today’s successful chiropractor - wca · 8/30/2019 1 today’s successful chiropractor: expert...

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Today’s Successful Chiropractor:

Expert Clinician and CEODr. Jay Greenstein

Thank You!

Subject Line: “Dr. Jay’s Docs”

[email protected]

For a FULL copy of my notesand ALL Resources from both talks

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1. THE MACRO ENVIRONMENT:HEALTHCARE CRISIS

2. THE MICRO ENVIRONMENT: YOUR PRACTICE

3. WHAT’S NEXT: & TECH

4. LEADERSHIP LESSONS FROM BJ PALMER…AND MORE

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• Implement EVIDENCE TOOLS to positively impact your practice– Research

– Patient / Provider Education

– Technology

– Leadership

1.THE MACRO ENVIRONMENT: CRISIS

What Hasn’t Changed in the Last 25 Years?

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The total direct and indirect cost of Low Back Pain in the US is upwards of $200,000,000

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New England Journal of Medicine study reports deaths from benzodiazepine overdose increased from 1135 to 8791 from 1999‐2015.

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CONCLUSIONS AND RELEVANCE: “Despite numerous published clinical guidelines, management of back pain has relied increasingly on guideline discordant care. Improvements in the management of spine‐related disease represent an area of potential cost savings for the health care system with the potential for improving the quality of care.”

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• “Six of the 13 included RCTs showed that NSAIDs are more effective than placebo regarding pain intensity. NSAIDs are slightly more effective than placebo regarding disability.

• However, the magnitude of the effects is small, and the level of evidence was low. When we only included RCTs at low risk of bias, differences in effect between NSAIDs and placebo were reduced.”

“The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.”

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http://www.palmer.edu/alumni/research‐publications/gallup‐report/

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Standard Medical Care alone

Standard Medical Care + Chiropractic SMT

Percent of Patients who rated their Global Improvement as pain completely gone, much better, or moderately better

17% 73%

Satisfaction with Care at 2 weeks

4.5 8.9

Satisfaction with CareAt 4 weeks

5.4 8.9

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Breakout #1

• Besides musculoskeletal health, what other areas of population health do we create positive impact?

• What level of scientific proof is there around those outcomes?

• How do we create impact at greater scale?

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Breakout #2

• Who else would be interested in cost data?

• What obstacles must we overcome in order to get to the right decision makers/gate keepers?

• What else can we do to effectively show our competitive advantage for cost effectiveness?

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Breakout #3• What key variables drive patient satisfaction?

• What are the barriers that patients face that decrease their satisfaction with a healthcare provider?

• What’s the one most important action a chiropractor can take to ensure patient satisfaction?

• What’s the difference between patient satisfaction and patient loyalty?

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SIDE NOTE

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Top Drivers of Patient Satisfaction

PRESS GANEY:1. How well staff worked together to care for you .792. Overall cheerfulness of the hospital .743. Response to concerns/complaints during your stay .684. Attention paid to the your personal and special needs .655. Staff sensitivity to inconvenience of hospitalization .656. How well nurses kept you informed .64

GALLUP:1. Staff worked together as a team .642. Nurses anticipated your needs .643. Staff responded with care and compassion .62

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2. THE MICRO ENVIRONMENT: YOUR PRACTICE

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[email protected]


PLAYBOOK = 6 P’s

• Patients

• Payers

• Providers

• Policy Makers

• Prevention

• Performance

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Pain Treatments Per week

1 2 3 4

Baseline 53 55 45 49

4 weeks 38 34 23 17

Percent Change 28% 38% 49% 65%

Disability Treatments Per week

1 2 3 4

Baseline 45 39 43 39

4 weeks 29 23 17 10

Percent Change 36% 41% 60% 74%

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Complicating FactorsWhich Drive the Need for Ongoing Care

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“I Don’t Believe In Chiropractic”

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• Recommendation 1:Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select non‐pharmacologic treatmentwith superficial heat, massage, acupuncture, or spinal manipulation. If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti‐inflammatory drugs or skeletal muscle relaxants. (Grade: strong recommendation)

• Recommendation 2:For patients with chronic low back pain, clinicians and patients should initially select non‐pharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness‐based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low‐level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation. (Grade: strong recommendation)

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“You’ve Convinced me!”

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PLAYBOOK = 6 P’s

• Patients

• Payers

• Providers

• Policy Makers

• Prevention

• Performance

Copyright Kaizenovation Lifestyle ©All rights reserved


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“Knowledge about effective

PREVENTION INTERVENTIONS

for musculoskeletal diseases is limited even as their contribution to chronic disability increases.”



“A health profession concerned with the diagnosis, treatment and

preventionof mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the

nervous system and general health.”

