Chiropractic

Nicole L. Ingrando, DC - May 7, 2020

An Epic Solution for a World in Crisis

• The Spine Pain & Disability World Crisis

• Current State of Spine Care

• Chiropractic Core Competency

• Communication Tools

• Promoting our Practice: Overcoming the Fear

Outline.

Bureau of Ocean Energy Management

“Ocean waves contain tremendous energy potential.”

The Spine Pain & Disability World CrisisUnderstand the storm to find the monster waves.

Core Competency Results Driven

Patient Centered

Outcome Motivated

Low Cost

Core CompetencyA defining capability or advantage that distinguishes an enterprise from its competitors.

• Remember our advantages. • What’s the difference between riding the wave and it destroying you? • Spine Pain is an Epidemic, it’s the STORM • Someone will ride this wave. The Chiropractic Profession is the most conditioned to do it right. • COVID moved in, but PAIN didn’t move out. • Already had a tremendous opportunity, it’s even better now. • Let’s explore the pain storm!

US Health Care Crisis• “ It is widely recognized that the dramatic increase in health care costs in the

United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care.”

Murphy DR et al. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States. Chiropr Man Therap. 2011;19(1):17.

US Health Care Crisis• “ In no area of medicine is this more true than in the area of spine related

disorders (SRD’s).”

Murphy DR et al. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States. Chiropr Man Therap. 2011;19(1):17.

Back pain: how to live with one of the world’s biggest health problemsThe most common cause of disability is a condition as old as time itself. But is the industry that has built up around scans, injections and opioids a waste of time?

Spinal-Related Disorders (SRD’s)• SRD’s Defined

• Back Pain

• Neck Pain

• Many types of Headaches

• Radiculopathy

• Other symptoms directly related to the spine

Murphy DR et al. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States. Chiropr Man Therap. 2011;19(1):17.

SRD Stats• CAM Defines

• Chiropractic

• Massage Therapy

• Acupuncture

• Herbal Supplements

• Yoga/Meditation

Paskowski, Ian et al.  A hospital-based standardized spine care pathway: report of a multidisciplinary, evidence-based process.  Journal of Manipulative and Physiological Therapeutics.  2011; 34(1):98-106.

SRD Stats• 85% of these individuals seek care from some type of health care professional

• LBP is the most common condition for which US adults seek complementary and alternative medical (CAM) treatment

Paskowski, Ian et al.  A hospital-based standardized spine care pathway: report of a multidisciplinary, evidence-based process.  Journal of Manipulative and Physiological Therapeutics.  2011; 34(1):98-106.

The Burden of SRD’s Problem Is Worsening

• Patients with back pain incur 73% higher health care costs than those without back pain related complaints (2)

• Majority of this cost is related to improper management of LBP: (3)

• Endless office visits for the same complaint.

• Office visits should result in patient relief, proper patient referral/imaging or positive clinical progression.

• Between 1997 and 2005, expenditures for neck and back pain rose 65%

• Measures of mental health, physical functioning and work, school and social activity among patients with SRD’s declined

Paskowski, Ian et al.  A hospital-based standardized spine care pathway: report of a multidisciplinary, evidence-based process.  Journal of Manipulative and Physiological Therapeutics.  2011; 34(1):98-106.

Low Back Pain• LBP is the most common reason for symptomatic physician visits [1-3]

• Increasing the number of of SRD patients seeing PCP’s will serve to further exacerbate the problem of under-availability [4]

1. Wolsko PM, Eisenberg DM, Davis RB, Kessler R, Phillips RS: Patterns and perceptions of care for treatment of back and neck pain: results of a national survey. Spine (Phila Pa 1976) 2003, 28(3):292-297. discussion 298

2. Hart LG, Deyo RA, Cherkin DC: Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey.Spine (Phila Pa 1976) 1995, 20(1):11-19.3. Deyo RA, Mirza SK, Martin BI: Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002.Spine (Phila Pa 1976) 2006, 31(23):2724-2727.4. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States, Donald R. Murphy. Chiropractic and Manual Therapies 2011, 19:17

Costs of Low Back Pain Wave of Financial Crisis

Supply Sensitive Care

Demand Sensitive Care

1. NIH: Na)onal Center for Complementary and Alterna)ve Medicine. Low back pain and CAM: May 2009 newsleCer. Available from hCp://nccam.nih.gov/news/newsleCer/2009_ may/backpain.htm.

