will get patients who have seen other practitioners, including other AOM practitioners. You may not agree with what others have done with your patient. You must, to the best of your ability, leave that past behind and simply do what you think is right for the patient in the present moment. It is unprofessional to criticize other practitioners’ work, even if you think they are a total idiot.

• Properly identify the file, the record keeper (you or your employee), the techniques employed in the treatment, the table and/or room used and the channels and points treated. When the patient comes back a few days later and says, “that was a great treatment; can you do that again?” you do not want to be in the situation of not remembering what treatment you gave and then find that you did not write it down!

• Patient instructions are documented. If you know what you asked the patient to do as homework, there is an engaged discussion to be had with the patient that makes them feel that you are paying attention to their case. If you don’t write it down, you won’t remember what you told them, unless you only have three or four patients in your practice!

• Document any patient non-compliance. If they did not do the homework, take the herbs, change their diet, whatever, they should not be complaining that they don’t feel any better!

• Informed consent is in the chart. This is one of the fundamental legal documents that you must have in order to legally stick needles in patients (or do moxa, or do whatever)

• Be certain that the “Release of Records Authorization” form in the chart is correct and valid. If you need the patient’s records from a previous practitioner, this form is vital.

• Referral letters from other practitioners are kept in the file. If you keep digital records, scan the letter or copy the email and store it.

• Prescription list is in the chart, both Western and Chinese. If the patient is taking western meds, that list needs to be in their chart. Whatever herbals or supplements you recommend must also be kept up to date.

• Herb list is current, when due to refill, reactions or allergies, or positive results documented.

• Patient education materials given to patient is documented. If you give a patient a brochure, copy of research, a book or an article to read, keep a note of this in the chart.

• Keep financial and clinical information separate. In a digital record-keeping system, this is automatic. If you use paper records, the Smeed Classic Fastener file folders help you keep both sides of the chart (a. financial/legal and b. clinical) tidy and separate.

• Retain patient records forever because of the statue of limitations on malpractice cases is very, very long. If you have paper records, you may at some point want to scan them and keep them on a CD or in a back up system.

• Signature of the provider of services on each new treatment date in the chart. Each time the patient comes in, a new signature by you as treating practitioner or any acupuncturist-employee you hire to do treatments must be in the chart notes for the day you or they did the treatment. Every time.

Final thoughts

Customize the forms you use for your specific clinic and style of work. Your forms should probably not be a clone of anyone else’s…unless you think that form is already perfect for you or they are all digital files in any case!

I Repeat again!!!: Create a system for keeping your charts (whether paper or digital) that you always repeat the same way with each patient every day in clinic. Don’t vary this procedure once memorized. Teach your employees how to help you and where their participation is appropriate, legal, and vital; this ins another reason to hire a front desk staff person! You don't want to do all of this yourself.

The most important thing to remember about record keeping is this: if you did not document it, it never happened from a lawyer’s point of view.

Good luck!

Everything you could ever ask about acupuncture needles

Here's a lovely blog by Shawn Kirby of Blue Poppy...

How to Buy Acupuncture Needles

by Shawn Kirby L.Ac.

Buying acupuncture needles is a lot like going to a really great smorgasbord – there are a lot of choices but it’s not always easy to know what you want and/or need. This handy little guide is designed to help you easily find and order the type of needle you know and love, and might even inspire you to try something new.

Handle Type

People are often confused as to what the various differences are between one type of handle style and another. What are the advantages of a given style, and why are they like that in the first place?
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The first, and absolute best, way to choose the type of handle that you use in your acupuncture practice is to experiment with many different styles of handle and choose the one that feels best to you. No two people are alike, and everyone’s hand is different. Only you can truly determine what handle style will work best for you in your practice. That being said, there are a number of different styles of handles available on the market, each catering to certain styles and techniques.

Here's a link to the rest of this great article...

http://www.bluepoppy.com/blog/blogs/blog1.php/how-to-buy-acupuncture-needles

Borrowing $$ from family? Do it right!

