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April, 2012

Lab Work: Improve Your Patient's Confidence and Compliance

By George Birnbach, DC

Standard of care are the three words that constantly guide our profession toward safe practices, consistency and professionalism. Standard of care provides a relief from fear over how patients may be treated by any member of our profession in any office anywhere in the country. In the professional world of chiropractic, medicine, clinical nutrition and basic patient management, the evaluation of lab studies whether radiological, hematological or otherwise are an accepted standard of care in the evaluation process.

Practicing chiropractors understand that the key to effective programs is first identifying the best starting point. This is a culmination of both subjective and objective examination procedures. If the key to unlocking any case lies in the history, a proper lab examination is the flashlight to see markers for conditions or scenarios the patients themselves may not know are developing. Of course, at some point, we must address whether you believe lab work is a proper component of chiropractic practice. On one end of the spectrum are those who say we don't need to address symptoms, we don't even need x-ray examinations before adjusting so why would we ever order blood work. On the other end are those who believe that every patient needs a complete work up of thousands of dollars of labs every six months if we are to be at all professional.

Without attempting to befriend all involved in the argument, I will just take the position that lab work has proven itself very beneficial to my practices in helping to understand the underlying causes and barriers to healing that create chronic conditions. That is the clinical benefit. The management or business-oriented benefit is quite a bit more simple. By showing patients an objective "report card" of their health at the starting point of care, we can show a progression throughout the treatment plan. In simpler words: lab work improves patient retention and compliance.

The staff in our office is fully trained on all clinic systems, and since I travel the world teaching the fastest way to effectively train clinical staff to competency, I expect nothing less. In our clinics we have always followed the words of Dr. Noel Lloyd, "Shared goals leads to unity." Every member of our staff understands the systems we utilize and the reason we use them. Our staff are able to explain and confirm that patients understand how to complete their lab tests after they leave the office, whether they must go for a blood draw or complete a test kit at home and mail it.

The next question may be how do you train your staff to communicate your systems effectively. There is a simple and logical path to this, but it begins by first sharing your vision with your staff. One of the most satisfying exercises a clinic owner can perform is to write out why you do the work you do and why you implement the services you do, and then share it with your staff. Their ability to get behind you and support you begins with their ability to understand you and your thinking process.

In our office, there are no posters on the walls attempting to educate our clients. We stimulate conversation about nutrition, lab work, chiropractic and our other services using specific focused sources. We run lectures we wrote on a large flat screen television in the reception area along with movies that support our clinic's philosophy. This leads interested patients to question our clinicians about certain symptom patterns, conditions or techniques. We utilize a variety of labs for our evaluations, including LabCorp, Cyrex, Metametrix, Diagnostechs and others. Rarely in our office is the lab testing generic where we order the same tests for each patient. Our customized approach keeps lab fees down and patient relationships strong. We are constantly looking for ways to improve patient care while keeping the fees controlled.

We run lab work on virtually every patient and so we are often asked about the costs of utilizing lab work versus the potential profit that might be gained and this is a very important issue that needs to be addressed. Patients believe with good reason that any money paid to your clinic is income for the clinic. In the case of lab fees, this is rarely the case. The lab fees may be collected by you and yet paid directly to the lab facility. This is a confusing point for a patient, yet one we successfully negotiate daily.

Each state has different laws regarding how income collected from lab work can be charged and managed. In our home state of Washington, practitioners are not permitted to profit from lab work. In other words, the cost of the lab cannot be marked up. Our office receipts delineate the fees paid for lab work and also show the lab interpretation fee to be paid directly to the clinic. We charge a small, but fair, lab interpretation fee that may range from $15 to $50 depending on the extent of lab tests ordered. We base this fee on the amount of time we spend reviewing the lab results compared to our calculated hourly fee.

In other states and with other practitioners I speak to, they choose to charge a one-time case management fee that will account for all lab interpretation fees for the life of the patient's care program. This fee, usually in the range of $500, would allow for the office to avoid the smaller fees and instead have a general fee that the office and the patient are comfortable with. If you average 15 new clients a month, this $500 case management fee would equate to $7000 per month in administrative fees for the practice.

We generate six referrals per week and have a seven week waiting list for new patients appointments. In clinical nutrition and chiropractic, the proper use of lab work allows for the recommendation of certain supplement programs, treatment protocols and care programs that have good profitability for the clinic. It also elevates the professional nature of the work and justifies a professional fee structure. To again quote Dr. Lloyd of Five Star Management in Seattle, "Our professional lives would be greatly enhanced by focusing on just three objectives: have more fun in practice, help more people and allow yourself to be more successful in the process." This a wonderful road map to follow. Understanding and implementing lab work will accelerate your progress.


Dr. George Birnbach is the senior clinic director of Designed Clinical Nutrition in Redmond, WA and is also a senior consultant of FIVE STAR Chiropractic management and Clinical Nutrition Management in Seattle, WA. Dr. Birnbach, along with his wife, Dr. Jeannette Birnbach have owned and operated 4 successful clinics throughout the United States.

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