BUILDING BETTER PRACTICES

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 BUILDING BETTER PRACTICES

ISSUE #13: AUGUST 18, 2017 • CHIROECO.COM

The
Electronic
Edge
Implementing an
EHR system can be a
complex process, but
the potential gains for
a practice make the
effort worthwhile.

INTEGRATED CASE STUDY

SPINAL HYGIENE CAMPAIGN
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 VOLUME 63, ISSUE 13

READER RESPONSE WELLNESS APPROACH

17 A ‘flat earth’ statement 79 From grazing to amazing

BY JAN TUNÉR, DDS, AND Understand the link between grass-fed
ROBERT SILVERMAN, DC meat and healthy cell signaling.
BY ROBERT DAVIDSON, PHD
CASE BY CASE

19 Team treatment 82 The rest of the story

Why sleeping position matters.
An example of chiropractic and
surgical interprofessional consultation BY ROBERT G. SILVERMAN, DC
in an adolescent patient undergoing
lumbar fusion. MARKETING MATTERS
BY SALVATORE MINICOZZI, DC; KAVEH
KHAJAVI, MD; ANTHONY HUTCHINSON,
87 Strategies to grow
ACNP; AND BRENT RUSSELL, DC your practice
Work smarter, not harder, to connect
CLINICAL CONCERNS with your patients.

27 Heightened awareness BY ROB BERMAN

The time is now to enact a spinal

hygiene campaign. 90 A bigger brand
BY TABOR SMITH, DC
Attract news media to build your
expert status.

32 Beta testing BY STEVE COX AND CLAUDIO GORMAZ

Treating insomniac brainwave TECH TALK

dysregulation with neurofeedback.
BY GUY ANNUNZIATA, DC 99 Success by design
60 The electronic
Keep your patients happy with a great
RESEARCH RESULTS online user experience.

edge 41 The fascial system

What you need to know about this
BY PATRICK FOSTER

Implementing an EHR MONEY MANAGEMENT

missing link in chiropractic.
system can be a complex BY WARREN HAMMER, DC 109 Good debt, bad debt
process, but the potential Just because it’s a business loss doesn’t
gains for a practice make PRACTICE CENTRAL always make it a tax deductible.
the effort worthwhile. 49 The silver lining BY MARK E. BATTERSBY

By Kaitlin Morrison Leverage the power of the sweat-

equity buy out.
BY MARK SANNA, DC

54 Invest in them IN EVERY ISSUE

10 Editor’s Note
Reap the benefits of a highly
motivated team. 12 News Flash
BY MILES BODZIN, DC, 114 StudentDC.com
AND AMBER SHEPHERD 116 Datebook
118 Ad Index
SOFTWARE ROUNDUP
BUYERS GUIDE 120 Product Showcase
102 Software 69 2017 chiropractic software 122 Marketplace
marketplace 124 Classifieds
PHOTO CREDITS: ADOBE STOCK

Chiropractic Economics (ISSN 1087-1985) (USPS 019-178) is published monthly except semi-monthly (twice a month) in January, February, April, May, June, August, September, and October; 20 issues annually. Address: Chiropractic Economics Inc., 820 A1A N, Suite W18, Ponte Vedra Beach,
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to www.ChiroEco.com and click on “Magazine.”

6 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

 YOUR ONLINE CHIROPRACTIC COMMUNITY

Top Stories Missed the

uWearables are gaining popularity and becoming more advanced. Last Issue?
Help your patients understand the data they are getting about
their health. The big
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uStudy shows the brain benefits gained from chiropractic care. Working with
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Editor’s Pick
Preserving your chiropractic table
through repair
One of the most valuable pieces of
equipment in any chiropractic office
is the table used to treat patients.
No matter how well it is constructed,
at some point, it will likely need ChiroEco.com/hipaa-ebook
repairs. This presents DCs with
two alternatives: Do the repair yourself or get the table fixed by a
professional. No matter which you decide, there’s ways to make
both successful options.
Self-repairs on chiropractic tables
Hunter Greenwood, DC, ND, at Chiropractor Plus in Nixa, MO, says
“I have done numerous repairs to chiropractic tables from various
manufacturers in my practice over the last 30-plus years.” They
didn’t require any out-of-the-ordinary tools either, Greenwood says.
Most simply required a screwdriver, an adjustable wrench, and a
ratchet wrench with sockets the size of the bolt heads.
ChiroEco.com/chiropractic-table-repair ChiroEco.com/macra-ecourse

Social Media More Resources at ChiroEco.com

Let’s discuss on Facebook
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Real time news and updates on Apple News uBuyers Guide uCurrent News
Favorite us on Apple News.

8 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

 EDITOR’SNOTE

Stay sharp
Y
VOLUME 63, NUMBER 13
ou probably know more than a few doctors
of chiropractic who are, to put it politely, EDITOR-IN-CHIEF
Daniel Sosnoski

“set in their ways.” They’ve found a style of prac- dsosnoski@chiroeco.com

tice that works for them, and they don’t see any reason to ASSOCIATE EDITOR Hannah Fell


change it. There’s just one problem with that: The world hfell@chiroeco.com

keeps changing anyway. ART DIRECTOR Christine Wojton

Healthcare is a large part of the world in which you live, cwojton@chiroeco.com

and it’s a field that’s constantly on the move. Every time MARKETING ART DIRECTOR
Kelley Lucas
you visit the eye doctor, the dentist, or the podi-
klucas@chiroeco.com

atrist, you probably notice something new. And DIGITAL CONTENT STRATEGIST
Casey Nighbor
in the area of nutrition science, the landscape is
cnighbor@chiroeco.com

constantly shifting. WEBMASTER

Aaron Belchamber
Technological change in many ways drives the
abelchamber@chiroeco.com
course and delivery of healthcare, too. There was CONTROLLER
Elizabeth Chance
a time when medical radiography involved bulky
echance@chiroeco.com
equipment and chemical processing facilities. CIRCULATION MANAGER Tyler Bell

Let me know what’s
on your mind: Today’s digital systems use less radiation, are tbell@chiroeco.com
904-567-1539 compact, and take better images, while allowing
dsosnoski@chiroeco.com on-screen markup and manipulation.
DIRECTOR OF SALES Susan Nevins
Digital imaging offers another benefit: the patient 904-567-1554

“wow” factor. Keeping current with technology isn’t an snevins@chiroeco.com
inexpensive proposition, but it doesn’t have to break the NATIONAL ACCOUNT Janice Ruddiman Long

bank, either. EXECUTIVES 904-567-1541

jlong@chiroeco.com
As many experts will tell you, you can’t buy your way
out of a troubled practice. We aren’t recommending you Jeff Pruitt
904-567-1542
go into debt just for appearances’ sake. We do suggest jpruitt@chiroeco.com
you stay current with research and keep an eye on new
Jennifer Jolly
products. When you do decide to invest, do so with a clear 904-395-3394

grasp of why, and have realistic expectations. jjolly@chiroeco.com
This issue of Chiropractic Economics focuses on software ADVERTISING COORDINATOR
Rebecca Mabrey
and technology, and if you’ve been thinking about moving 904-567-1545

rmabrey@chiroeco.com
to an EHR system, our feature will show you how to do it.
There’s plenty of tech and research as well. BUSINESS & EDITORIAL OFFICES

You don’t have to go out on the bleeding edge to have 820 A1A N, Suite W18
Ponte Vedra Beach, FL 32082
a busy practice with a full waiting room, but the right Phone: 904-285-6020
combination of tools and systems can definitely set you Fax: 904-285-9944
chiroeco.com
apart from the rest. Increasingly, today’s patients won’t
FOUNDED 1954
just notice—they’ll be expecting it. William L. Luckey and Helen C. Luckey

To your success,

BPA Worldwide Chiropractic Economics’

subscriptions are now audited by BPA Worldwide,
Daniel Sosnoski, editor-in-chief the most dominant global media auditing company
for B2B publications in the world. BPA certifies that
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chiropractic choose to read Chiropractic Economics
than any other BPA-audited publication serving
chiropractic.

10 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

CHIROECONEWSflash.com

z THE CHIROPRACTIC PULSE

BY THE NUMBERS
Study: Foot Levelers custom orthotics significantly
reduce low-back pain, help reduce reliance on opioids
A conclusive new study, “Shoe Orthotics for the Treatment of
Chronic Low Back Pain: A Randomized Controlled Trial,” conducted
by National University of Health Sciences and published in the
Archives of Physical Medicine and Rehabilitation, shows that

ADOBE STOCK
Foot Levelers custom orthotics, particularly in combination with
chiropractic care, significantly reduce low-back pain (LBP). The
National Institutes of Health (NIH) reports 80 percent of adults experience LBP at some point

23
in their lifetime, and it’s the single leading cause of disability worldwide, with many taking
prescription drugs for pain relief, which often leads to long-term drug abuse and addiction.
“The study unequivocally confirms what we have known for over 65 years: Foot Levelers custom
orthotics are a powerful first-line treatment in the battle against LBP,” says Kent S. Greenawalt, The percentage of adults 18 and
CEO of Foot Levelers, the world’s leading provider of custom-made functional orthotics and older who have been diagnosed
other therapeutic products. “There is significant scientific evidence that explains the foot-spine with arthritis.
connection, but the bottom line is that using Foot Levelers to balance and support the feet—the Source: Centers for Disease Control and
foundation of the body—helps balance and support the spine. This study is another striking Prevention

development in the case for evidence-based, conservative care of LBP which, in the face of
America’s ongoing opioid crisis, is more important news than ever.”
Key findings
uFoot Levelers orthotics significantly reduce low-back pain by 34.5 percent
uFoot Levelers orthotics plus chiropractic care reduce low-back pain by 40.4 percent
uFoot Levelers orthotics alone or in conjunction with chiropractic care improves function by 18.5

ADOBE STOCK
percent and 32.3 percent, respectively
To read more, visit ChiroEco.com/lowbackpain

1 in 3
Source: Foot Levelers, footlevelers.com

Chiropractors encouraged as Senate

recognizes need for resources to The number of children who are
fight opioid crisis physically active each day.
The American Chiropractic Association (ACA) is encouraged by reports that the U.S. Senate is Source: U.S. Department of Health & Human
slated to add $45 billion to its healthcare reform bill, emphasizing the need for healthcare reform Services

efforts that further address the nation’s opioid epidemic.

“Both the House and Senate bills designed to restructure the healthcare delivery system have
been mostly silent on the opioid issue,” says ACA President David Herd, DC. “A key component of
any healthcare legislation emerging from Capitol Hill must be a strong focus on combating opioid
abuse and encouraging alternatives to the overprescribing of pain medications. ACA applauds the
Senate for recognizing this shortcoming in the bill; however, we believe Congress needs to continue
work on the measure to ensure Americans have access to substantive healthcare plans.”
ADOBE STOCK

The chiropractic profession offers a non-drug, noninvasive approach to chronic low-back pain
management that is supported by research. This conservative approach may include trying spinal
manipulation combined with exercise and stretching prior to moving on to procedures involving
higher risk. Active self-care and integrative strategies may provide a solution for many chronic pain

20
sufferers.
“Earlier this year, the American College of Physicians updated its clinical guidelines for acute and
chronic low-back pain to promote the use of conservative treatments such as spinal manipulation,
among other treatments, before moving on to over-the-counter and prescription painkillers,” Herd The percent decrease in deaths from
says. “It should be noted that all of these services are commonly offered by chiropractors, who are cancer in the U.S. over the last two
acknowledged experts in the use of spinal manipulation.” decades.
To read more, visit ChiroEco.com/opioid Source: Time
Source: American Chiropractic Association, acatoday.org

12 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

CHIROECONEWSflash.com
z THE LEARNING CURVE
Palmer Center for Chiropractic Research Randy Swenson, DC, MHPE, NUHS vice president for academic services.
The Master of Science in Advanced Clinical Practice (MSACP) degree
and UK scientists receive grant provides an in-depth immersion into integrative medicine. The program
Scientists at the Palmer is specially designed for professional healthcare providers including
Center for Chiropractic chiropractic physicians, naturopathic physicians, medical doctors, and
Research (PCCR) and the osteopathic doctors.
University of Kentucky Taught by expert faculty with diverse professional backgrounds, the
have been awarded a program includes advanced coursework in neurophysiology, functional
$451,522 grant by the National Institutes of Health, National Center for medicine, research methodology, nutrition, pharmacology, and more.
Complementary and Integrative Health. The grant will fund a three-year To read more, visit ChiroEco.com/nuhsclinical
research project to learn more about spinal manipulative therapy (SMT), Source: National University of Health Sciences, nuhs.edu
a treatment commonly used by doctors of chiropractic to relieve pain.
“We still know very little about how SMT alleviates pain,” says NYCC named ‘2017 Great College to Work
principal investigator Stephen Onifer, PhD, associate professor at the For’ for ninth consecutive year
PCCR. “This study addresses that knowledge gap by investigating the According to a new survey by The Chronicle
underlying factors of pain relief following SMT.” of Higher Education, New York Chiropractic
The project also includes a student research training component, the
College (NYCC) is yet again one of the best
first of its kind at a chiropractic college. Doctor of chiropractic students at
colleges in the nation to work for.
Palmer’s Davenport campus will have an opportunity to learn about basic
The results, released today in The
science research by working with scientists to obtain hands-on laboratory
Chronicle’s annual Academic Workplace
experience.
report, are based on a survey of colleges and
To read more, visit ChiroEco.com/palmercenter
Source: Palmer College, palmer.edu universities across the nation. Recognition
is based on a two-part assessment process: an institutional audit
Master of Science in Advanced Clinical that captures demographics and workplace policies, and a survey
Practice program now offered online by administered to faculty, administrators, and professional support staff.
The primary factor in deciding whether an institution received recognition
National University of Health Sciences was the employee feedback.
Healthcare providers New York Chiropractic College has participated in the Great Colleges
can now earn a post- program for nine consecutive years and has been honored each time.
professional degree Institutions found to be particularly outstanding are further recognized
in advanced clinical as “Honor Roll” schools. NYCC has achieved this coveted status for eight
practice from National consecutive years, making it a stand-out institution in its category of
University of Health Sciences (NUHS) entirely online. small four-year schools.
“The program has been redesigned to help busy physicians easily To read more, visit ChiroEco.com/greatcollegenycc
complete this advanced degree while managing their practices,” says Source: New York Chiropractic College, nycc.edu

z WHAT’S HAPPENING IN HEALTH?