2. Mar)n BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, Sullivan SD. Expenditures and health status among adults with back and neck problems. JAMA 2008;299: 656-64.3. Deyo RA, Mirza SK, Turner JA, Mar)n BI. Overtrea)ng chronic back pain: )me to back off? J Am Board Fam Med 2009;22:62-8.

Trouble with the current clinical approach.“Supermarket of Spine-Care Services” (1)

1. Haldeman S, Dagenais S. A supermarket approach to the evidence-informed management of chronic low back pain. Spine J 2008;8:1-7. 2. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States, Donald R. Murphy. Chiropractic

and Manual Therapies 2011, 19:17

The Current State of Spine CareUnderstand Needs First - PNA

Patient with spine pain

Primary Care Physician

Physical Therapy/Medication

Primary Care Physician

Orthopedist

Physical Therapy or PCP

Patient with spine pain

Orthopedist

Physiatrist

Physical Therapy

Solution for Spine PainWhen needs are understood, opportunities flourish.

• Needs Based Analysis

• Formal process that focuses on the other person.

• Similar to a history and exam!

• Companies beta test, all we need is common sense.

• What does a patient need?

Our Patients.

Patient Needs

• What Do People Want from Their Health Care? A Qualitative Study. Leana S. Wen | Jun 25, 2015

Conclusions What people want from their health care?

It relates to the core of the doctor-patient relationship.

Conclusions What do patients need from doctors?

Doctors!

Need to listen, to care and be compassionate, and to be transparent and open with patients

Need to be accessible, practice in interdisciplinary teams, and demonstrate that they have patients’ best interests at heart

Innovations that aim for patient-centeredness should encourage doctors to practice medicine in the way that patients need

“We hope future studies will make use of our methodology to ensure that patients — people — are at the center of caring partnerships that prioritize dignity and respect.”

• We can communicate with them more.

• Demonstrate where we fit.

• Position ourselves as the solution.

• Habit = Patients are triaged to the Chiropractors FIRST.

• Exponential power potential in positioning ourselves as a solution.

How can chiropractors help the healthcare system?

Core Competency

I asked our referral partners…Why do you refer to our office?

Physicians Assistant - National Pain Institute, Lake Mary, Florida

“The referral offers practical solutions for patients that doesn’t solely rely on manipulation. There is a multifaceted approach to patient care that includes the patient to encourage them to “buy into” the treatment. The other thing I like is consistently re-assessing progress and if goals aren’t being met, changing therapy or looking for a reason that they may need to see someone else. I want my patients to need less medicine.”

Communication Tools

* Patient Narratives & Results * Newsletters* Thank You Cards* COVID Phone Calls* Appropriate office visits

** Clever grassroots lunch tips - restaurants need you more than ever. Consider having lunch delivered with a narrative.

Communication Threats

* Misunderstanding

* Lack of Understanding * Lack of Persistence* Fear

Objection Resistance (How to push back.)

The ability not to be affected by something, especially adversely. Marriott’s advice in creating competition.

J. Willard Marriott

“Good timber does not grow with ease. The stronger the wind, the stronger the trees.”

• Change the way we view objections.

• Increase our focus on patient needs.

• Reflect on patient results and intake histories to share.

• Identify other popular doctors practicing in the area.

• Build Strategic Partnerships (Especially for students.)

• Host Fundraisers (Seniors First)

• Enjoy Riding the Wave (Winning feels fantastic!)

• Objections are a pre-requisite..let’s explore

“Claims to cure everything caused my patients to panic when they ran out of

money and still felt their pain.” DM

“Failure to diagnose.” NR

“Lack of demonstrated results. I need to send patients out for care that works.” JS

“I tell my patients that you won’t crack their necks or make them come back

forever.” JC

North Orlando Spine CenterPost COVID Traffic Statistics

• Uncertainty in our “necessity” and “essential” posture.

• Conflicting Guidance (You’re not alone.)

• Chiropractic message hasn’t changed - Be The Solution

• How did our patients needs change? Traffic became more essential every week - CEO, surgeons, people trying to walk.

• How did the needs of our referral partners change? (Waves are flat…)

North Orlando Spine CenterPost COVID Traffic Statistics

• NP Traffic Shifted

• Units of Traffic Weekly Shifted

• Week one by 39%

• Week two by 33%

• Week three by 23%

• Week four by 19.8%

• Week five by 19.2% (NP traffic rose.)

In ClosingJump on this wave.

Chiropractors are losing market share (closing) and the market share is GROWING.

If you weren’t branding yourself as a pain solution, now is the time.