It's common enough. Especially if you already have debt from student loans. You go to a well-off (or at least better-off!) family member to help you start your business. Still, you are likely to maintain healthy family relationships if you do this right and protect your family as much as you can if you ever had to default on the loan. Here are some tips to help you keep happy family relationships: 1. Don't think about borrowing from anyone until you have done a thorough business plan. Know exactly how much you need, what you need it for, and how you will market and grow your business to pay the loan back! If you aren't organized and grown up enough to do this work, you are not likely to be grown up enough to run a business in any case. 2. Establish the amount of the loan and terms of repayment in writing...with signatures. 3. Treat this loan the same as you would a bank loan. Make your payments in full and on time. 4. Keep you family updated about what is happening at your business. Send them regular reports in writing. That way, you don't have to discuss it during Thanksgiving dinner or other family gatherings! 5. If things go badly and you cannot make a payment, don't avoid the issue. Tell them immediately and request an extension. 6. If you think that you may have to default on the loan, don't avoid that issue either. Doesn't your family member deserve to know about your problems first? 7. Do a UCC Filing your loan as part of the initial establishment of the terms. (http://wiki.answers.com/Q/What_is_a_UCC-1_agreement) This gives your family member a better chance at getting their money if you have repayment problems or even go into default, and especially if you are also going to borrow some from a bank. http://secondwindconsultants.com/2010/04/26/if-you-borrow-money-from-your-family-you-need-to-do-it-right-for-reasons-you-are-not-even-considering/ 8. Don't even consider borrowing money from someone in your family who cannot afford to lose it. If this person can lose the money without causing financial hardship, you will sleep better, and so will they. So it's better NOT to borrow money from friends or family if you can avoid it. I have only done it once in my life and it worked out fine, but added a level of stress to the relationship that was undeniable until it was paid off. If you decide this is the only way you can get your business started or up to the next level, be sure you know what you are doing and why and what actions are going to allow you to grow enough to pay the money back.
Honora Wolfe writes and speaks on business and practice success at schools and conferences all over the world. Her upcoming classes include an all day workshop at the NEW England School of Acupuncture on March 20th, an Internet Marketing class for the AOBTA conference in Austin on April 7th, and a keynote speech on business success at the Acupuncture Society of NY on May 22nd.

When was the last time you called your inactive patients?

It's difficult to overemphasize the power of patient re-activation phone calls. It's way easier than cold calling (calling people who don't know you) and it's a tried and true method to get a positive response from the universe in growing your practice.

You don't need to have a huge agenda for the calls, but it may be easier if you write a few "scripts" for the calls. Here are some ideas for those:

1. For patients where you parted ways after treatment success: "I saw a recent article about your condition (which I'd be happy to email to you if you're interested) and it made me think of you. How are you doing? Still no more symptoms?" Then listen to the patient and see what they say. If they are still better, you have at least reminded them of your ongoing care for them as a patient. You might suggest a "tune-up" appointment or two at the next change of season to maintain their health.

2. For the patient that cancelled and disappeared: "I see you cancelled your last appointment and then we never heard from you after that. Can you tell me how you are doing? I was just wondering if you disappeared because you were feeling great, or was there something that did not work for you at our clinic...something that we could have done better?"

3. For the patient where their written contact information no longer works: "I'm calling for two reasons...one just to check in and see if you are still feeling improvement from your treatment through my clinic. Second, I see that your email address as changed. Did you still wish to be on our mailing list? We really hope so, but we need an updated email address!"

4. The patient where your interaction was OK, but you don't know why they stopped coming: "Hi Jane. It's been awhile since I saw you and I just wanted to say hello and see how you are. I know you had ...(you divorce finalization, our son's graduation, your mother's serious illness, your new job, whatever). I know that was stressful for you and I wondered how you are doing."

After each of these possible openers to the conversation, you then be quiet and see where the patient will take the conversation. If they haven't much to say, you can ask if they'd like to continue to receive your email newsletter; you can offer to send them a coupon for 1/2 off the next time they might want to come in for a visit; you can let them know about a new class you are teaching or a new skill you have acquired; you can tell them about a free lecture you are giving somewhere; you can remind them that regular tune-up treatments can keep them symptom free. Whatever feels appropriate.

After the call, you might follow up with a card or a personalized email and include a piece of research or an article on their condition if you can find one (check out our TCM Infoline here at Blue Poppy for lots of free research: see the search mechanism in the center at the top of our home page). If you send a regualr piece of snail mail (what a concept), include a copy of your biz card as well.

Does this take a little courage? You bet, but then if you were a wimp you probably would not be running your own business anyway. Plus, you don't know what fruit this will bear. For every ten phone calls you make, you will likely get one patient to make an appointment right away and another one to call back for an appointment within a few weeks, or to refer a friend since they have now been reminded about you and your services. Or perhaps one of them calls and asks if you will come and give a talk for their special group. You just don't know.

So don't abandon your inactive patients. Make it a monthly task to call six-or-eight-or-ten of them. The more you do, the eaiser they become (and what's the worst that could happen anyway?). It's easier to get your old patients back into your clinic than to develop new ones who have never been there before!

Honora Wolfe is the author of POints for Profit: The Essential Guide to Practice Success for Acupuncturists. She is teaching a class on biz and practice success at the New England School of Acupuncture on March 20th. Check it out here.http://www.nesa.edu/calendar/show_item/112

I Stole These 15 Marketing Ideas from Other Industries (and you should, too)

Do you read magazines or publications from other niches and industries? I find it very revealing and worth my time as a marketer to check out all kinds of ads, articles, and ideas from industries outside the world of Chinese medicine and then “cross-pollinate” the ideas in ways that make them relevant to improving the marketing plans for my company and my clients’ in private acupuncture practice. Try out some of these and see where your creativity may take you.