More than 100 million Americans have diabetes or prediabetes
More than 100 million U.S. adults have diabetes or prediabetes, health officials say. As of 2015, more than
9 percent of the population—30.3 million—had diabetes. Another 84.1 million had prediabetes, the U.S.
ADOBE STOCK

Centers for Disease Control and Prevention reported in July 2017.

People with prediabetes have elevated blood sugar levels, but not so high that they have full-blown
diabetes, which requires medication or insulin injections. With exercise and a healthy diet, prediabetics can halve their risk of developing type 2
diabetes, the CDC noted. However, awareness levels remain too low. The new report found that nearly 1 in 4 adults with diabetes didn’t even know
they had the disease, and less than 12 percent with prediabetes knew they had that condition. If not treated, prediabetes often leads to type 2
diabetes within five years, the CDC said.
To read more, visit ChiroEco.com/prediabetes
Source: HealthDay News, consumer.healthday.com

14 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM


A ‘flat earth’ statement
I
n the March 14, 2017 issue of
Chiropractic Economics [Vol.
63, Issue 4, pp. 19–20], Dr.
Silverman, who frequently lectures
on behalf of Erchonia, presents the
advantages of using low-level lasers
in chiropractic therapies. While I
can subscribe to most of the text, it
contains a stunning statement.
Dr. Silverman claims that the
light of these lasers can pass through
clothes, so patients do not have to
undress. This is some kind of “flat
earth” statement, since it is only
too well known that red laser light
will lose more than 90 percent of its
photons even after having penetrated
a thin white shirt. Then another some
90 percent is lost before the photons
have passed through the skin barrier.
Red laser light is excellent for
superficial conditions such as open
wounds and mucosa. For average
chiropractic conditions, infrared light
(800–1,000 nanometers) of fairly
high power (in contact) is needed to
achieve a reasonable penetration. A
635 nm red laser through clothes is
clearly only a placebo treatment.
— Jan Tunér, DDS, is
the editor of LaserAnnals
and LaserLessons. He can
be reached at jan.tuner@
swipnet.se.
Robert Silverman, DC, responds:
As a self-professed expert in the
field of low level laser therapy
who performs no research, Jan
Tunér should read his own books.
On page 73 of his Laser Therapy
Handbook (2004): “Biostimulation
has been reported in the literature
as low as 0.001 J/cm2.” Erchonia
research (2000) demonstrated that
the Erchonia laser emits 20 billion
photons per second; yet, Tunér’s
claim that a white T-shirt would block
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 17
about 90 percent of these photons per
second would still leave billions of
photons per second to create photo-
chemistry (biostimulation). Tunér
goes on to state in the Laser Therapy
Handbook on page 349: “In theory,
1 single photon can actually start a
chain reaction.”
He refers to the same quote in
his New Laser Therapy Handbook
(2010); and on page 708 of his Laser
Phototherapy (2014), he goes on to
state: “A fully adapted human eye can
see about 10 lux. This corresponds to
about 1.5 x 10 watts of visible power
or about 30 photons per second of
energy through the pupil of the eye.
This little energy flow can create a
minute nerve sign.” What happens if
2 billion photons per second are going
through clothes?
His lack of knowledge is further
proven by his statement that “90
percent is lost before the photons pass
through the skin barrier.” The first law
of photochemistry states that “light
must be absorbed for a photochemical
reaction to take place.” If, in this case,
visible light is not absorbed, what
good is it? Power and depth of pene-
tration are marketing terms. Visible
low level lasers work on pain through
photochemistry or biostimulation and
reduce Cox 1 and 2 along with many
other photochemical pathways—
this is the same biochemical effect
NSAIDS produce for pain reduction.
Depth of penetration does not
matter in photochemistry (visible
lasers) or biochemistry (drugs). Has
anyone ever asked their doctor how
deep their NSAIDs penetrate?
Both biochemistry and photochem-
istry work by stimulating biological
pathways; both have to be absorbed
to create systemic effects. With photo-
chemistry, you can go to the site of
pain and still get systemic effects
READERRESPONSE
without side effects.
Tunér’s lack of knowledge on
photochemistry with visible lasers is
further quantified by his statement:
“For the average chiropractic condi-
tions, infrared light (800–1,000 nm)
of fairly high power, and in contact,
is needed to achieve a reasonable
penetration.” As Tuner has stated
in his books that infrared lasers do
not create photochemical effects but
visible lasers do, he is comparing
apples to oranges.
His statement that “a 635 nm red
laser through clothes is a placebo
treatment” is self-serving and has
been proven false in a paper published
in a 2016 issue of the Journal of the
International Association of Functional
Neurology and Rehabilitation. In
this blinded and placebo-controlled
clinical trial on chronic neck and
shoulder pain, patients were not
required to disrobe and positive
results were achieved.
It should also be noted that
Erchonia red lasers have obtained
FDA clearances through blinded and
controlled clinical trials on plantar
fasciitis; post-surgical pain following
liposuction and breast augmenta-
tion; and fat reduction of the waist,
hips, thighs, and arms. If his theory
that infrared laser is needed for
penetration is correct, then how did
Erchonia prove fat emulsification in
a 2000 study (published in the AACS
journal)? He was sent a copy of it but
declined to comment.
— Robert G. Silverman,
DC, CNS, CCN, CSCS,
CKTP, CES, CIISN, DACBN,
DCBCN, HKC, SASTM, can
be reached at info@drrob-
ertsilverman.com.
[The letters above were edited for brevity
and clarity, and printed with permission. We
encourage the open exchange of ideas. — eds.]

Team treatment
An example of chiropractic and surgical interprofessional
consultation in an adolescent patient undergoing lumbar fusion.
BY SALVATO RE MINIC O Z Z I , D C, CCE P; K AV E H K HAJ A V I , M D , F A C S ;
ANTH ONY HUTCHINSO N , ACN P; AN D B R E N T R U SSE L L , M S , D C
Introduction
The history of the chiropractic profes-
sion is one of numerous conflicts
with medicine. The authors believe
that trends in the current era may be
different, based on anecdotes from
colleagues.
A recent article in the Journal
of Chiropractic Medicine notes
“expanded collaboration with and
participation in mainstream health
care delivery systems,” and “an
increasing demand for and acceptance
of chiropractic within mainstream
allopathic medicine.”1 And there are a
number of publications in the recent
literature describing examples of
interdisciplinary communication and
cooperation, including DCs working
in military facilities, hospitals, and
primary care settings.2-9 In the case
described below, interprofessional
consultation between the treating
surgeon and a DC altered the planned
course of treatment and contrib-
uted to a successful outcome for the
patient.
Presentation
A 15-year-old female patient is
presented to a neurosurgery center
with back pain, bilateral lower
extremity pain, and difficulty walking.
Her initial injury occurred in 2012,
when she was performing a “clean-
and-jerk” type overhead weight press
and lost control of the weights.
She suffered a lumbar hyperex-
tension injury and had immediate
onset of back and bilateral posterior
leg pain. She was diagnosed with
a herniated nucleus pulposus, and
received conservative treatment that
included chiropractic care, physical
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 19
CASEBYCASE
therapy, thoracolumbar sacral orthosis slices, but on the scout views, the
(TLSO) bracing, and epidural steroid left side of the disc space was quite
injections. collapsed, resulting in a significant
She continued to have a left lateral coronal deformity. A focal kyphotic
flexion deformity, however, and an deformity was noted at L5–L6. In
inability to flex the left hip, which comparing these findings to an MRI
she compensated for by rotating the done in 2012, she had the same
left pelvis forward and internally disc herniation at that time, though
rotating the right hip. This resulted slightly smaller and without the asym-
in a persistent transverse plane pelvic metric disc space collapse or coronal
rotation of approximately 45 to 50 deformity. The left psoas was clearly
degrees. shortened; the asymmetrical appear-
ance of the left and right sides may be
Examination seen in Figure 1 (coronal, A-P view)
A 2014 physical exam, conducted and Figure 2 (transverse view).
by the neurosurgery center’s nurse
practitioner, revealed no neurological
deficits, and quite brisk reflexes—felt
most likely to be normal given her
young age. She had obvious coronal
shift, with the central vertical axis
shifted to the left, and prominent
left-sided paraspinal musculature, but
without the “rib hump” that is typi-
cally seen with idiopathic scoliosis.
She was able to flex her right hip
to 90 percent when standing, but she
was unable to do so with the left hip;
and she could extend the right hip
but not the left. She walked with a
somewhat flexed-forward posture. It
was suspected that she had developed
intractable left-psoas spasm.
In a review of her 2014 lumbar
spine MRI study, it was apparent
that the patient had 6 lumbar verte-
brae. The L5–L6 level was clearly
transitional, as evidenced by the
morphology of the psoas muscle and
the vessels anterior to the spine. There
was a large disc herniation at L5–L6
that was primarily central, which The MRI was reviewed by the
caused rather severe spinal stenosis. neurosurgeon in collaboration with
There were no formal coronal the chiropractor. The surgeon’s
CASEBYCASE
perspective focused on the spinal
pathology of the L5–L6 segments; the
chiropractor’s view was that the severe
spasm of the psoas muscle was key to
the overall dysfunction of the patient’s
gait.
It was determined that her pain
and ambulatory impairment were the
result of the disc herniation, unilateral
disc-space collapse, and intractable
psoas spasms. Her flexed-forward
posture was postulated to be an
attempt to reduce buckling of the
ligamentum flavum and open up the
spinal canal.
An anterior lumbar interbody
fusion was proposed. To address
the dysfunction caused by the psoas
muscle spasm, an intraoperative
injection of Botox into the left psoas
muscle was deemed necessary by the
consulting chiropractor. This was
accepted as a reasonable treatment
option.
20 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
Treatment and response
Surgery was performed in July 2014,
and consisted of retroperitoneal expo-
sure of the L5–L6 disc space, extensive
discectomy, and placement of a 16
mm polyether ether ketone (PEEK)
spacer with 12 degrees of lordosis. The
spacer was filled with 5 mL of cellular
allograft and local bone from poste-
rior osteophytes.
The spacer was anchored to the L5
and L6 vertebral bodies with two 4.5 x
30 mm screws at L5 and two 4.5 x 25
mm screws at L6. The left psoas was
exposed, and the genitofemoral nerve
identified. A total of 200 units of
Botox were injected at four different
sites in the psoas muscle, well away
from the genitofemoral nerve, in
increments of 50 units.
The patient did well following the
operation. Her gait began improving
almost immediately. Observation of
her gait on post-op day one revealed
improvement of her left hip flexion
and less pelvic rotation. On discharge,
she was referred for gentle psoas
stretching.
At her initial follow up appoint-
ment two weeks later, she had no
complaints of back or leg pain. Her
gait had improved markedly, and
she was able to ambulate for approx-
imately four hours a few days prior
to her visit without significant pain.
Radiographs showed improvement in
the coronal deformity.
Discussion and conclusions
The chiropractor brought a perspec-
tive of “balance” to the case, in an
anatomical sense. While the surgeon
focused on the disc injury and its
consequences, the chiropractor
focused on the psoas muscle imbal-
ance. In the process, both doctors
learned something about expanding
their viewpoints.
CASEBYCASE
Without the DC’s perspective, the
plan for the Botox injection might
not have been considered or imple-
mented. The chiropractor agreed
that the injection seemed particularly
appropriate for this case, as it had
the potential for a more rapid impact
than the stretching and strengthening
methods he would normally have
employed, and it seems to have had a
lasting effect.
22 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
In this case, both the surgeon and
the chiropractor were exposed to
thinking beyond what they might
normally consider in their regular
course of practice, and the patient’s
outcome was the better for it. Bridges
need to be built and cooperation
should be sought between chiroprac-
tors and surgeons. There are many
patients who would benefit from this
approach.
References
1 Bronston LJ, Austin-McLellan LE, Lisi
AJ, Donovan KC, Engle WW. A survey of
American Chiropractic Association members’
experiences, attitudes, and perceptions of prac-
tice in integrated health care settings. J Chiropr
Med. 2015;14(4):227-239.
2 Kruse RA, Cambron JA. Large C4/5 spondy-
lotic disc bulge resulting in spinal stenosis and
myelomalacia in a Klippel-Feil patient. J Altern
Complement Med. 2012;18(1):96-9.
3 Deleo T, Merotto S, Smith C, D’Angelo K. A
posterior ring apophyseal fracture and disc
herniation in a 21-year-old competitive basket-
ball player: a case report. J Can Chiropr Assoc.
2015;59(4):373-82.
4 Wong JJ, Di Loreto L, Kara A, et al. Assessing
the change in attitudes, knowledge, and
perspectives of medical students towards
chiropractic after an educational intervention.
J Chiropr Educ. 2014;28(2):112-22.
5 Salsbury SA, Goertz CM, Vining RD, et al.
Interdisciplinary practice models for older
adults with back pain: a qualitative evaluation.
Gerontologist. 2017; Jan 11. pii: gnw188. doi:
10.1093/geront/gnw188.
6 Green BN, Johnson CD, Daniels CJ, et
al. Integration of chiropractic cervices in
military and veteran health care facili-
ties: a systematic review of the literature.
J Evid Based Complementary Altern Med.
2016;21(2):115-30.
7 Branson RA. Hospital-based chiropractic
integration within a large private hospital
system in Minnesota: a 10-year example. J
Manipulative Physiol Ther. 2009;32(9):740-8.
8 Garner MJ, Birmingham M, Aker P, et al.
Developing integrative primary healthcare
delivery: adding a chiropractor to the team.
Explore (NY). 2008;4(1):18-24.
9 Kligler B, Brooks AJ, Maizes V, et al.
Interprofessional competencies in integrative
primary healthcare. Glob Adv Health Med.
2015;4(5):33-9.
Quick Tip
Preventing airline
injuries
uWhen stowing belongings under
the seat, sit in your seat first,
and using your hands and feet,
gently guide your bags under the
seat directly in front of you.
uWhile seated, vary your
position occasionally to improve
circulation and avoid leg cramps.
Prop your legs up on a book or a
bag under your seat.
— American Chiropractic Association
acatoday.org
ADOBE STOCK
Heightened awareness
The time is now to enact a spinal hygiene campaign.
BY TA BOR SMITH, DC
S
pinal degeneration pervades
society at unprecedented
levels. While many people
think this condition only concerns
the elderly, this is no longer the case.
A recent study showed that nearly 40
percent of 20 year olds currently have
degeneration of the spine.1
A review of the extant literature
indicates there is a substantial link
between spinal degeneration and
a sedentary lifestyle.2-4 Since the
introduction of computers and cell-
phones, office workers find themselves
in degenerative postures all day.
Whether a person is sitting at a desk
working on a computer or looking
down at a phone for a long time,
degeneration is an undeniable and
fast-growing problem.
Unfortunately, adults are not the
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 27
only ones at risk of spinal degenera-
tion. A recent study by researchers in
Scotland found that almost 10 percent
of 10 year olds showed evidence of
spinal degeneration.5 As children
seem to be exchanging exercise for
computer and video game time, it
is unsurprising that their spines are
showing signs of damage and decay.
Considering these trends, the ques-
tion is whether anything can be done
to combat the effects of spinal decay.
The first step is to look at another
field in healthcare that has done
something similar: dentistry.
Earlier roots
In the early 1900s, tooth decay was
at epidemic levels. Rapid industrial-
ization led to mass food production
and processed sugar became a staple
CLINICALCONCERNS
in everyone’s diet.6 As a result, the
dentist’s primary job in that era was
pulling teeth. Dentists were so busy
performing extractions that they
rarely had time for much else, such
as lecturing patients on preventive
methods. In 1906, a dentist named
Alfred Fones was exhausted with
this process, so he invented a way
to prevent—or at least reduce—the
occurrence of tooth decay.7
Only a few decades prior to Fones’
revelation, the cause of tooth decay
had been discovered. A researcher by
the name of Willoughby D. Miller,
DDS, MD, discovered that an acid
byproduct expelled by bacteria was
the culprit.8 Following this discovery,
many dentists looked for ways to
combat the process of decay. Others
lacked motivation as there was so
CLINICALCONCERNS

