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May 8, 2025 • 14 mins

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In this episode of The Provider's Report, the host shares a recent challenge that arose from an unexpected insurance policy change affecting Michigan practices. The discussion covers the initial shock, the steps taken to address the issue, and the importance of strategic crisis management. Key points include utilizing AI tools for efficient communication, leveraging professional networks for advice, and maintaining transparency with staff and patients. The episode concludes with a reflection on the growth achieved through navigating this crisis, emphasizing the importance of a proactive mindset and the readiness to adapt in the face of adversity.

00:00 Introduction and Episode Overview
00:08 Facing Unexpected Challenges in Practice
01:11 The Impact of Insurance Changes
02:56 Immediate Response and Strategy
04:46 Implementing Solutions and Team Communication
08:38 Reflecting on the Experience
10:13 Encouragement and Final Thoughts

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Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hello and welcome to anotherepisode of the Provider's

(00:02):
Report.
This one is a little spicy.
I wanna talk about a truepractice.
You start your week on a Monday,you get not so great news,
whether it's in relation to yourpractice directly or maybe a
patient or an employee, and itjust kind of sets a damper on
the week.
This just happened to me, and Iwanna talk to you guys about how
I chose in this moment.

(00:23):
To respond and I will be honestand transparent in the sense and
remind you guys and myself thatI think I chose to respond this
way differently now than the oldme, especially the old slash new
business owner.
And here's why.
I now have a team.
My team is typically anywherebetween five to seven
individuals.

(00:44):
It's not just me anymore.
So how I choose to respond topractice blows.
Really matters like a lot.
and I think that's really one ofmy favorite areas where I feel
like I have achieved growth asan entrepreneur and as a
business owner.
Is because I know that now thedecisions that I make and the
actions that I take not onlyaffect me and my family, but
also affect employees andsometimes their families.

(01:08):
So here's what happened.
Let's just dive right into thestory.
So a lot of my listeners knowI'm a chiropractor by trade.
My office is a, about a 99%insurance based practice.
and we work with specificallymusculoskeletal conditions of
course.
And, because we are so insuranceheavy, we are of course bound by
contracts.
we have to follow certainparameters per insurance

(01:29):
company, and we're very used to,the ins and outs of the coding
system, billing and how all ofthat works.
So because of this, we have tostay up to date with, Anything
that changes by the insurancecompanies.
And we did not receive anynotice whatsoever about a big,
big change coming to the worldof chiropractic and
rehabilitation slash physicaltherapy.
Now, fast forward a couplemonths, I knew that this thing

(01:51):
called the MPPR rule, which isabout multiple procedure codes
and pt, I knew that this wascoming because I own a billing
company.
But I did not realize it wasalso going to affect
chiropractors, and in hindsight,I probably should have, but I
knew that this was going toaffect my colleagues in the
physical therapy community.
but nowhere was this beingtalked about in the world of
chiropractic.

(02:11):
So this was probably likeJanuary, February, and PTs have
been fighting it hard.
Basically what's happening is ifyou bill more than one code in a
given session.
What Blue Cross is doing now issimilar to what Medicare already
does for physical therapy.
You get reimbursed the fullamount for that first code, but
each subsequent code is gettingreimbursed at a lesser rate.

(02:31):
So now they're deciding to dothis for Blue Cross, which is
the number one payer in my stateand probably in most states.
so this is big.
And so initially when ithappened, I only found out
because I just happened to begoing through, some numbers and
eras for a client.
And that's when I realized, ohmy goodness, things are coming
back differently.
What does this mean?

(02:52):
Thankfully, I knew what it wasbecause of my PT community, but
in that moment.
I'm not gonna lie, I did setinto a little bit of a panic
because when you look at thenumbers, this was a 23%
reduction for certain proceduresand services that my practice
delivers to patients.
So immediately when thishappened, I'm like, what are we
gonna do?

(03:12):
And the biggest thing that it'saffecting is insurance massage,
which there are only a couplecompanies left that even cover
insurance, massage.
But in my practice, this is areally important service.
We have a provider on my teamwho does it, and he is lights
out, like incredible.
He does a sports medical massagewith a trigger point emphasis
and he's just such a valuableasset.
So when this happened, I mean asa business owner, everything was

(03:32):
going through my head.
What does this mean?
Not only for collections, butfor my patients?
What does this mean for theregulars that have been seeing
this provider for 5, 6, 7 years?
What does it mean for myemployee?
I need to find a solution.
Do I drop insurance, massagealtogether?
And then of course, you know,thinking the worst case
scenario, do I have to let mymassage therapist go?