1. Use holidays to tie in with your promotional efforts. Go to www.holidays.net/index.htm or http://www.holidayfestival.com/ and look for lists of holidays or commemorations that may somehow be related to health. Can you write an article about any of those subjects, give a lecture, or create an event that will attract attention? Example: Feb 3rd (yesterday!) was Chinese New Year. It is a common tradition to give red envelopes containing money to family members and especially children. You might have a party at your clinic inviting all your patients. At your party, fill a basket with red envelopes, each one containing a coupon for something (A free treatment during February, a discounted series of treatments, a free bottle of herbs, whatever. On the back of each coupon put a Chinese proverb. Serve tea and fortune cookies!) You can spin this idea for any day, week or month of the year....National Breast Cancer Prevention Month to Mental Health Week. Check out Chase's Calendar of Events at your library for endless ideas about this.

2. Give your patients value-added information every time they come in. This might include bookmarks, pocket guides to dietary health, free books (buy in bulk for wholesale prices), a CD with a recent lecture you gave to some organization and have taped (CDs are not expensive to make), a small pocket guide to "Using Chinese Herbs to Enhance Your Diet". These ideas are endless. And don’t forget that everything going out your door should have your contact information on it, website, etc.

3. When contacting the media about covering your clinic, use odd times of the day. These people often work weird schedules, but the gatekeepers who work for them work regular 9-5 schedules. Thus, if you call at 7:30AM or PM, who knows who will answer and what access you may have?

4. Teach classes and workshops. Find any excuse or reason to teach for anyone who will listen on any subject you are comfortable speaking about. The students in the classes will, more often than not, become your patients. Does your local YMCA or community college offer continuing ed classes? How about your church, PTA, large local corporations, or Better Business Bureau? Don’t be shy and make sure you have flyers, business cards, and brochures to give out.When you get a gig, also take along a sign-up sheet to receive your e-newsletter or blog.

5. If you get a speaking engagement, follow up with a Thank You card to the person who was your contact.

6. Have something really exciting to share? Contact every syndicated columnist in the US. You can purchase a list for $20 from Editor and Publisher. Contact subscription services at circulation@editorandpublisher.com, (888) 732-7323.

7. Start and maintain a support group. These may be other acupuncturists or other kinds of business people. Napolean Hill, in his famous book, Think & Grow Rich, calls this a “master mind” group. You can meet for breakfast once each month or each week. At each meeting, take on one or two people’s questions or problems and share your ideas for a solution. This is tremendously powerful!

8. Want to be a radio personality? If you’ve got something interesting to share, go to http://www.ontheradio.net/cities/boulder_co.aspx for a list of stations.

9. If you want to be an expert on a specific subject (improved sports performance, preventing anorexia, treating or preventing fibromyalgia, go to your local/regional paper and TV station websites and find the names of relevant editors (health, special features, modern living, etc.) and send them a short, to the point email message. Keep it to three paragraphs and use powerful words and sentences to get across your message. If possible, reference or tie to a previous story that this journalist has written or covered.....and never use attachments. Give them the guts of what you have to say in a sound bite. Deliver it in a way that makes their job easier and who knows, you might become their main contact for alternative health for years to come.

10. Create a affiliate program on your website to sell products you love. This is not a new article, but you can get started with affiliate marketing using Lisa Hanfiletti's information here: http://www.insights-for-acupuncturists.com/affiliate-information-for-acupuncturists.html

11. When there are no patients in your office, don’t sit and read clinical books, go out and meet people. Are you in a building with other offices? Does every other business in your building know who and where you are? If not, go introduce yourself and take your business cards. Walk every street in each direction for a mile or so and give out cards and brochures to all who will take them!

12. Are you Hispanic in origin and/or fluent in Spanish language? Find every Spanish language newsletter, paper, TV or radio station. Then try #9, 8, 4, 3, and 1 above....but do it with Spanish!

13. Use artwork for free. Check out http://www.aaaclipart.com. You can download over 30,000 free images. Brochures, business cards, flyers, signs, and more.

14. Have a great piece of artwork you’d like to share? Take it (and your contact information) to Kinko’s or a local printer and have posters made. Give away to your best patients. Make sure that a sticker with your phone and email are on the back.

15. For women only.......does your town have a Women’s Networking Entrepreneurial Training resource? You can find out from the U.S. Small Business Administration in your area. They offer wonderful classes and networking opportunities in most metropolitan areas.

16. Cruise over to www.morenewpatients.com .....originally for Chiropractors, but has some great ideas no matter what services you offer to your patients.

17. Want to sell your practice? Get a free quote and selling ideas from Professional Practice Specialists, Inc. www.practicesales.com 800-645-7590.

18. Want to create beautiful window signage? Contact www.grafia.com or 800.767.5609 for eye-catching window decals, banners, light boxes, sidewalk and interior signage.

Ok, so that was more than 15. I got carried away looking at ideas from other publications and websites while writing this article. I encourage you to look at every publication you can with a “marketing eye” and steal ideas from everywhere. You’ll be surprised at how your creativity is sparked by other industries’ solutions to marketing problems. Pick one of these 18 ideas and just do it....see how the added qi makes your practice grow!

Good luck!

Honora Wolfe is the co-author of Points for Profit: The Essential Guide to Practice Success for Acupuncturists, available from Blue Poppy Press at www.bluepoppy.com. She is teaching an upcoming one day biz class at the New England School of Acupuncture, March 20, 2011.