If chiropractors start educating patients about the concept of spinal

hygiene, then their practices and society will reap the benefits.
much money to be made just from
pulling teeth.
After Fones (considered to be the
father of dental hygiene) trained
his cousin to do teeth cleanings in
his office, the dental hygiene revo-
lution began in earnest.7 At first,
most dentists rejected the idea that
tooth decay could be prevented and,
as previously mentioned, some felt
threatened by it and feared they
would be put out of business. Of
course, the concept of dental hygiene
did eventually catch on, and today
most people keep their teeth because
of it. Dentistry is now primarily
about preventive care and, interest-
ingly enough, it is the second-largest
healthcare profession in the world.10
So what does all this have to do
with chiropractic care? The similari-
ties between dental health and spinal
health should be obvious.
Recall that spinal degeneration
is occurring at epidemic levels in
today’s society similar to the 1900s,
when dentists were faced with an
epidemic caused by lifestyle changes.
Ultimately, they addressed this issue
and bettered society.
The spinal hygiene model
It is time for chiropractors to do
something similar for spinal health
by creating a movement that makes
“spinal hygiene” a household term.
This movement should promote
overall spinal health and create a foot-
print for the chiropractic profession
that is as big or bigger than the one
dentistry created for itself over the last
120 years.
In fact, if this movement doesn’t
get traction soon, the health of our
next generation may be at risk.
You might have concerns about
the cohesiveness of ideas among all
chiropractors, as many have diverse
theories and interests; however, spinal
health—or hygiene—is a founda-
tional premise among all chiropractic
endeavors.
If chiropractors start educating
patients about the concept of
spinal hygiene, then their prac-
tices and society will reap the
benefits. There are three basic
concepts of spinal hygiene, and
it is reasonable to assume that
most professionals will agree

28 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

 CLINICALCONCERNS

on their practicality and medical benefits.

The three foundational concepts of spinal hygiene are as
follows:
1. The spine should be in alignment. It should be
straight from the front and should have natural curves
from the side. Any anatomy book will have an image of
the spine in this proper alignment.
2. The spine should be able to move through its full
range of motion. Decreased range of motion is accepted as
a negative finding during an exam. The spine should move
symmetrically and fully through all three planes of motion.
3. The muscles around the spine should be strong and
fit. Postural and core muscles are a vital part of spinal
health. The muscles around the spine should be balanced
and strong.

The above thus defines spinal hygiene as the set of prac-

tices associated with preserving and maintaining spinal
health, which involves both home spinal care and regular
chiropractic check-ups and adjustments.

TABOR SMITH , DC, is a trailblazer in the subject of

spinal hygiene. He owns and runs two of the largest
chiropractic offices in the state of Texas, where he has
treated thousands of patients and developed some of
the life-changing lessons he teaches today. To learn
more about spinal hygiene and how you can educate your patients,
build retention, and grow your practice, contact Smith through
spinalhygienemovement.com.

References
1 Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review
of imaging features of spinal degeneration in asymptomatic populations.
Am J Neuroradiol. 2014;36(4):811-816.
2 Tomkins-Lane CC, Lafave LZ, Parnell JA, et al. The spinal stenosis
pedometer and nutrition lifestyle intervention (SSPANLI) random-
ized controlled trial protocol. BMC Musculoskeletal Disorders.
2013;14(1):1-22.
3 Buchholz AC, Horrocks J, Ginis KA, et al. Changes in traditional
chronic disease risk factors over time and their relationship with leisure-
time physical activity in people living with spinal cord injury. Applied
Physiology, Nutrition, and Metabolism. 2012;37(6):1072-1079.
4 Tremblay MS, Colley RC, Saunders TJ, et al. Physiological and health
implications of a sedentary lifestyle. Applied Physiology, Nutrition, and
Metabolism. 2010;35(6):725-740.
5 “Shock Over Disc Degeneration in 10‐Year Olds (n.d.).” The Back Letter.
http://journals.lww.com/backletter/Citation/2004/01000/Shock_Over_
Disc_Degeneration_in_10_Year_Olds_But.1.aspx. Published January 1,
2004. Accessed May 11, 2017.
6 Adler CJ, Dobney K, Weyrich LS, et al. Sequencing ancient calci-
fied dental plaque shows changes in oral microbiota with dietary
shifts of the Neolithic and Industrial revolutions. Nature Genetics.
2013;45(4):450-455.
7 Dental hygiene at 100: who was Dr. Fones? The Free Library. https://
www.thefreelibrary.com/Dental+hygiene+at+ 100%3a+who+was+Dr.+-
Fones%3f-a0316665198. Published 2014. Accessed June 23 2017.
8 Siqueira JF, Rôças IN. Microbiology and treatment of acute apical
abscesses. Clinical Microbiology Reviews, 2013;26(2):255-273.
9 NBCE: About chiropractic. National Board of Chiropractic Examiners.
http://www.nbce.org/about/about_chiropractic. Accessed May 11, 2017.

30 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

 CLINICALCONCERNS
Beta testing
Treat insomniac brainwave dysregulation with neurofeedback.
B Y GUY ANNUN Z I AT A, D C
A
ccording to the American
Academy of Sleep Medicine,
about 30 percent of adults
have the symptoms of insomnia,
about 10 percent of adults have
insomnia severe enough to cause
problems during the day, and fewer
than 10 percent of adults are likely
to have chronic insomnia. When
you take into account that most
patients with musculoskeletal disor-
ders suffer with insomnia, chances
are that up to 90 percent of your
patients suffer from some degree of
sleeping trouble.
Our office conducted an informal
survey of our patients to find out
how many suffer from insomnia.
We surveyed 221 patients, and 198
said that they had experienced some
degree of insomnia in the last six
32 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
months. Of the nearly 200 patients
reporting insomnia, 174 considered
their symptoms chronic and have
tried medications that had intolerable
side effects or did not work. Thus
there is likely a whole population of
patients currently in your care that
suffer with a condition that you can
help them with.
The nature of insomnia
Insomnia is difficulty falling asleep or
staying asleep when a person has the
chance and desire to do so. People
with insomnia can feel dissatisfied
with their sleep and usually experi-
ence one or more of the following:
fatigue, low energy, difficulty concen-
trating, mood disturbances, and
decreased performance in work or at
school.
ADOBE STOCK
Insomnia can be characterized
based on its duration. Acute insomnia
is brief and often the result of life
circumstances. Chronic insomnia is
disrupted sleep that occurs at least
three nights per week and lasts at least
three months.
Insomnia facts
More than just an inconvenience,
insomnia poses considerable health
risks. Consider the following:
uAverage number of fatal crashes
caused by drowsy driving each year:
1,550
uPercentage of healthcare workers
who have had a near-miss accident
at work as the result of fatigue in the
last year: 39
uPercentage of health workers who
report worsening a patient’s condi-
CLINICALCONCERNS
tion because of fatigue: 19
Percentage of law enforcement
u
workers who report having taken
unnecessary risks while tired: 44
Percentage of U.S. regional pilots
u
reporting they sometimes nod off in
the cockpit: 80
Relationship stress: Disruption of
u
a bed partner’s sleep due to a sleep
disorder may cause significant prob-
lems in a relationship
Poor quality of life: Sufferers might
u
be unable to participate in activities
that require sustained attention, like
going to the movies
Occupational injury: Excessive
u
sleepiness more than doubles the
risk of sustaining an occupational
injury
Automobile injury: The
u
National Highway Traffic Safety
Administration estimates that each
year drowsy driving is responsible
for at least 100,000 automobile
34 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
crashes, 71,000 injuries, and 1,550
fatalities
Several major disasters have been
u
linked in part with too little sleep in
the workplace: Three Mile Island,
Chernobyl, and the Exxon Valdez
Sleep-deprived drivers are just as
dangerous as drunk drivers. In one
study, people who drove after being
awake for 17 to 19 hours performed
worse than those who had a blood
alcohol level of 0.05 percent. (A
blood alcohol level of 0.08 percent is
considered legally intoxicated in many
states.)
Studies show an increased mortality
risk for those reporting fewer than
six or seven hours of sleep per night.
One study found that reduced sleep
time is a greater mortality risk than
smoking, high blood pressure, and
heart disease.
Sleep disturbance is also one of
the leading predictors of institution-
alization in the elderly, and severe
insomnia triples the mortality risk in
elderly men. Remarkably, sleep loss
may also be a contributing factor to
obesity.
John Winkelman, MD, PhD,
medical director of the Sleep Health
Center at Brigham and Women’s
Hospital, says, “What most people do
not realize is that better sleep habits
may be instrumental to the success of
any weight management plan.”
Sleep disorders always accompany
chronic pain and fibromyalgia. In
1975, two Canadian physicians and
researchers, Harvey Moldofsky, MD,
and Hugh Smythe, MD, suspected
sleep disorders as a factor in fibro-
myalgia. They conducted sleep
studies and concluded that patients
not only had sleep abnormalities but
also had dysregulation of normal
body circadian rhythms affecting
CLINICALCONCERNS
periods of wakefulness too. Circadian
rhythms are primarily controlled by
brainwaves.
In the long term, the clinical conse-
quences of untreated sleep disorders
are large indeed. They are associated
with numerous, serious medical
illnesses, including:
u High blood pressure
u Heart attack
u Heart failure
u Stroke
u Obesity
u Psychiatric problems, including
depression and other mood
disorders
u Attention Deficit Disorder (ADD)
u Mental impairment
u Fetal and childhood growth
retardation
u Injury from accidents
u Disruption of bed partner’s sleep
quality
u Poor quality of life
36 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
The medical approach
The medical profession has no real
cure for insomnia. The best it can
offer are medications to help manage
the condition. Some of the medi-
cations include over-the-counter
sleeping aids, non-benzodiazepine
hypnotics, benzodiazepine hypnotics,
and antidepressants.
Some of the general side effects of
these medications include:
uDrowsiness
uDizziness
uFatigue
uHeadache
uDiarrhea
uRespiratory problems
uIncreased depression
uSignificantly increased risk for auto-
mobile accidents and falls
Drugs prescribed for insomnia can
cause memory loss (sometimes called
“traveler’s amnesia”), sleepwalking,
sleep driving, eating while asleep,
and other odd mood states. Among
patients who were prescribed one
to 18 sleeping pills per year, the risk
of death was 3.6 times higher than
among similar participants who did
not take the medications.
QEEG analysis and
neurofeedback
Several parts of the brain have
been implicated in the etiology of
insomnia. Recent research, using
quantitative electroencephalogram
(QEEG), neuroimaging techniques
and the study of the microstructure of
sleep, suggests a state of CNS hyper-
arousal with a biological basis.
QEEG analysis involves an analysis
of brainwave patterns at 12 different
sites in the brain. The analysis is
painless and noninvasive, providing
valuable information regarding
patterns that may be associated with
CLINICALCONCERNS
increased predisposition to insomnia.
In many cases, these dysregulated
patterns can be corrected with neuro-
feedback, resulting in the complete
and permanent alleviation of
insomnia.
There are several different brain-
wave patterns associated with
insomnia disorders; however, the
most common pattern is elevated
magnitudes of Beta brainwaves
38 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
coupled with decreased magnitudes of
Delta and Theta. The Beta brainwave
resonates between 12 and 30 Hz and
is normally produced at high magni-
tudes when the brain is involved in
external thought, critical reasoning,
and problem solving.
In some individuals, the brain
becomes dysregulated and begins
producing high magnitudes of Beta
most of the time. The brain map
below illustrates this type of brain-
wave dysregulation:
This type of dysregulation is typi-
cally associated with insomnia as well
as migraines, anxiety, and chronic
pain syndromes.
Neurofeedback therapy is a method
of exercising the brain that guides
dysregulated brainwave patterns back
to normal, organized patterns. By
doing this, the brain is able to operate
efficiently and properly. Chiropractors
are increasingly adding neurofeed-
back to their offices to address serious
neurological disorders that present in
the chiropractic setting.
In the case of Beta dysregulation
that causes insomnia, neurofeedback
training can teach the individual how
to lower the magnitude of the beta
waves that are being produced, thus
normalizing the pattern and allevi-
ating the insomnia. Neurofeedback
therapy has no serious side effects,
and it has been shown effective in
managing many neurological condi-
tions including anxiety, panic attacks,
ADHD, learning disorders, Asperger’s
syndrome, PTSD, TBI, chronic pain,
and insomnia.
GUY ANNUNZIATA , DC, BCN,
is one of only 25 chiropractors
who are board certified in
neurofeedback. He is the
founder and developer of
BrainCore Neurofeedback Therapy—the
only QEEG-based neurofeedback system
specifically designed for the chiropractic
profession. He can be reached through
braincoredoctor.com.