(03:53):
I mean, my brain was going toall of these different avenues
right away.
So once I realized my brain wasstarting to get negative, I kind
of sat down and I was like,okay, this is a gut punch
moment, but I need to make adecision here.
Do I choose to wallow?
Do I choose to not respond andjust complain I immediately got

(04:13):
to researching numbers andcoding and what's allowed, what
isn't allowed.
Looked into the legislation ofthe state of Michigan where I
practice to come up with what myoptions were.
Step number two, I reached outto two very amazing colleagues
that I know that I can trustpeople who are going to.
Give me great advice, but alsolet me know when I'm heading in

(04:34):
a wrong direction or possiblymaking a mistake.
You know, some of those trustedcolleagues that are also
friends, but people who aren'tafraid to hurt your feelings.
So in that moment, I just knew Ihad to gather whatever I could
next.
The third step that I had to dowas prepare to let patients and
staff know so immediately withthe help of chat GBT, because if
you listen to my podcast, youknow that I'm definitely using

(04:55):
AI to help me, especially when Ineed to save time.
immediately drafted up a textand email message that could go
out to my patients, justexplaining some basic
information until we have moredetails, we drafted up.
I went through like stats andprojections, plugged that all in
there.
Looked at my own records.
So for example, I wanted toknow, okay, in quarter four, our

(05:15):
busiest month, what did I dolast year?
That way if this is going to bea 23% drop in collections, which
at the time it looked like Iwanted to prepare for quarter
four this year.
So I ran numbers from last yearcompared to this year.
Threw all the stats andprojections into monday.com,
which I use for a lot of it, butthen also threw it into chat GPT
for some further analysis, andthat's what really helped steer

(05:38):
my direction for what oursolution was going to be.
And then lastly, I looked at itfrom a timeline perspective.
When did I want to have ananswer?
When did I want to have a finalSOP?
For my team, I knew that I wasgonna have to come up with a
solution, which, by the way,we're doing the same thing that
a lot of physical therapyoffices are doing.
We cross-referenced a bunch ofcoding options and pick the
right ones that fit theparameters and procedures that

(05:59):
we're already doing in ouroffice.
When do I wanna test thesecodes?
And then how am I going to makea decision when I get that
response back?
So typically trying somethingnew in the world of billing,
you'll generally find out withina week or so, maybe 10 days max.
So I set up a timeline firstweek, second week, third week of
what I was looking for.
Questions that I had, my currentestimates at the time, put that

(06:20):
together.
Let my team know, Hey, just aheads up, all of you, including
my massage therapist.
I let them all know like, Hey,this is what's going on.
No need to panic right now.
We're going to come up with witha solution.
However, it's gonna take sometime.
please plan for about two tofour weeks of uncertainty.
Here's what we know now.
Here are my current questions.
I'll update you as soon as Ican.

(06:41):
And I gave them individualscripts that they could use if
patients specifically asked themabout this particular procedure
or code or any changes thatwould come back on EOBs.
I wanted my team to feel.
Prepared and not feel like thiswas a burden to them.
In reality, if it's gonna be aburden to anyone, it has to be
me as the business owner.
So those are the steps of actionthat I took.

(07:02):
We use monday.com for anythingproject and task related, any
kind of communication.
I'm very anti email, whichshould probably be another
episode because email is kindof.
Quite literally the worst thingever, and I think it bogs down
productivity and just confusespeople.
So I threw it all in ourcommunication strategy in
Monday, and once I had thatwritten down, when I tell you

(07:25):
that the mental change and allof my frustration, my stress, I
mean, we're talking high levelsof stress that day because mind
you, all of this input Igathered on a Saturday.
So in my mind I'm like, oh mygoodness, I have to have
everything prepared by Monday.
What am I gonna do?
Places are closed on theweekend.
So Saturday, Sunday, Monday, Iwas in high levels of stress.

(07:48):
Monday morning I was able tocontact a lot of the contacts
that I needed.
And by about, I don't know, twoo'clock on that Monday, just
getting it all written down andcreating a plan immediately
calmed down my stress levels.
And what could I have done?
I could have just panicked.
I've spoken to, quite a fewoffices now about what's going
on with this whole billing andcoding issue.

