UNSTUCK

R.J. Hammett, DC

The old axiom is true; if you’re digging a hole in the wrong direction, stop digging!! Having practiced from 1980 to present, I’ve seen at least two financial/economic recessions. Both had similar psychological effects on the public and in Chiropractors’ practices. First, the sky was falling. Second, what do I do now?

In a minimal study of both national and state associations, chiropractors’ incomes and patient volumes are down 25% to 35% across the country. Fortunately, not everyone has decided to participate in this down turn. It’s all about your focus and where your head is at and not what’s going on outside. Don’t get me wrong, the economy does affect your practice and life, but your job is to adapt to the environment, much like an adjustment allows the body to adapt to its environment. It’s curious that I have friends who practice in the worst depressed cities in the country helping 60 to 80 new patients a month. I have friends who are laying off staff, working longer hours, and seeing 5 to 6 new patients a month in relatively sound economic cities. The difference is their perception of what and who is their focus.

Today, right now, look at your attitude, your staff’s. What are you focused on? Old Dr. Gonstead used to say, “I have one patient that’s before me right now, not the one hundred plus waiting in the reception room.” That’s exactly where your head must be at. What can I do for this patient, right now, right here?

Here’s your exercise for 2010:

1. Only focus on what you can fix, not what you can’t.

2. Look to your patients for answers to growth in your practice. It is your hours? Your fees? Your staff? Your attitude? Your treatment? Whatever they tell you to do, do it.

3. Forget yesterday, last year, or anything from your past…you can’t go forward until you let go of the past.

4. Clean up your home, your clinic. Clean up anything you are not using. Get simple, get free.

5. Do something you’ve never done before, especially something you are afraid of.

6. Write down your goals and get pictures of them. Look at them daily.

7. Get rid of negative friends, peers, or anyone who doesn’t add to the quality of your life.

8. Be grateful that people trust in your ability to help them become healthy. It is, after all, a privilege to help others, no an obligation.

9. Get real with people. Tell them the truth of chiropractic. Quit being a pseudo-medical wimp. Quit buying and using practice gimmicks.

10. Have fun, laugh more, and live more. Remember, you can’t get out of life alive, so act like it.

11. Fear nothing.

Till Next Time…

Pre-Existing Injuries and Why They Increase the Value of an Injury Claim!

Matthew D. Powell,
Board Certified Civil Trial Attorney - Florida
Matthew Powell is a board certified civil trial lawyer in Tampa, Florida, who started his career representing over 20 insurance companies. After learning the defense side, he quickly found he could not represent insurance companies and started out on his own to represent injured victims. He is a frequent speaker and instructor, teaching lawyers and chiropractors how to sharpen their skills in trying low-speed rear-end car collision cases. He has had the honor of obtaining $1,000,000 verdicts for his clients. He can be reached at matt@EPTInjuryLaw.com.

INTRODUCTION
An all too common problem is the patient with pre-existing conditions or injuries who comes to you for care after a car crash. You may ask, how should this be handled? Very often I hear lawyers and doctors try to ignore, forget, or bury the prior injury or condition. This is a recipe for disaster. By down-playing the pre-existing condition, it will destroy the patient’s credibility with a jury and the insurance adjuster. Omitting or down-playing the pre-existing condition also makes the doctor look really bad on the stand and results in a win for the defense team. The defense will know about every prior insurance claim thanks to Insurance Office Service, Inc., which for $25.00 will provide a full report of any and all insurance claims in their massive data base. The good news is that the law is generally quite helpful for the patient who suffers from a pre-existing condition.

The law basically says:
“If the patient’s injury (from the new car crash) resulted from an aggravation of an existing injury or disease (such as degenerative changes), the jury should attempt to determine what portion of the patient’s condition was caused by the car crash. If the jury cannot determine what new damages were caused by the crash, then the jury is told to award damages for the entire condition.”

So the good news is that a pre-existing condition does not hurt the patient’s claim. In my opinion, it makes it easier to explain to a jury why it does not take as much trauma to injure my client considering they were already suffering from the pre-existing disease or condition. So this really helps with the causation issue in a low speed crash. Juries get it that the recent car crash is really the straw that broke the camel’s back.

Once the jury understands that the crash caused the bigger problem, they have a hard job separating the new injuries from the old ones. If they can’t clearly separate the old injuries from the new ones, then they should award damages for everything.

As a practical matter, you have to really educate your patients about why a pre-existing condition can help their case. If they understand the implications of the pre-existing condition to the value of their injury case, they will give you a better history. They won’t be tempted to forget about their old problems in hopes it will help their case.