ADOBE STOCK
The fascial system
What you need to know about this missing link in chiropractic.
BY WARREN HAMMER , D C
F
or the progress of any
profession, it is essential to
be aware of new information
regarding one’s practice. The chiro-
practic subluxation has proven to
be an important factor for attaining
superior results. But it must be
accepted that the spine is a passive
structure moved by muscles, and
recent data demonstrates that muscle
coordination and function depends
on the fascia that surrounds and
penetrates the muscle.
It is imperative to be an expert in
the tissues that move and support the
function of the joints, and often these
factors are more related to a patient’s
complaint than the subluxation.
A missing link in chiropractic
is treatment of the fascial system.
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 41
Fascia literally covers everything in
the body including nerves, blood
vessels, organs, and muscles. But until
recently, science has virtually ignored
fascia.
Glide, applied
As Carla Stecco, MD, PhD, states
in her recent text, most anatomists
recognize fascia as something to be
removed so muscles, joints, organs
and tendons may be studied care-
fully.1 She states that “muscles move
in relation to one another as a func-
tion of the fascial structures that give
them form and permit the proper
amount of glide.”
The “proper amount of glide” of
fascia surrounding and within muscles
is the essential element responsible for
RESEARCHRESULTS
muscle coordination. Fascia is now
considered a sensory organ rather
than just a protective covering.
Many techniques are available,
including the use of various instru-
ments, to enhance this glide. All of
these methods are helpful, but new
information about fascia and its rela-
tionship to the central nervous system
(CNS) is critical if you want to effec-
tively restore coordination and restore
the kinetic chain, instead of just
freeing up painful restrictions.
The CNS requires accurate sensory
input to control muscles, and the
information it receives from muscle
receptors is critical. The chief sensory
input receptor controlling how
muscles work comes from muscle
spindle cells. These are responsible for
RESEARCHRESULTS
reporting to the CNS the status of the
muscles and joints.
Research shows that it’s the spindle
cells, rather than joint receptors,
that play the most important role in
postural sensations of joint angle.2
They control fine motor movements,
joint range of motion, and body
position. They control and maintain
muscle tone and contraction.
The most extraordinary informa-
tion about this important sensory
system is that muscle spindle cells are
located in fascia within muscles and
not in muscle tissue. In reality, muscle
spindles should be called fascial
spindle cells.
Interestingly, the acupuncture
system is in the fascia. Fascial manip-
ulation (FM), which last year was
taught in 40 countries, provides an
ideal system of restoring fascial glide
at particular locations located in
muscular or fascial sequences.
42 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
Pathways of dysfunction
The practitioner must first determine
which of the fascial acupuncture
pathways are implicated based on
functional testing and palpation. If a
fascial pathway contains tender, dense
points from an old ankle injury (and
the patient may not even be aware of
it), and these points correspond to
similar points along a pathway, e.g.,
to a painful knee, hip, or lower back,
then often during the initial visit the
treatment of a 10-year-old “painless”
ankle sprain will immediately relieve
the proximal compensatory area of
complaint.
Most therapies concentrate on
the location of pain that is often a
compensatory area overworking due
to a previous injury. When treating
these areas, it is essential that the
practitioner re-palpate the designated
points to feel the restoration of glide
and then determine if the painful
motion is relieved. Rarely is one point
sufficient.
The big question is why glide is so
necessary. All receptors in the muscu-
loskeletal system must be able to
stretch to send sensory impulses back
to the CNS. This is so critical that a
nerve from the CNS called the gamma
has the principal job of making sure
spindle cells stretch. This gamma
nerve controls more than 30 percent
of the motor supply to muscles along
with the alpha motor neuron, which
causes muscle contraction. These two
nerves work together.
So the gamma tells the spindle cell
to stretch to inform the CNS about
muscle function and the spindle cell
may report that it can’t stretch as
much as it needs to because it’s stuck
in the fascia.
Muscle bundles and muscle fibers
need to glide within the fascia as
muscles contract or stretch. A lack of
ADVERTISEMENT
 RESEARCHRESULTS

free gliding of the fascia within the muscle prevents normal

feedback of sensory impulses back to the CNS, resulting
in muscle weakness, pain, and alteration of muscle vector
force and coordination. Many of the points used in FM are
acupuncture points and directions of muscle and fascial
relationships have been shown on dissection.3
Fortunately, more chiropractors are adding soft-tissue
methods to their approach to healthcare. The future of the
profession depends on it. It is always prudent to evaluate a
method as to the research behind it and its results. Visit
fascialmanipulation.com, fascialmanipulationworkshops.
com, fasciaresearch.com, and warrenhammer.com for
further information.

WARREN HAMMER , DC, MS, DABCO, has lectured

internationally on soft-tissue modalities and
chiropractic. He wrote the third edition of Functional
Soft-Tissue Examination and Treatment by Manual
Methods, 2007. In 2013, he became a certified instructor
in fascial manipulation and, along with Antonio Stecco, MD, has
introduced FM in the U.S. He is the English editor for the text
Functional Atlas of the Human Fascial System, by Carla Stecco, MD.
He can be contacted at softissue@optonline.net or through
warrenhammer.com.

References
1 Stecco C. (2015). Functional Atlas of the Human Fascial System. London:
Elsevier.
2 Kandel ER, et al. (2013). Principles of Neural Science. (5th ed, pp.
475-497). McGraw-Hill: New York.
3 Stecco C, Gagey O, Macchi V, et al. Tendinous muscular insertions onto
the deep fascia of the upper limb. Morphologie. 2007;91(292):29-37.

Quick Tip
Cordyceps for the immune system
Chinese fungi are known to do everything from
increasing endurance in athletes to helping rebuild
the body after long-term illness. They help the body
regulate the development of lymphoid stem cells and
other important defense responses.
Cordyceps has properties similar to those of ginseng.
It is one of the most valued medicinal fungi in all of
Chinese medicine, and among the most potent. The
fungi can produce an increase in energy, as it actually
attaches to the same receptors as caffeine—all without
the negative side effects. In fact, one study found
that elderly patients suffering from fatigue who took
cordyceps reported a 92 percent improvement in their
symptoms in 30 days.
— The Baseline of Health Foundation
JonBarron.org

44 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM


Putting technology
to work
Computerized
instruments
standardize
your practice.
BY CHIRO PRAC TI C
ECONO MICS ST AF F
H
ave you ever wondered why
some doctors of
chiropractic are wildly
successful and some aren’t? Perhaps
you’ve wondered why some patients
seem to have better outcomes than
others do? And what it is that makes
great chiropractors so special?
Steve Arculeo, DC clinical director
of Peak Performance Health Care,
has been living out the answers to
46 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
Innovative Ideas from the Industry Leaders
ADOBE STOCK
those questions. He has been training
doctors of chiropractic on the use of
adjusting instruments for the past 17
years and studied with Walter Pierce,
DC, at Sherman College before he
passed away.
During his travels, he found a
common thread shared among the
most highly successful chiropractors:
“They had certainty where the sublux-
ation was, that they corrected it, and
confidence they were making an
impact,” he says.
Many chiropractic techniques are
based on the use of touch or motion
palpation as a means of identifying
problem areas. The uncertainty and
lack of a formal approach to palpation
led Hawk, Simmonds, Schops, and
others to study the need to devise
a standardized approach to reduce
the subjective variables of manual
adjustment.
Simmonds noted that inter-ther-
apist variability was high, and there
was a systematic bias toward under-
estimating the magnitude of applied
force and in overestimating motion.
The variability in force application
and the general overestimation of
motion detection may explain the
poor reliability of measurements
obtained with clinical tests based on
motion palpation.1
Practice Growth
Arculeo says that having a predictable
result to show patients is invaluable
because chiropractic care isn’t gener-
ally standardized. “Being able to show
patients pre-and post-scans and get
them involved in their treatment is a
bonus,” he says. It helps patients feel
involved with their care.
Computerized instruments are one
way to provide a level of control and
standardization that allows the chiro-
practor to take their techniques one
step further. A computerized treat-
ment instrument provides enhanced
analysis over motion palpation, which
literature and studies state are unreli-
able, and provide a treatment protocol
with predictable results.
“When I have a patient with a
specific subluxation (Figure 1), I
perform adjustments with a comput-
erized instrument,” Arculeo says,
“then have them walk across the room
and they can feel the difference, I
know I have improved the quality of
life for that patient.”
Many doctors of chiropractic look
EDITORIAL SERIES SPONSORED BY SIGMA INSTRUMENTS
Figure 1
to expand their practice by bringing
an associate aboard. But many
patients insist on seeing the primary
DC who is known for giving the best
adjustment, which can make growing
a practice challenging. Chiropractors
tend to think this need for clients to
see the primary DC is a personality
issue, but quite often it can be a stan-
dardization issue instead.
Computerized instrument adjusting
provides consistency and allows
for predictable treatment plans and
outcomes from one DC to the next.
Ensuring the adjustment is the same
for each patient—no matter who
performs it—can make for a smoother
transition to an associate and reduce
the stress of practice growth.
In addition to providing stan-
dardized and repeatable treatments,
computerized adjusting instruments
can extend your career because there
is less wear and tear on the body
compared to performing manual
adjustments. “Doing full-body adjust-
ments day in and day out is tough on
the body,” Arculeo says. Instruments
can allow you to continue to prac-
tice if an unforeseen injury or illness
occurs that affects your hands, arms,
or shoulders.
The National Center for
Complementary and Integrative
Health says chiropractic is a health-
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 47
Instruments take the guesswork out
of adjustments
Starting a business, maintaining a
business and, more importantly, growing
a business, are the foundation that relies
on many parts working together to create
symphony of profitable operations.
This is no different when talking about
a chiropractic clinic. Coaches, mentors,
and business leaders all have great
ideas and proven theories on how to
successfully manage your goals, growth,
and expectations.
While focusing on marketspace,
branding, patient flow, aesthetics,
and advertising, one can lose sight of the power of consistency and
standardization. By consistently delivering the highest level of care
patient to patient every day, you and your practice create a trusted
and respected atmosphere for your patients. Computerized instrument
adjusting can provide the consistency needed to drive patient retention
and referrals. The Sigma Instrument provides comfortable and consistent
care repeatedly day in and day out, giving you and your patients
the peace of mind, knowing they are receiving the most advanced
and consistent level of care each and every time they visit you.
You need time, time for yourself and time for your family. Do you
have to close your clinic to take personal time? Do you see a decline
in appointments when you are not available? This is another often
overlooked scenario when growing your business—standardization.
Not only does the Sigma Instrument allow the same chiropractic care
to be delivered from doctor to doctor in your practice, it allows the
same level of care from clinic to clinic, city to city and around the world.
Patients now have an additional level of confidence in the service and
care you provide no matter which doctor is delivering that care.
Now you can have confidence going forward that you have the ability, in any
situation, to provide excellent consistent and standardized care.
For more information on Sigma Instruments and the Ultralign System, call 724-776-
9500 or visit sigma-instruments.com.
care profession that focuses on the after patient, and not having to guess
relationship between the body’s struc- whether your patients’ health will
ture—mainly the spine—and its improve can reduce stress and move
functioning. While many use different you closer to having a superstar
approaches, the overarching goals are practice.
spinal alignment, pain alleviation,
muscular and skeletal improvement, Reference
and support for the body’s natural 1 Simmonds MJ, Kumar S, Lechelt E. Use
ability to heal itself. Providing consis- of a spinal model to quantify the forces
and motion that occur during therapists’
tent and documented adjustments, tests of spinal motion. Physical Therapy.
making a neurological impact patient 1995;75(3):212-22.
ADOBE STOCK PRACTICECENTRAL