(08:10):
'cause people are up in armsabout it and the vast majority
of practices don't even have asolution.
They're just kind of waiting.
and that's, I think.
A very normal response to think,woe is me.
What is the solution?
I have no idea.
I'm just going to wait forsomebody to tell it to me.
and I think I wanted to be thego-getter and because I knew

(08:30):
colleagues in the physicaltherapy world that had already
gone through this and hadalready, found solutions, I knew
that that was the next move.
so I'm very grateful.
It was obviously stressful for afew days, but it's just a great
reminder for us that.
we have to get this work done inorder to establish transparency
and a sense of competency withnot only our patient base, but

(08:51):
also our team.
And that's what this reallyallowed me to do, instead of
just not solving it and thenletting them have discrepancies
with billing for months.
And that's what I think happensin a lot of practices, which is
not okay.
So what I want this experienceto serve as an awesome example
for you guys.
Obviously this is one example ofmany, you know, if you're a
business owner or a practiceowner or both.

(09:13):
These things happen all thetime, right?
Not every day is sunshine andrainbows.
We are putting out fires, youknow, once a month, once a
quarter, something goes wrongthat we have to fix.
So I encourage you to think whensomething goes wrong.
What are your first three stepsthat you do?
Who's a good point of contactfor you?
Do you have a colleague?
Healthcare or in your specificspecialty that is a go-to
resource for you?

(09:33):
I know I do.
His name's Dr.
Blake Upton, and man, he's awealth of knowledge, but more
importantly, he's been doingthis about twice as long as I
have.
He's been in Michigan way longerthan I have, and not only is he
a great friend, but he'ssomebody that I can reach out to
and somebody I know that's gonnabe honest with me and also help
me whenever I need it.

(09:54):
I encourage you to find thatperson for you.
I have those people who are noteven healthcare providers who
just know so much about certainthings, whether it's legal
information, tax information.
Who is your network?
Do you have a friend or a familymember that instantly will calm
your energy and your nervoussystem when you have a really
hard day?
So.
Yes, I'm starting this podcastepisode off with a horrible

(10:17):
situation that happened withBlue Cross, but I think it's a
great opportunity for us to talkabout how we resolve conflict,
not only with our team, but alsojust from a professional
perspective.
Things happen, like things getreally messy and I feel like
we're literally just constantlydealing with chaos.
So who are the people in ourlives and what is our three to
four step system of how we comeback from these things?

(10:40):
So I'm curious if you have anawesome three-step system that
you guys do, let me know.
So, fast forward to now, it'sbeen a couple weeks and so far
our, our solution has workedreally, really well.
We've now been in communicationwith other practices and all of
us are in agreement.
There's also some bigconversations happening at a
higher level with Blue Crossright now.
and so I feel really content andsecure.

(11:01):
I'm so grateful I did all thehard stuff right away and that
I'm, you know, not sitting hereseveral weeks later.
With so much money loss and somany confused patients in a
confused team.
We did everything veryaggressively.
We got everything done right offthe bat, and I'm so, so grateful
for that.
So now when I look at thisexperience, I'm like, okay, what
if that was the nudge I neededto become more solid in some of

(11:23):
my procedures?
what did I learn from thisexperience?
for me, one of the thingsinitially on that very first day
of chaos that I thought aboutwas I've been wanting to raise
my rates for this procedure andthis service for a long time.
We have incredibly low rates forthis service, and what if this
was the nudge I needed to makethe conscious business executive
decision to raise those rates.

(11:44):
We haven't done it yet, but nowwe have a strategic plan of when
we're going to do that, which ishuge.
And I think it's reallyimportant to note that sometimes
pressure creates clarity, andagain, chaos is everywhere.
As a business owner and as muchclarity as we can get, why not
hang on to that?
Embrace those periods of timewhere we are going through
something and it is creatingpressure on a day-to-day basis

(12:05):
and focus on what the outcomewill be when we get through it.
There's always a light at theend of the tunnel if you work
hard for that solution.
I think shifting your mindset isreally important.
we can't always choose whathappens to us.
We can always choose how wereact to it, and in this moment,
we chose to take this experienceand move things in a better
direction, and ultimately itshould help our practice instead

(12:25):
of harming it.
So if you're listening to thisand maybe there's an
uncomfortable decision that youknow you need to make as a
practice owner, whether that bechanging a software that you use
for your practice, firingsomebody or adding a new
service, or removing justsomething that's a little bit
more uncomfortable and a harderdecision to make.
Maybe this is your sign.
Maybe you have just this weighton your shoulders right now

(12:47):
until you make that decision andgo through that awkward step
Take this as your sign to runwith it.
Let it bring you some peace andclarity.
I know how much better I feelnow compared to a couple weeks
ago, and let me tell you, it isworth it.
So I hope this episode washelpful.
If you've gone through anythinglike this and have some great
strategies on how to mitigatesome of these challenging times,
I would love to hear about it.

(13:09):
Shoot me a DM on Instagram atthe providers report, or send me
an email at rebecca dot Deo, do@spinecarepartners.com.
Thanks guys.
See you next time.
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