At trial, when my client has pre-existing injuries, I always bring this out early so that everyone knows we are not trying to down-play them. When I call my client to the witness stand, I will ask them a line of questions about how did they feel five minutes before the crash? Was their old neck injury bothering them at that time? How about one hour before? How about one day before the crash? When did it last bother you before this crash? “Oh, I was doing very well for about ____ months. Then I will ask, how did it feel after the crash? “Oh, it was terrible, it was like 3 times worse than it had ever been before.”

Then, when I call my doctor to the stand, we talk about how my client was damaged goods before this crash due to the pre-existing conditions, and why they have been hurt more easily by the crash and why the injury is more serious than someone who did not have these pre-existing conditions.

If we are lucky enough to have digital motion X-rays taken before the car crash, then I request a second digital motion X-ray taken after the crash to compare the studies. With the PostureRay’s (from PostureCo www.postureco.com) help, we can make great objective comparisons between the two studies. The PostureRay allows us to accurately show how much more the pre-existing condition has been made worse due to the crash.

SUMMARY
Don’t be shy about pre-existing conditions. Embrace them for what they are, often times, you can ethically use them to increase the value of your patient’s legal claim, not reduce it.

Chiropractic BioPhysics, Instability Ligament Laxity, PostureRay, whiplash, x-ray digitization software, Digital Motion X-Ray DMX

PostureRay®: You’ve Got X-rays, We’ve Got Analysis!

Joseph Ferrantelli, DC

Chief of Technology CBP Seminars

Private Practice New Port Richey, FL

PostureCo has continued to make strides in their delivery of the state of the art x-ray system known as PostureRay. This software package allows for chiropractic technique x-ray line drawing with biomechanical assessment, objective documentation, and patient education. Once the x-rays are analyzed, the doctor can generate:

• Impression reports;

• Education reports;

• Comparative reports; and

• Allows the Doctor to utilize a digital view box with telestrator functionality.

The CBP® technology synthesized into the PostureRay system makes it a snap for your staff to aid in processing of the x-rays; which allows the doctor to remain patient centered allowing more time for actual treatment - all the while serving their patients with the latest in technology. The PostureRay system has added more views and more features within the program to better fit the demands of today’s practicing chiropractor. Adding to the basic standard analysis, we now provide these following views:

1. AP and lateral cervical;

2. AP and lateral thoracic;

3. AP and lateral lumbar;

4. Lateral full spine;

5. Now coming in the next update will be Anatomical Short Leg Analysis; and

6. Future releases will include the Open Mouth Cervical view with lateral bending views.

FIGURE 1: Above is a portion of the new AP Modified Ferguson View, and assessment.

Having this feature saves a CBP chiropractor from the tedious line drawing methods for objective true anatomical leg length and sacral unleveling while accounting for anomalies and for magnification distortion(Figure 1). This will allow the doctor to prescribe the proper height of shoe/ heel lift with certainty. Our Development Team is continually upgrading our system to address the diversity in chiropractors’ needs which means that PostureRay will be adding additional abilities to measure utilizing other prominent chiropractic techniques in the near future.

In PostureRay fashion, a patient gets their unique analysis of their own x-rays to take home with them in easy to understand terms – with their x-ray pictures, not just stock photos. For obvious reasons, this has been reported as having beneficial impact on doctor’s practices for educating the patient’s family and friends – stimulating referrals! Often times questions are fielded on what formats the system can utilize. PostureRay is a retrieval tool that looks into any dicom root folder to import the dicom images. Yes, the system is

able to read from DR, CR and PACS systems plus we are also able to read Dicom from outsourced vendors or hospitals that burn on CDs. Best of all, most doctors do not yet have digital systems, so YES, using our unique calibration tools you are also able to take pictures from your digital camera and import the jpg images into PostureRay for analysis. Additionally, a Digital Motion X-ray (DMX) import feature is also available to allow a doctor to easily capture an x-ray image directly from the finalized digital motion x-ray DVD.

It is clear and simple: PostureRay helps you serve your patients better in a consistent, evidence based manner all the while protecting your practice with objective x-ray documentation. With the patient’s explanation of findings report, the patients now understand what is wrong with them and why they need chiropractic care. Remember, the true value is the system’s capacity to compare x-rays with previous studies. Before and after treatment x-rays are one of the best tools to show objective patient progress, and monitor objective changes in spinal subluxations, showing not only percentage differences from established normals, but also showing segmental and global percentage changes from the pre to post x-ray evaluation.