The silver lining

Leverage the power of the sweat-equity buy out.
BY MARK SANNA, DC, ACR B LE V E L I I , F I CC

T
he Great Recession that
began in December 2007
and extended through 2009
forced many seasoned chiropractors
to reconsider their retirement plans.
Many chiropractors in their mid-50s
and 60s envisioned retiring at 65 with
a comfortable nest egg, the result of
a lifetime of earning followed by the
successful sale of their practice.
Unfortunately, the recession
crushed this dream for many. Savings
and investment accounts were wiped
out, and the availability of credit for
potential practice purchasers dried up.
The financial reality for this genera-
tion of chiropractors required adding
a decade to their practice career and
becoming the source of funding for
the sale of their practice. This placed
them at considerable financial risk
should the potential buyer default on
their promise to pay—not a desir-
able way to end a career of dedicated
service.
At the other end of the chiropractic
career path, many recently gradu-
ated students are finding themselves
saddled with $200,000 or more in
student loan debt. Not only does this
mean that many will have to work
until their mid-40s or 50s to pay off
their student debt but it puts them in
the position of being unable to start
a practice of their own or purchase
an existing one. The future for this
generation of chiropractors looks like
a lifetime of employment working
as an associate without the potential
of owning their own practice. This is
not the reason why most chose chiro-
practic for a career.
The silver lining
While the picture painted above
sounds dire, there is a silver lining.
The confluence of the financial uncer-
tainty of both senior and new practi-
tioners alike provides the opportunity
for a solution that is mutually benefi-
cial to all parties: the sweat-equity buy
out (SEBO). The SEBO provides the
practice owner with an exit strategy
that significantly reduces the need
to act as the source of funding and
ensures that the maximum value
of the practice will be maintained
throughout the process. It provides
the practice buyer with an entrance
strategy by enabling him or her the

CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 49

 PRACTICECENTRAL

ability to accumulate funds for the purchase of a practice

that could not be accumulated through traditional means.
Here’s how it works: The practice owner and practice
purchaser enter into an agreement whereby the purchaser
becomes an associate of the practice. A tabulation of
the associate’s monthly financial needs is made. This
includes all the associate’s living expenses such as rent
or mortgage, meals, personal debt, auto loan, and credit
card and student loan payments. It is important not to
underestimate these living expenses, as they can divert the
associate’s attention from building and growing the prac-
tice to seeking income from outside the practice to meet
his or her financial needs. The typical living expenses of
a new practitioner range between $4,000 and $5,000 per
month (including student loan payments).
Once monthly living expenses have been agreed upon,
a calculation of the potential increased overhead required
to support the addition of an associate to the practice is
made. This will include items such as malpractice insur-
ance, health insurance, additional staff hours, additional
equipment, and CEU and licensure expenses. Here too,
underestimating these expenses could place the existing
practice under cash flow requirements it might be unable
to provide. The typical increased overhead expense is
$3,000 to $4,000 per month, including a cushion for error.

The SEBO escrow account

The combination of living expenses plus increased over-
head expenses becomes the base salary for the associate.
Once the associate generates sufficient income to cover the
base salary, the balance of the income generated becomes
part of a bonus pool.
The difference between a SEBO and a traditional asso-
ciate agreement is the creation of an escrow account. The
bonus pool is divided between owner and associate, with
the owner retaining between 60 and 70 percent of the pool.
A portion of the associate’s 30 to 40 percent of the bonus
pool is set aside in an escrow account to accumulate over
an agreed-upon period (typically five years), to be used
to fund the purchase of the practice. The more aggressive
the associate is in funding the escrow account, the sooner
he or she will accumulate the funds needed for a down
payment or full purchase of the practice.
Some owners agree to provide matching funds, offering
to supplement the associate’s deposits in the escrow
account to some level, thereby paying themselves forward
by contributing to the amount available for the future
purchase of the practice. The base and bonus percentages
can be altered if the associate has an existing practice that
is being merged into the owner’s practice (rather than
starting a practice from scratch). Both associate and owner
should work with a consultant, attorney, and accoun-

50 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

PRACTICECENTRAL
tant when entering into a SEBO
agreement.
What makes this arrangement
work is that should the associate
decide before the agreed-upon date
to break the agreement, the funds in
the escrow account are forfeited to
the practice owner. This accomplishes
two important goals: First, it enables
the associate to accumulate the funds
needed to purchase the practice
without having to seek outside sources
of funding such as a bank loan. If the
amount in the escrow account doesn’t
cover the entire purchase price of
the practice, the associate will have
an easier time qualifying for outside
funding. He or she will have estab-
lished a financial track record working
in the practice being purchased and is
also putting his or her own funds into
the deal.
And second, the practice owner
has peace of mind in knowing the
52 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
associate has “skin in the game”
and, should the deal be broken prior
to the agreed-upon date, he or she
won’t have to reset the clock back
to zero, but can move forward with
only a slight speed bump in their exit
strategy.
Multiple benefits
There are many other advantages
to the SEBO. The associate chiro-
practor has access to the expertise and
guidance of the senior practitioner’s
patient and business management
skills. The owner, entering the final
stretch of their career, has the benefit
of a tech-savvy younger associate,
familiar with electronic record-
keeping, internet, social media, and
other technologies required to run a
practice in the digital age.
Ideally, the associate should seek to
match the owner in technique and
treatment recommendations so that
eventually patients will accept care
from either provider. In this manner,
upon the purchase of the practice by
the associate and retirement of the
owner, the practice will be perfectly
positioned with staff and systems
required to receive the next associate
(who could possibly become the exit
strategy for the new owner). The
SEBO breaks the cycle of our
currently dysfunctional strategies for
practice entrance and exit by
providing a winning solution for the
past and future accomplishments of
the chiropractic profession.
MARK SANNA , DC, ACRB Level
II, FICC, is a member of the
Chiropractic Summit, the ACA
Governor’s Advisory Cabinet,
and a board member of the
Foundation for Chiropractic Progress. He is
the president and CEO of Breakthrough
Coaching. He can be reached at 800-723-
8423 or through mybreakthrough.com.
 PRACTICECENTRAL

ADOBE STOCK
Invest in them
Reap the benefits of a highly motivated team.
BY MILES BODZ I N , D C, AN D AM B E R SHE PHE RD

I
t’s happened to everyone: You
walk into a business that is
doing everything right, but has a
staff member or two who are lacking.
This can affect your impression of the
business.
You know that running a successful
practice means having a team that
is as motivated and invested in the
success of the business as you are. The
staff not only want to see the business
grow, but are taking actions to achieve
this vision. Here are three successful
strategies you can implement that will
create happy, owner-minded staff for
your practice.
Hourly bonus system
based on collections
Yes, you read that right—an hourly
bonus. You are probably more
familiar with bonuses based on a
one-time, flat-dollar amount. For the
hourly bonus, consider giving each
employee a base collection level (it
can be different for each employee).
For every thousand dollars that is
collected over that base, they make a
certain increment more per hour the
entire next month.
For example, let’s say you have
an employee who makes $13 per
hour and their base level is $24,000.
Their increment could be 20 cents.
Supposing last month you collected
$30,000, that puts this staff member
$6,000 over their base level and thus
they get 20 cents for each $1,000. This
translates to an additional $1.20 per
hour and means they are now making
$14.20 per hour the entire month.
Try putting your new hires’ base
level at around your six-month
average collection level, giving them
a taste of the bonus. You will notice
something major once you give your
staff bonuses—they will get used to
them and want to keep them.
What happens if collections begin
to slip and their bonus starts to drop?
You will see your staff making recalls,
asking for referrals, suggesting prod-
ucts, or gift certificates. They’ll be
more motivated to get people enrolled
in care, making sure patients keep
their appointments, and finding even
more creative ways to grow the prac-
tice. They’ll start to take action (just
like an owner).
From the viewpoint of a staff

54 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

 PRACTICECENTRAL
member, it is empowering to be in
charge of your own pay rate. You
can use a program that records each
staff member’s bonus settings. All you
have to do each month is enter the
collections and hand off the gener-
ated calculation sheet to your payroll
handler so they can make the neces-
sary adjustments.
You can include in each paycheck
a pay rate breakdown and personal
message regarding the bonus. You’ll
likely find that your team keeps these
because they are proud­­—similar to
hanging a great test score on the
refrigerator.
Reward the behavior you want
This is something you’ll regularly see
in your office if you have a program
for your team that rewards them for
what you expect and want to see more
of. It can be based on points that later
translate into gift cards, bonuses on
checks, or extra massage time.
The categories you create and
assign a point value to should reflect
their importance. You can include
basic things related to employment
like perfect attendance (not even
being one minute late, not leaving
work early or calling out), putting
in requests for time off with enough
notice, or no time-card edits.
You can take it a step further and
include things like getting a good
review posted on social media, good
customer feedback, getting adjusted,
giving a health talk on a topic,
attending a chiropractic seminar, or
making a healthy meal and sharing
the recipe with the team. Not only
do you get the benefit of a team that
follows your policies, which makes
your life easier, but it also helps your
team embrace your company culture.
Once a week, your staff enters in
their points and a leader (or you)
can verify them. Then, every quarter,
award prizes based on the point range
that they fall into.
At the end of the year, you can
56 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
present awards to the top three
highest point-earners at the company
holiday party. You’ll be surprised
how many times your staff will refuse
to make last minute appointments
during their regular schedule because
they don’t want to mess up their
points for that week.
Invest in them
Invest in the education of your staff.
There’s a wide range of training
options available. There are compa-
nies like Fred Pryor Seminars that do
trainings on basics like communica-
tion, leadership skills, and customer
service. This invests in their personal
and professional growth, while you reap
the benefits of improved employees.
Staff in turn are thankful to have
an employer who is giving them the
tools to succeed in their positions
and encouraging them to expand
their knowledge of their current posi-
tion. What better way to help your
chiropractic office than staff who are
knowledgeable about chiropractic?
There are seminars that have excel-
lent courses geared directly to CAs.
They will be more invested in your
office and your profession and also
feel valued. You are only as strong as
your weakest link. Take the time to
have a team invested in the growth of
your business, that feels valued, and
has the proper tools and the empow-
erment to succeed.
MILES BODZIN , DC,
is founder and CEO
of the Inc. 5000-
listed company Cash
Practice Systems.
AMBER SHEPHERD has served the
chiropractic profession for 10 years as
Bodzin’s CA. For the past seven years she
has served as the company’s coordinating
manager. Cash Practice Systems offers
web-based software for chiropractors to
implement a four-step process resulting in
increased patient retention. They can be
contacted at 877-343-8950 ext 101,
amber@cashpractice.com, or through
cashpractice.com.
 The
Electronic
Edge
Implementing an
EHR system can be a
complex process, but
the potential gains for
a practice make the
effort worthwhile.
BY KAITLIN MORRISON
ADOBE STOCK