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“Patients suffering nonspecific work‐related LBP who received health services mostly or only from a chiropractor had a lower risk of recurrent disability than the risk of any

other provider type”



“MC was more effective than symptom-guided treatment in

reducing the total number of days over

52 weeks with bothersome non-specific LBP.”

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1. Establish the extent of injury (s)

2. Identify risk factors and

mechanisms of injury

3. Introduce preventative measures

4. Evaluate the effectiveness


1. Prevent or reduce the severity of injury

2. Change risk factors associated with the

injury mechanism

3. Total injury reduction


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[email protected]


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Clinical Compass 2018

UpdateA Year of Continued

CollaborationDr. Jay Greenstein

To improve patient outcomes by advancing evidence-based care.

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• Formed by COCSA in 1995

• Volunteer Board

• Main Work Products are Clinical Practice Guidelines, and more recently Best Practice Papers.• Research + Expert Field Doctor Opinion

• Delphi Process

• Gaps in the literature

• BPP’s Fill Those Gaps

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Strategic Plan

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Current Partners

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30 Days

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•50,000 Chiropractors•Treat 1 UHC Headache Patients Per Day•Average Reimbursement Example of $50 Per Diem•Five Days Per Week•52 weeks Per Year

$650,000,000

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Research = Access

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Cervical Spine Best Practices

Chiropractic’s Impact on

The Drug Crisis

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Whedon Study Part II

Hazard Ratios (CI) p-value

CT 1.57 (1.12 to 2.20) <0.0086MA 1.65 (1.57 to 1.73) <0.0001NH 1.98 (1.88 to 2.08) <0.0001

• All significant results• Similar hazard ratios, i.e. risk over time• Non-chiro users are 1.5 to 2 times as likely to fill a prescription for opioids during treatment for back pain.

Adjusted models coming soon…

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$100

100 Doctors = Fund Future Chiropractic Research Leaders

for the Next Three Years

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More $$$ -> More Research

-> More Impact

Thank You!

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How Do We As Leaders Move The Needle?

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#5?

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Kenneth Frazier

Moon Jae In

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www.yourleadershiplegacy.com/assessment/assessment.php

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“Courage and resolve; Strength of character”

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You have something you find enduringly fascinating

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You view frustrations as a necessary part of the process

You look for ways to make your work more meaningful

You believe you can change and grow

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Step one: Learn, learn, learn

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Step 2: Realize Hard work is the key

“The only place success comes before work is in the

dictionary.”

Step 3: Face Setbacks

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3 FACTORS LEAD TO BETTER PERFORMANCE & PERSONAL SATISFACTION…

AUTONOMYMASTERYPURPOSE

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Mastery – the urge to get better at stuff…

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To be the trusted leader in enriching the healthand well‐being of the public ‐ one life at a time.

To make the world a healthier, happier place.

IntegrityResourcefulnessPatient and Customer FocusTeamwork and LeadershipTechnical ExpertiseGrowthKaizenovation®

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Top Drivers of Patient Satisfaction

PRESS, GANEY:1. How well staff worked together to care for you .792. Overall cheerfulness of the hospital .743. Response to concerns/complaints during your stay .684. Attention paid to the your personal and special needs .655. Staff sensitivity to inconvenience of hospitalization .656. How well nurses kept you informed .64

GALLUP:1. Staff worked together as a team .642. Nurses anticipated your needs .643. Staff responded with care and compassion .62

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“First Who,Then What”

“Right People,Right Seat”

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99.99966% Good (6 Sigma)

20,000 lost articles of mail per hour

Unsafe drinking water for almost 15 minutes each day

5,000 incorrect surgical operations per week

Two short or long landings at most major airports each day

200,000 wrong drug prescriptions each year

No electricity for almost seven hours each month

Seven articles lost per hour

One unsafe minute every seven months

1.7 incorrect surgical operations per week

One short or long landing every five years

68 wrong prescriptions per year

One hour without electricity every 34 years

99% Good (2.8 Sigma)

Six Sigma – Practical Meaning

Healthcare Business• Service or Manufacturing Industry?

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Manufacturing!– Insurance Claims– Patient Outcomes &

Experiences

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Know Thyself

Convey Authority And Warmth

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Be Humble

Know The Power Of Feelings

…But Be ToughIn A Crisis

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Judge People By What They’re Good At

Know What Makes Employees Stay… And What Makes Them Leave

Culture Is What You Do, Not What You Say

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Managers Are About Processes, Leaders Are About People

Take a Risk Worth Taking

Serve the Greater Good and You Will Be Inscribed in the Book of

Life with Love

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• Implement EVIDENCE TOOLS to positively impact your practice– Research

– Patient / Provider Education

– Technology

– Leadership

today’s successful chiropractor - wca · 8/30/2019 1 today’s successful chiropractor: expert...

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