For more info., contact PostureCo at sales@postureco.com or visit www.postureco.com AJCC

Chiropractic BioPhysics, PostureRay, PostureRay, x-ray digitization software, x-ray digitization software, x-ray digitization software

PostureRay®, Case Series, and Case Studies

In February, CBP® Researchers traveled to Huntsville Alabama to digitize more than 150 x-rays. Dr. Deed Harrison, Dr. Joe Ferrantelli, and Dr. Don Meyer met with Tad Janik, PhD, MSE to measure the reliability and concurrent validity of the PostureRay® system compared to CBP’s validated x-ray digitizer. At the same time, they digitized a Case Series of Dr. Meyer.

In the near future, several Case Studies are planned for x-ray information from the digitizer and PostureRay® system. The PostureRay® systems utilize code from the CBP® x-ray digitizer within a report of finding setting.

Chiropractic BioPhysics, PostureRay, x-ray digitization software

PostureRay®: Building your practice through objective data!

Many times when either answering emails through our website or when at seminars, doctors question us on how we have used technology to aid in building and sustaining a thriving practice. For chiropractors who understand the need for x-rays and especially CBP® Doctors; x-rays do the talking when it comes to patient care, education and retention.

In the early years of CBP®, we were taught to give patients a “New Patient Report Package” which is like what many of you do every day.

The difference is that instead of simply using “tear off sheets” which though helpful – are generic, especially that you have to hand write on them which is unfortunately less professional, custom or specific to the patient. With x-rays, it was always challenging to make something patients would understand, and also objective and comprehensive enough that if they were shown to another doctor would be objective, concise, and in lay terms.

Before PostureRay®, we had a word document template and then would take digital pictures of the x-rays, insert them manually (of course painstakingly resizing, cropping and editing each image prior to importing into the word file), then edit the text for the patient as well as their pertinent subluxation findings and deviations from normal (i.e. Percentage the patient was from our normal model).

A new patient report handout is nothing new; Dr. Don Harrison trained us all to give this to all new patients. The difference now is to incorporate patient’s x-rays and have the reports that are very professional. The old manual way, each report would take at least half an hour to make, not to mention that we actually had to measure the subluxations by hand and calculate deviation percentages ourselves!

On follow up reports, we had to do the same thing, showing the patient’s pre and post x-rays, without the capacity to actually compare digitized numbers – again having to calculate everything and measure everything by hand.

The manual way works very well until an office gets busy, and you soon realize you have to dedicate a CA to make all new patient packets, taking them away from actually aiding in more critical office and patient procedures.

Now fast forward to today. Using the PostureRay® system, all x-rays are easily digitized, and the time to perform this task is mere minutes! Once digitized, any variety of reports can be generated, not to mention those comparison reports that took so much time at the resolution of a program of care.

Educating the patient at the time of the patient’s report of findings is necessary and should be common as nearly every chiropractor does this to some magnitude in his/her office.

Here are three tips for better exposure of your office using PostureRay®.

1. Place clinical x-ray reports in the x-ray jackets every time a patient checks his/her x-rays out of the office to go to a general practitioner, physiatrist, or surgeon. This should be done every time! Soon, the local doctors in your area begin to understand why you are on top of patient care due to the detailed nature of Posture Ray’s Impression reports, not to mention when comparison reports are placed in the jackets. Doing just this task has increased medical referrals back to our offices, and opened lines of communication with many top doctors in our local areas.
2. Another tip is to always find out the patient’s primary doctor and send him/her your initial reports with, of course, the PostureRay® Impression reports — regardless if the doctor ‘actually’ referred him/her to your office or not. You would be surprised on how many primary doctors begin referring patients, when they along with their staff realize that chiropractors such as yourself actually perform quality patient care and documentation.
3. For those doctors who care for patients involved in motor vehicle crashes or work-related injuries, here is a very easy tip: Find attorneys in your area and demonstrate how subtle ligamentous injuries such as instability can clearly and objectively be documented using the technology of PostureRay®. If attorneys know that your notes are bullet proof, and you have x-ray images that clearly demonstrate injuries, they will be more likely to refer to your practice.

It is common that many PostureRay® equipped offices report that attorneys actually ask to have the marked images exported by their office for them to use in the mediations as well as at trial. Of course, once the x-rays are digitized, generating reports, comparative reports (pre-post care or following injuries, Figure 1 & Figure 2), exporting marked x-ray images with normal spinal models superimposed is a snap to perform!

So if you are ready to take the next step in letting your x-rays market your practice, consider becoming more objective in your x-ray documentation on every case regardless if they are personal injury, cash, or Medicare, because not only does using PostureRay® save you precious time, it also makes your practice that much more marketable and bullet proof.

For more information on PostureRay®, please email sales@postureco.com or go to their website atwww.postureco.com.

Chiropractic BioPhysics, Ferrantelli, PostureRay, x-ray digitization software