60 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

B y 2015, almost nine
in every 10 physi-
cians had some form
of EHR capability,
according to the Office of the
National Coordinator for Health
Information Technology (ONC).¹
This is roughly double the EHR
adoption rate in 2008. Many
chiropractors still use paper,
however, even with the signifi-
cantly greater number of offices
now using electronic records.
If your office still lacks an EHR
system, it may be time to reconsider
your relationship with paper.
Implementing EHR today
In the past, implementing EHR could
be a real headache for some practices.
Hours of scanning patient records and
countless phone conversations with a
vendor’s technical support team made
abandoning paper or switching to
new software seem unrealistic if not
impossible.
While quitting paper records can
still be an adventure, in most cases
today the implementation process is
less dramatic and more user-friendly.
Finding the technology you need,
starting a new system, and moving
patient records into EHR is generally
less arduous than yesteryear’s elec-
tronic records.
Current EHR is not terribly hard
to implement, says Mike Norworth,
president of MPN Software Systems.
“These days, it’s not very difficult.
Computers have become ubiquitous
in one form or another. And software
has become more powerful. Thus, it’s
easy to scan any patient’s older paper
files for immediate future reference.”
With most computers readily compat-
ible with EHR systems, doctors can
likely find the technology they need
with relatively little fuss. From there,
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 61
implementation now is a more acces-
sible process.
“It’s not difficult and is rather
dependent upon the user,” adds Nicole
Cowley, a senior technology solution
specialist at VitaLogics. Getting the
right training and support for your
system is a key part of implementing
any new software. And help from
your vendor can make the journey
easier.
Patient records that are well-
organized are also easier to transfer
over, according to Cowley. “We
have converted thousands of clinics
over the years from pen and paper
to VitaLogics and [we] help the
chiropractor and staff break it down.”
The paperless route
While today’s EHR is adop-
tion-friendly, you’ll likely still invest
significant resources in your transition
to new software. This may be particu-
larly true if you do not have electronic
records already or if you have other
issues occur.
The most challenging part, as it
happens, is transferring information
into the new records system. For
paper users, this step might involve
scanning or manually entering infor-
mation. This requires administrative
hours and may mean hiring data
entry assistance or even tackling the
project yourself.
“You need to determine whether
to do it all at once or as patients
return for regular visits; and the types
of data to move, such as names and
addresses, appointments, and billing
information,” Norworth says. Your
vendor can help you navigate these
decisions, so you won’t have to figure
it all out on your own. Having a
solid plan for how you will approach
implementation is vital. Beware the
temptation to take shortcuts.
Time and admin costs can add up,
leading some practices to conclude
that switching is not worth the effort.
“Converting all-paper medical records
to EMR is a costly and time-con-
suming approach,” says Damon
Cozamanis, DC, founding partner and
president of ChiroFusion Practice
Management.
Instead of immediately changing
over to fully electronic records,
Cozamanis advocates a gradual tran-
sition that gives a practice time to
transfer the essential data needed for
each patient. In fact, you may only
need to start with a small amount of
digitized information. “Most practices
find that scanning less than 10 percent
of the paper chart gives them the data
they need to fully transition a patient
to the EHR,” Cozamanis says.
In addition to choosing whether or
not to stop using paper, you need to
find the right system for your clinic.
“A more critical question is how
should doctors choose the EHR that’s
right for them,” says Brian Albery, DC,
CEO of ChiroSpring practice manage-
ment software.
Albery recommends that doctors
should pay more attention to finding
a great platform with the features they
need, keeping in mind that an office
with EHR is still not fully paperless
unless sticky notes, patient intake
forms, and other documents are
totally digital.
Tackling problems
and challenges
EHR is a worthwhile investment, but
implementation costs are a barrier
for some practices. Onsite installs
can cost tens of thousands of dollars,
while cloud-hosted software as a
service (SaaS) systems may set chiro-
practors back on upfront equipment
purchases and ongoing monthly fees
 Meet the experts
Mike Norworth, president of
MPN Software Systems, in
Saddle River, NJ.
eclipsepracticemanagementsoftware.
com
Nicole Cowley, senior
technology solution specialist
at VitaLogics, in Peoria, Ill.
vitalogics.com
Damon Cozamanis, DC,
founding partner and
president of ChiroFusion
Practice Management, in
Wilmington, Del.
chirofusionsoftware.com
Brian Albery, DC, CEO of
ChiroSpring, in Davenport,
Iowa.
chirospring.com
Robert Moberg, CEO of
ChiroTouch, in San Diego.
chirotouch.com
for maintenance. That said, many
affordable systems available today
offer the features and capabilities most
practices need.
Installing a new EHR system can be
62 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
expensive, but the return on invest-
ment can help your office recover
those initial costs over time. Improved
productivity may generate real savings
for offices that previously dealt with
confusing workflows and misplaced
paper information. Retrieving patient
data securely and effectively is usually
much easier with EHR, enabling your
practice to save even more.
“The only downside of switching
from paper to an EHR would be the
initial startup costs of software, hard-
ware, and additional training and
administrative hours for office staff,”
Cozamanis explains. “EHR software
can be a large investment, and prac-
tices need to do in-depth research
to ensure that they choose the right
product.”
Failures and learning curves
With all the advantages of electronic
records, are there disadvantages?
“Sure,” Norworth says. “Though we’d
like to think that computers stay func-
tional 24/7, they don’t. Be prepared.”
According to Norworth, this prepa-
ration means being ready to manage
internet connectivity issues, computer
problems, and malfunctioning soft-
ware. Having redundant systems in
place to address outages can help.
Your EHR system is dependent on
your technology and connection to
the internet working properly, so you
may want to conduct your own mini-
audit and have contingency plans
ready.
If your office has chiropractic
assistants, co-workers, or other staff
members, consider designating
someone to communicate with your
vendor and note the system begins
working again following an outage.
Ensure everyone on your team who
uses electronic records is familiar with
your EHR contingency plans and is
ready to use an alternative process, if
needed, or fall back on a redundant
system such as an emergency internet
connection.
Cowley believes it is also important
to account for the learning curve of
any new system. Implementation can
temporarily introduce elements of
controlled chaos in your practice. If
you have co-workers or chiropractic
assistants, it is imperative they be
given time to learn.
For a short time, your office may
seem to operate in slow motion as
 designed, find a vendor with a good
The 100 percent paperless office
reputation, compare overall costs, and
“The first step in this process is recognizing that not all EHR systems offer choose a vendor who is compatible
truly paperless freedom,” says Brian Albery, DC, CEO of ChiroSpring Practice with your practice’s long-term goals.
Management Software.
Albery suggests shopping for these software features if you want to Software design: “The user interface
completely cut out paper from your office processes: of an EHR system will be largely
responsible for the success or failure
uImage and document uploading and storage
of integration,” Cozamanis says.
uPatient intake kiosk to make the intake process paperless Easy-to-use software that your team
uPaperless receipts that can be sent to patients
can navigate should be a top priority.
Your staff members can also demo
uDigital statements you can send to patients the software and provide feedback to
uDigital SOAP notes guide the selection process.

uTask management features (no more Post-It notes)

everyone acclimates to the technolog-
ical shift. “New processes and systems
can mean that your business could
stall temporarily,” Cowley says.
Robert Moberg, CEO of
ChiroTouch, says that clinics should
not rush the learning process.
Training can take time. Getting it
right means not pushing too hard
during implementation and not
cutting corners.
“Don’t shortcut the training. These
systems are not too terribly compli-
cated, but they aren’t turnkey either,”
Moberg says. He recommends using
the first few months of EHR imple-
mentation as a time to adjust to
changes and adapt your workflow to
accommodate the new software.
Security matters
Practices should take significant steps
toward keeping patient information
secure—especially now in the age of
HIPAA. This does not change when
you switch to electronic records,
because practices are still expected to
perform due diligence. Today’s cloud-
based EHR systems take much of your
records’ security off the premises of
your clinic and place it in the hands
of your vendor. However, cloud-based
systems can actually be more secure
in many respects than traditional
on-site installations.
“While uncertainty is understand-
able, cloud-based systems can actually
deliver greater security than client-
server systems and paper records.
They use data centers with bank-level
security,” Cozamanis says. With
state-of-the-art encryption, these
technologies can make data unusable
in the event of a security breach,
securing your patients’ protected
health information.
Ultimately, it is your responsi-
bility to ensure your data is secure
by choosing vendors carefully and
keeping your clinic compliant with
HIPAA. As such, choosing a hosted
EHR system should involve both care
and research.
“We recommend that customers
do full due diligence into where their
information is being stored, what type
of cloud the company is using, and
how the company is encrypting and
backing up the data,” Cowley says.
Toward that end, prepare a list of
your own questions and requirements
and ensure that any software product
or platform you choose meets all
HIPAA security requirements.
Choosing your vendor
As Cozamanis points out, vendor
decisions should be made with great
care. He has four recommenda-
tions: Consider how the software is
Vendor reputation: Spend time
reading online reviews and ask trusted
colleagues about their software to
gauge whether a company is stable
and reliable.
Cost: There are also long-term costs.
Certain systems require additional
hardware, networking, and monthly
support and maintenance fees that
all add to the price, Cozamanis says.
“Asking questions can reveal hidden
costs.”
Long-term goals: Evaluate whether
your chosen EHR system will support
your goals and fit with your strategic
planning for growth and profitability.
With these considerations in mind,
you can generate questions for each
vendor you want to demo or shortlist
for your purchase decision.
The implementation
Having a solid implementation plan,
as previously mentioned, is essential.
With a schedule and checklist that
are sensible for your practice, you can
begin the process of switching over to
a new system or changing from purely
paper records.
Your plan can help you save time
and avoid significant headaches. If
you start working without one, you
may make mistakes that require
substantial backtracking. And

64 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

 With each new appointment, entering new data
into the EHR can help you move into your new
system gradually.
repeating your work can be costly.
“Changing your mind about data
entry after you’ve entered hundreds
or thousands of patients can waste an
enormous amount of time,” Norworth
says. This translates directly into
lost productivity and efficiency for a
practice.
Being selective about patient infor-
mation can help you. For instance,
Norworth points out that some forms
of data may not matter enough to
keep in a new system. Depending
on your own clinic’s operations and
records requirements, transferring old
appointments or services that were
already successfully billed may not
be necessary. “Ask your vendor for
advice. Determine what’s important to
transition and how to enter it.”
A customized approach
Implementation timelines vary
depending on the system you use,
whether you are transferring paper
records into your EHR, and other
factors. Generally, you can begin
using your new system sooner than
you might think. But exercising care
by slowing down may be a wise deci-
sion for your practice.
Expect implementation to take
some time. Moberg says a typical
implementation process should
probably take between four and six
months. During that period, your
office will still be learning the new
system and adjusting to both the
learning curve and any efficiency
improvements that begin to manifest
as you leave paper behind.
As Cozamanis notes, little initial
patient data is needed to get started.
With each new appointment, entering
new data into the EHR can help you
move into your new system gradually.
“You should decide if you’ll opt for
66 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
a shorter, more immediate transition
from paper or do the transition in
phases,” he says
With your vendor, create your own
plan to minimize downtime and keep
the transition moving. Cozamanis
recommends a methodical approach:
“The best advice I can offer is not to
rush. Take your time and try to popu-
late the EHR with only the essential
data required to understand your
patient’s health and deliver quality
chiropractic care.”
Reap the rewards
Beginning your implementation
process with the right information
and planning may prevent many of
the EHR struggles you’ve heard of
from colleagues. An EHR system is a
great investment for many practices
looking to improve their productivity,
secure patient data, and offer high-
quality chiropractic care at lower costs.
Selection and implementation are
definitely not worth rushing into. But
these parts of the process needn’t be
intimidating to the clinic that is prop-
erly prepared for the experience.
In addition to compliance, most
certified EHR systems can help with
coding and billing. They could reveal
where and how you’ve been leaving
money lying on the table.
KAITLIN MORRISON is a
freelance writer in Washington,
and she specializes in healthcare
and technology issues. A
frequent contributor to this
magazine, she can be contacted at kaitlin@
kaitlinmorrison.com, or through
kaitlinmorrison.com.
Reference
1 Office of the National Coordinator for Health
Information Technology. “Quick Stats.”
https://dashboard.healthit.gov/quickstats/
quickstats.php. Last updated Jan 2017.
Accessed July 2017.

CK
O
ST
BE
O
AD
2017 chiropractic software marketplace
F
or the past seven years, Chiropractic Economics
has kept you abreast of changes in the payment
landscape related to the advent of electronic health
record (EHR) software and the HITECH Act’s $44,000
reimbursement program for early adopters of certified
systems. A lot has changed since 2010.
As promised, the Centers for Medicare and Medicaid
Services (CMS) is starting to reduce payments for
providers who lack ONC-ATCB certified EHR systems,
and it’s widely assumed that other third-party payers will
follow suit. And now with the advent of ICD-10 coding,
the need for effective software solutions is becoming more
urgent to those who have been dragging their feet with
respect to adopting new technology.
Some software packages integrate multiple functions,
and some integrate with other programs, but the best solu-
tions on the market will, in some fashion, benefit you in
two ways. First, they’ll “earn their keep” by helping you bill
more effectively and reducing the number of contested or
declined payments by third parties. They’ll increase flex-
ibility while lowering your reporting burden. You never
want to leave money on the table when a slight coding or
billing adjustment would have put it in your pocket. And
second, software can help you stay compliant.
The penalties for HIPAA violations are breathtakingly
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 69
SOFTWAREROUNDUP
severe, and the Office of Inspector General (OIG) has
made no secret of singling out DCs for special scrutiny.
But the right solutions for one office aren’t necessarily
the best for another, as each practice and practitioner is
unique. Some systems are optimized for small solo prac-
tices, and some are better suited to multidisciplinary and
integrated providers. In all cases, decisions of this magni-
tude require due diligence. When you are examining
software and vendors, ask for a demonstration if possible—
try before you buy.*
The following listing is an overview of some of the
industry’s leading products, but space doesn’t allow us to
list every company and product we have in our database.
For a full listing, visit us online at ChiroEco.com and click
on “Products & Services.”
EZBIS Office
EZBIS Office is a complete practice management and
electronic health records system, with features for patient
accounting and billing, appointment scheduling and
reminders, electronic health records, patient check-in,
credit card processing, inventory control, and more. EZBIS
software is ICD-10-ready and ONC-ATCB certified for
meaningful use.
800-445-7816 • ezbis.com
 SOFTWAREROUNDUP

ACOM Medical Billing

ACOM Medical Billing from ACOM Health is a new
chiropractic billing service. Its key features include free
online access to all billing activities. Chiropractors can
view what’s been billed, collected, and any communica-
tions with the insurance company or patient—all in real
time. In addition, its billing dashboards aim to provide
easy access to key information, such as average collection
per visit, accounts receivable balance, and average days
from patient visit to collection. In addition, AMB services
also include a free coding review service to all clients. This
service ensures that a practice is receiving its maximum
reimbursement.
866-286-5315 • acomhealth.com

Chiro8000
Chiro8000 from Forté Holdings is a straightforward, easy-
to-use billing and EHR solution designed to manage your
practice. Specifically created for the chiropractic profes-
sion, the Chiro8000 is offered in three levels. The program
fits the needs of a practice looking for a reliable billing
system, all the way through the practice that needs practice
management and EHR.
916-476-1919 • chiro8000.com

3D BodyView system
The Foot Levelers 3D BodyView system is designed to help
you show patients the connection between the feet and
overall wellness, making it easier to recommend functional
orthotics. Visually explain to your patients the importance
of the foot in treating conditions related to the kinetic
chain, which results in greater patient understanding and
satisfaction.
800-553-4860 • footlevelers.com

EHR Thomas practice management software

The EHR THOMAS practice management system offers
inventory tracking, financial reports, e-statements and
billing, a customizable appointment book, and auto-
mated appointment reminders. The company also offers
documentation, coding, and compliance training. Genius
Solutions helps you automate a little or a lot by coordi-
nating its eTHOMAS practice management system with
your favorite EHR solution of choice.
800-645-0955 • geniussolutions.com

Medicfusion EHR
Medicfusion, a subsidiary of VSS Medical Technologies,
is a certified EHR for chiropractors. Since its inception in
2002, Medicfusion has been focused on providing a certi-
fied EHR to professionals seeking an easy-to-use paperless
system with superior customer support. Medicfusion has

70 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

SOFTWAREROUNDUP
an extensive range of features including automated work-
flows, patient web portal, electronic prescribing, electronic
payments, clinical documentation (SOAP notes), compre-
hensive reporting, and online training resources.
866-643-7778 • medicfusion.com
ECLIPSE
ECLIPSE has been used by thousands of chiropractors
across the U.S. since 1985. Practices range from single
practitioner to multidisciplinary, multisite practices
with dozens of providers and more than 150 networked
computers that bill millions in revenue monthly. ECLIPSE
is the only software that has been highly rated in multiple
independent polls by state associations in 2001 and 2012,
and reviewed in 1988 by NYSCA. ECLIPSE handles docu-
mentation, billing, scheduling, and custom forms. It’s
certified for ANSI 5010 electronic claims.
800-966-1462 • ineedeclipse.com
Report Master
Report Master is a chiropractic report writing system
designed to make it easy to document your patients’ care
with complete and compliant SOAP notes and narra-
tives for insurance, Medicare, personal injury, workers’
72 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
compen­sation, MDs, and you. Report Master is easy to use
and comprehensive. It’s marketed as the top chiropractic
report writer in the industry, and it just got better with
Report Master 7 Classic.
727-449-0817 • reportmaster.com
Chart Talk
Chart Talk Clinical Workflow Solutions from Mighty Oak
Technology is a fully integrated, cloud-based EHR system
with easy-to-use practice management, billing, sched-
uling, patient reminders, speech recognition, and excel-
lent support and service. The product is available on any
mobile device or internet browser. Outcomes assessments
are sent with patient reminders.
952-374-5550 • charttalk.net
GoMotive
GoMotive provides chiropractors with an app branded
to their practice to retain clients and build referrals. The
web and mobile platform links chiropractors with trainers
and coaches to create and share online workouts, news,
and best practices. Stay connected to every client, and give
patients a mobile health and fitness solution to track their
progress. Create your own or use our 6,000-plus rehab
exercise videos and evidence-based protocols to build a
workout, set goals, and measure outcomes over time.
206-462-6379 • gomotive.com
Electronic Claims Processing
Electronic Claims Processing from Infinedi is a nation-
wide electronic claims clearinghouse that has been serving
healthcare providers for more than 25 years. Infinedi offers
a wide range of EDI services and tools to make day-to-day
practice and facility operations run smoothly. Features
include claim status reporting (track revenue from trans-
mission to claims payment), electronic remittance advice,
and data collection and analytics.
800-688-8087 • infinedi.net
VitaLogics EMR
VitaLogics EMR is an all-in-one, cloud-based, easy-to-use
practice management solution. The system was built on
Microsoft’s .NET 3.5 platform, which is marketed as the
fastest, most dynamic and easy-to-update platform on the
market. VitaLogics now includes scheduling, calendar,
self-check-in, appointment reminders, billing, electronic
bill batch creation, custom SOAP note macros, one screen
in-visit doctor’s dashboard, one-button practice diagnosis,
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 73
multiple customizable fee schedules, and everything a
chiropractic clinic needs to operate efficiently.
415-529-4338 • vitalogics.com
Platinum System
Platinum System is marketed as the No. 1 fully automated,
paperless EHR system in the world for chiropractors.
Platinum System uses electronic keys to build complete
phrases for detailed SOAP notes within seconds. Then,
it will do all the billing automatically, including insur-
ance. The system features automatic insurance payments
posting, integrated credit-card processing with lower fees,
a unique patient subjective module, and it is ICD-10 ready.
888-808-4898 • platinumsystem.com
Chiro QuickCharts Complete
QuickCharts Complete is a state-of-the-art certified EHR
system featuring billing, electronic claims, electronic
statements, automated payment entry, barcoded sales,
inventory control for supplements and orthotics, prac-
tice-building features, patient retention features, and
collection modules. Supports HIPAA 5010 and ICD-10
standards.
610-820-0440 • get.quick-charts.com
SOFTWAREROUNDUP
PayDC
Make paperwork disappear with PayDC—the easy, afford-
able cloud-based software solution that makes scheduling,
docu­mentation, and billing easier than ever before. Access
PayDC securely from anywhere. Do SOAP notes in under
a minute, create highly detailed care plans automatically,
and submit billing in real time with 99-percent claims
acceptance. Unlimited users and automatic updates are
included.
888-306-1257 • paydc.com
EZnotes
EZnotes was created by two chiropractors in 2002 who
take suggestions from doctors and add them to the soft-
ware updates conducted regularly. The system features
a classic and a certified version (ONC-ATCB complete
EHR). The company added an affordable billing compo-
nent in 2014.
866-821-6837 • eznotesinc.com
Atlas Chiropractic System
Atlas Chiropractic System is a complete EHR solu-
tion. Atlas serves chiropractors with every type of
practice style and philosophy. The system includes
sign-in, touch-screen notes, X-ray analysis, sched-
uling, electronic billing and reconcil­iation, and much
more. Check out the company’s slick modern look
and experience its instant live support access.
877-602-8527 • atlaschirosys.com
EZClaim Medical Billing Software
EZClaim Medical Billing Software is a cost effective and
easy-to-use medical billing system for the small to medium
size office. An expert in the field of medical billing soft-
ware, EZClaim offers a variety of feature-rich solutions
to fit the needs of your provider office, including integra-
tion with Practice Fusion, Amazing Charts, Quick EMR,
WebPT, and other EMR/EHR vendors. EZClaim is also
billing service ready with the ability to create multiple
company files.
877-650-0904 • ezclaim.com
eChiro EHR
eChiro EHR is a compliance-driven, robust EHR
that works for you and helps you focus on what you
do best: providing patient care. This simple, effi-
cient, and secure web-based system operates in the
cloud where patient records are held in HIPAA-
compliant storage. With compre­hensive reporting
capabilities, clinical decision processes, and billing
service options, it’s everything you need.
877-788-2883 • bestpracticesacademy.com/ehr
74 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
WritePad EHR
WritePad chiropractic-specific EHR software is a complete
ONC-ATCB government-certified software system for
meaningful use Stage 2. The WritePad product suite gener­
ates notes and reports through a unique randomized text
feature to help clinics become paperless and compliant
with evolving healthcare industry regulations. Featuring
cloud-based or hosted options, WritePad is used by over
18,000 users nationwide and is compatible with desktops,
laptops, and tablets. WritePad links with your current
billing system and also offers a fully integrated practice
management option.
800-496-2001 • writepad.com
Kareo
Kareo Practice Management allows you to streamline
everything from the front office to back-end billing. Access
your information from anywhere with simple cloud-based
software. Scheduling is easy, and get tools and insights to
get your claims paid faster. Practice smarter with Kareo.
888-231-2871 • kareo.com
NexySoft-DC
NexySoft-DC from Nexyka is marketed as a state-of-
the-art paperless clinic management software. It uses the
most innovative technology, can be entirely customized
to your needs, and has been designed for touch-screen
computers. Being Windows standard, it is marketed as
the most user-friendly system on the market, leading to a
rapid learning process. NexySoft aims to increase the effi-
ciency and profitability of your clinic and save you time for
what matters the most—your patients.
877-891-3657 • nexysoft.com
ChiroFusion
ChiroFusion is a leading provider of affordable, cloud-
based practice management software for chiropractic
professionals. Our easy-to-learn-and-use EHR software
simplifies every aspect of your practice including sched-
uling, documentation, and billing. Our low monthly fee
includes all software updates, training, 24/7 support, and
secure data management. Free electronic claims with auto
EOB posting and ICD-10 compliance.
877-210-3230 • chirofusionsoftware.com
PracticeStudioX16 EHR
PracticeStudioX16 is a Stage 2 certified complete, begin-
ning-to-end, premium EHR solution designed for chiro-
practors. PracticeStudio is backed by over 25 years of EHR
software experience. Get started quickly with a low set-up
cost and affordable monthly plan options. Customizable,
prebuilt chiropractic-specific workflows come ready to use.
SOFTWAREROUNDUP

Choose from cloud-based or server-based options and start Product Directory

practicing using workstations or tablets.
800-235-1856 • practicestudio.net 3D BodyView System.............................................................70

ACOM Medical Billing............................................................70

ChiroSpring
ChiroSpring is a modern cloud-based EHR practice Atlas Chiropractic System.....................................................74
management software for chiropractors that will run your
entire practice. You can write SOAP notes with a touch Chart Talk.................................................................................. 72
screen. The software supports both Mac and PC systems, Chiro Quick Charts Complete.............................................. 73
and was designed by a practicing chiropractor. Check out
the full demo available online. Chiro8000.................................................................................70
888-426-0007 • chirospring.com
ChiroFusion................................................................................74
ChiroTouch and SmartCloud ChiroSpring................................................................................76
ChiroTouch is the premier provider of fully certified inno-
vative chiropractic software technology solutions including ChiroTouch and SmartCloud................................................76
ChiroTouch: Chiropractic’s No. 1 complete practice soft-
ware and SmartCloud: Chiropractic’s No. 1 cloud-based ChiroWrite.................................................................................76
EHR software. Fusing advanced software systems with eChiro EHR.................................................................................74
superior support services, the company partners with
chiropractors across the country to help them automate ECLIPSE....................................................................................... 72
operations, improve patient care, and increase profitability.
312-480-6768 • chirotouch.com
Electronic Claims Processing................................................ 73

EHR THOMAS Practice Management Software.............70

QNotes Office EMR and PDQ Chiropractic
Touch Notes EZBIS Office...............................................................................69
Quick Notes has been a leader in portable chiropractic
documentation software since 1989. This affordable EZClaim Medical Billing Software.......................................74
product line protects your practice against Medicare EZnotes.......................................................................................74
audits, medico-legal issues, and catastrophic loss. PDQ
Touch is the ultra-portable touch solution for iPad and GoMotive................................................................................... 72
Android tablets. PDQ Touch is 100-percent custom-
izable and your patient charts are always in your own Kareo...........................................................................................74
words—never canned or computer randomized. Add the Medicfusion EHR......................................................................70
EasyReports Template Solution for narratives, letters, and
office forms. SOAP notes and documents are safely stored NexySoft-DC.............................................................................74
in the locally installed EMR.
800-899-2468 • qnotes.com
PayDC.........................................................................................74

Platinum System...................................................................... 73
ChiroWrite
ChiroWrite offers multiple packages to assist an office PracticeStudioX16 EHR...........................................................74
with its software needs. Cash-based practices or those
QNotes Office EMR and
who outsource their billing will find ChiroWrite to be an
affordable solution. Offices that need documentation only PDQ Chiropractic Touch Notes........................................76
will find that ChiroWrite can assist in that manner and
Report Master........................................................................... 72
integrates with many different billing systems including
ECLIPSE, Medisoft, InPhase, EZBIS, and many others. The VitaLogics EMR........................................................................ 73
software is easy to use and customizable.
800-642-6082 • softworxsolutions.com WritePad EHR........................................................................... 73

For more software solutions and a comprehensive, searchable products directory go to ChiroEco.com and click on
“Products and Services.”

76 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM


From grazing to amazing
Understand the link between grass-fed meat and healthy cell signaling.
BY R OB ERT DAVIDSO N , PHD
F
ood can play a powerful role
in transforming patients’
lives. No surprise there, but what
may be news to many are the ways
a diet incorporating grass-fed rather
than grain-fed meat and dairy can
benefit patients, particularly those
suffering from inflammation.
It all comes down to lipids—mole-
cules that include fats, fat-soluble
vitamins, and fatty acids that store
energy to enable signaling between
cells, and they provide cell membrane
structure. The lipid composition of
cellular membranes and the organelles
within them mirrors the lipid compo-
sition of a person’s diet. And the lipid
composition of that diet comes from
the nutrients that go into the food’s
production. Grass-fed meat and dairy
is high in healthy omega-3 fatty acids,
while grain-fed products are high in
harmful omega-6 fatty acids. In other
words, you are what you eat, and
you’re also what your food eats.
Lipids strengthen or
weaken health on the cellular
level. In order for the body
to function, cells receive signals
from other cells and the exterior
environment. To receive signals, cells
use receptors. Lipid composition can
alter how well those receptors work.
For instance, a diet higher in omega-3
fatty acids versus omega-6 fatty acids
weakens the receptors between cells
and the genes that cause the inflam-
matory response. Those signals are
still being received by cells, but not
as strongly, decreasing the amount of
inflammation that occurs.
Healthy lipids, healthy body
The inflammatory response is just one
of the negative cellular responses that
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 79
WELLNESSAPPROACH
omega-3 fatty acids weaken. Multiple Nutrition Journal, grass-fed animal
studies have demonstrated the myriad products, including meat and dairy,
benefits of a diet high in omega-3 reflect the lipid composition of the
fatty acids. For instance, eicosapentae- grass on which the animals fed,
noic acid (EPA) and docosahexaenoic compared to conventional corn-fed
acid (DHA)—both omega-3s—play animal products. So why does grain
a crucial role in the prevention of produce meat and dairy high in
atherosclerosis, heart attack, depres- omega-6 fatty acids? The genetically
sion, cancer, and age-related memory modified corn we feed cows has 46
loss. They also lower the risk of devel- times more omega-6 than omega-3
oping Alzheimer’s disease or rheuma- fatty acids. Grass, in comparison, is
toid arthritis. higher in omega-3s. Conventional
Animal studies have also shown U.S. meat production relies on grain
that conjugated linoleic acid—another because it helps cows rapidly
lipid found in high rates in grass-fed
animal products—is beneficial in
reducing carcinogenesis, atheroscle-
rosis, the onset of diabetes,
and in reducing the
accumulation of
adipose tissue.
Studies in humans verify
the effect of linoleic acid
on reducing adipose tissue
accumulation, although only
at ultra-high doses.
Grass-fed meat has additional
benefits; numerous studies have
shown that cattle finished on grass
pastures have up to three times as
much vitamin E than grain-fed cattle.
In addition to making the meat
AD
and dairy more nutritious, this also O
BE
ST
extends the shelf-life of retail meat. O
CK
According to a 2010 study in
 WELLNESSAPPROACH

When recommending grass-fed

meat products to your patients,
you may need to walk them
through the benefits and also what
to expect.

pack on fat and muscle, getting them in shape to slaughter

more quickly than cows that eat grass.

Make the switch

The health benefits of a diet high in omega-3 versus
omega-6 fatty acids are well known. But American diets
do not reflect this knowledge: The typical American diet
contains 11 to 20 times more omega-6 than omega-3 fatty
acids. This trend has been suggested as a significant factor
in the country’s rising rate of inflammatory disorders.
Perhaps Americans have been slow to make the switch
to grass-fed meat products because of the difference in
appearance and flavor. It’s simple: People tend to prefer
the foods and flavors they grew up eating. If you were
raised on grain-fed meat, you expect it to smell and taste a
certain way. But grass-fed meat has a different composition
of fatty acids and flavonoids, leading to a slightly different
sensory experience. And it looks different, too. Carotenoids
in green foliage produces more yellow fat in grass-fed
livestock, compared to the white fat Americans are used to
seeing in grain-fed meat. This yellow fat, however, signifies
a healthy fatty acid profile and high antioxidant content.
In other words, when recommending grass-fed meat
products to your patients, you may need to walk them
through the benefits and also what to expect, so they know
to adjust to the differences.
Another hurdle for many patients may be approaching
fat as a friend rather than an enemy. For decades, fat has
been regarded as a dietary evil, to be avoided as much as
possible. But the science behind this viewpoint is outdated
and nullified by years of research proving that fat—the
good kind—is a necessary component of a healthy lifestyle.
You may need to re-educate your patients on fat and how
it benefits the body.

ROBERT DAVIDSON , PhD, MS, holds degrees in

nutritional science from the University of Wisconsin-
Madison and Utah State University. He has additional
training in the effects of aging, caloric restriction, and
exercise on insulin signaling in the Biodynamics
Laboratory at University of Wisconsin-Madison as well as an NIH
fellowship with the Center for Environmental Toxicology and
Technology at Colorado State University. Before coming to Logan,
he was an assistant professor of nutrition at Brigham Young
University in Utah.

80 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

 WELLNESSAPPROACH
The rest of the story
Why sleeping position matters.
BY RO BERT G. SI LV E R MAN , D C
H
ow do feel when you
wake up in the morning?
Refreshed, rested, and ready
to go? Or stiff, achy, and wishing you
could go back to sleep for another few
hours? The difference may depend on
your sleeping position.
Sleeping on your back
Most experts agree that sleeping on
your back is the ideal position, but
it’s not for everyone. When you sleep
on your back, you stretch your body
out evenly on the mattress. Your
head, neck, and spine are aligned in
a neutral position—there’s no extra
stress on any part of your body. As
a chiropractor, I recommend back
sleeping, because it puts the least
amount of pressure on the vertebrae
82 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
and discs of the spine.
If you have trouble with acid reflux,
lying on your back with your head
elevated a bit by your pillow is a good
way to keep acid from coming up.
But sleeping on your back has one big
drawback: snoring.
If you already snore, lying on your
back makes it louder. This is the most
likely position to trigger “Honey, roll
over” from your bed partner. It’s also
the worst position for sleep apnea,
a sleep disorder that makes your
breathing repeatedly stop and then
start again, sometimes with a loud
snorting or choking sound, usually
because the throat muscles relax
during sleep and block the trachea.
Sleep apnea is linked to heart
disease and high blood pressure
ADOBE STOCK
(among other problems), and can
even be fatal. If you’re a heavy snorer,
talk to your doctor about doing a
sleep study to detect sleep apnea.
Sleeping on your side
The side position, with your torso
straight and legs stretched, keeps your
spine elongated and unstressed. If you
tend to wake up with back and neck
pain, try this position—after a few
days, you’ll notice a positive change in
how you feel in the morning. It’s also
a good choice if you snore or have
sleep apnea, because it helps keep
your airway open.
If you have acid reflux, sleeping
on your side keeps the acid from
coming up. Sleeping on your left side
works better for this, because in that
WELLNESSAPPROACH

Sleep apnea is linked to heart disease and high blood pressure

(among other problems), and can even be fatal.
position, the stomach is below the
esophagus; gravity keeps the acid in
the stomach where it belongs.
During pregnancy, many women
find that sleeping on their side is
the most comfortable position for
breathing comfortably and relieving
backache. If you can, sleep on your
left side to increase the amount
of blood that flows to the womb
and nourishes the baby. For added
comfort and support, put a pillow
between your legs.
The fetal position
Curling up on your side, much as
babies and small children do, is
perhaps the ideal sleeping position.
With your torso and legs bent, you’re
putting as little stress as possible on
your spine while you sleep. This is a
great position for reducing snoring
and preventing acid reflux.
The drawback is that it can be
tough on the joints if you’ve got
arthritic hips or spinal stenosis—you
might wake up feeling stiff and sore.
Put a pillow between your knees to
reduce the risk of lower back pain or
stiffness.
If you regularly sleep on your side,
your pillow matters. You want a
pillow that will support your head in
a neutral position and avoid putting
stress on your neck. Side sleepers
who wake up with neck pain or stiff-
ness should take a good look at their
pillow. Ideally, it will be firm enough
to comfortably support the head and
neck. Position yourself so only your
head and neck—not your shoulders—
are on the pillow.
Sleeping on your stomach
Ordinarily, you would be inclined to
tell your patients to sleep in what-
ever position is most comfortable for
them. There’s one exception, however
sleeping on your stomach. This posi-
tion puts a lot of pressure on the back
and neck. Because you have to turn
your head to one side to breathe,
you’re likely to wake up with stiff and
sore neck and shoulder muscles; you
might even wake with numbness and
tingling in your arms. Sleeping on
your stomach also puts a lot of pres-
sure on the lumbar (lower) spine, so
you could wake up with lower back
pain.

84 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

 Sleeping on your stomach also puts
pressure on your digestive system,
heart, and lungs. If you snore, you’ll
snore more sleeping on your stomach.
And if you have sleep apnea, it will
be worse when you sleep on your
stomach.
If you’re a stomach sleeper, I
suggest trying to alter your sleeping
habits and sleep on your side instead.
To help you get used to the new posi-
tion, lie on your side and put a pillow
next to you near your abdomen. It
will help keep you from rolling onto
your stomach.
Choosing the right pillow
Your sleep position is crucial for
waking up feeling great, but other
factors come into play. Your bed
pillow is critically important for
supporting your head and keeping
your head and neck aligned while you
sleep. Choose a pillow that matches
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 85
your favorite sleeping position.
Back sleepers usually do best with a
medium-soft pillow that supports the
natural curve of the neck. If you’re a
snorer, elevating your head may lower
the volume and help with sleep apnea.
Try using two or three firm pillows
or a wedge pillow to raise your head,
neck, and shoulders.
Side sleepers should look for a firm
or even extra-firm pillow that will
keep your head and neck aligned. If
you must sleep on your stomach, look
for a thin soft pillow that won’t bend
your neck out of its natural curve. For
your patients with neck pain, recom-
mend a cervical pillow.
Pillows are filled with all sorts of
materials: latex, polyester, down, even
buckwheat hulls. Many chiropractors
feel the best choice of material by far
is memory foam. The foam adapts
to provide pressure-free support for
the head and neck and helps keep the
spine in alignment during sleep.
Nevertheless, good sleep position
won’t make up for a bad mattress.
Anecdotal reports from patients that
suggest the ideal mattress is made of
memory foam. A memory foam
mattress contours to the spine’s
natural curves and distributes body
weight evenly. With no pressure
points or sags, memory foam
mattresses promote comfortable sleep
through the night.
ROBERT G. SILVERMAN , DC,
CNS, CCN, CSCS, CKTP, CES,
CIISN, DACBN, DCBCN, HKC,
SASTM, teaches seminars
nationwide and in Canada and
has a successful sports injury and sports
performance private practice in
Westchester County, New York, and is on
the advisory board for BioPosture. He can
be reached at 914-287-6464,
drrobertsilverman.com, info@
drrobertsilverman.com, or through
erchonia.com.
ADVERTISEMENT
ADOBE STOCK
Strategies to grow your practice
Work smarter, not harder, to connect with your patients.
BY R OB BERMAN
C
hanges in the healthcare
system, including electronic
health records, value-based
reimbursement, onerous reporting
to third-party payers, and shrinking
payments for your services, require
you to more aggressively market your
practice. And there are new ways for
you to engage and retain your current
patients without working harder. Are
you taking full advantage of these
trends?
Widening demographic
More people than ever are using
chiropractic care, according to
the 2015 Gallup-Palmer Inaugural
Report: Americans’ Perceptions of
Chiropractic. Almost half the adults in
the U.S. have been to a chiropractor
as a patient, and almost 15 percent of
adults have seen a chiropractor within
the last 12 months. Additionally,
within the past five years, 12 percent
of U.S. adults have seen a chiro-
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 87
MARKETINGMATTERS
practor, and 25 percent say they saw a
chiropractor more than five years ago.
Not only does this data suggest that
more adults are seeking chiropractic
care but that nearly half of all adults
will see a chiropractor at least once.
Despite chiropractic’s success at
reaching a larger audience, there still
remains a population that needs to
engage or re-engage with chiropractic.
You are in a unique position as a
business owner to directly influence
your practice revenue by the efforts
you put into your marketing. Without
a sustained and conscious effort to
grow your patient base, your practice
will begin to slow down, level off, or
begin a downward spiral.
What about the competition?
Don’t be afraid to be different when
it comes to marketing your practice
on social media. Virtually all your
marketing efforts should be focused
on the key issues and concerns of
your potential patients: What is
keeping them up at night? What
would they like to get most out of
chiropractic care? Use this informa-
tion to create a simple message that
can be used across media and in
multiple ways.
Consider some different ways
to communicate with patients
both online and in person. These
can help you better evaluate your
current efforts in each of these areas.
Remember, do not double down on a
tactic or strategy that is not working;
instead, try something new.
Referrals from patients
and doctors
Referrals are an easy way to eval-
uate the health of your practice.
If patients are getting better and
enjoy interacting with your staff,
they’ll recommend you to their
family and friends. But no practice
 MARKETINGMATTERS
can thrive by counting on refer-
rals from happy patients alone.
Develop a referral system and use it.
Remember, referrals are a two-way
street: give them and ask for them.
Create a list of physicians and
providers who are likely to refer
patients to your practice and network
with them. You will quickly gain more
referrals in addition to expanding
your number of referring sources.
Always thank the providers with a
fruit basket or snacks.
Engage with patients
You can significantly increase the
responsiveness to your marketing
message by making a high value,
low stress offer. Develop an ongoing
educational and automated conver-
sation with your patients. Share blog
posts, newsletters, or helpful articles.
Think about what your patients would
benefit from the most and highlight
those articles. It can be anything from
services and procedures that have
been proven to get results, and which
your office also offers. Patients—or
potential patients—respond to a high-
perceived-value offer.
Send postcards to your patients to
fill them in on the latest in your prac-
tice, or to remind them how thankful
you are to have them as a patient.
Because most mail is white, off-white,
or beige, postcards let you stand out
with bright colors and attention-get-
ting graphics. A quality mailing list
is essential for this task. Look in your
EHR system for addresses of current
and lapsed patients or purchase
a mailing list from a reputable
company.
Speak and write
You can reach those who may know
little or nothing about chiropractic
by speaking at various clubs. For
instance, Rotary and Kiwanis clubs,
chambers of commerce, health clubs,
and sports clubs are constantly in
need of expert speakers. If you have a
88 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
sports and rehabilitation-based clinic,
then sports teams and sports clubs are
a natural. If you are amenable, offer
free initial exams or X-rays or other
services to bring them to your office.
Have a staff member record your talk,
divide the content into snippets, and
use those clips on your website in
addition to posting them to YouTube.
Always be looking for creative ways to
reuse and repurpose your content.
You can also hold short seminars
in your office or an outside location
on topics of interest to patients and
potential patients. Your office will
do all the marketing since you won’t
have a sponsor like a chamber of
commerce. Share your knowledge
and love for chiropractic, give the
attendees a special gift or offer, and
make the experience valuable. Help
your potential patients see the value
in chiropractic, and you will increase
your practice revenue.
Local newspapers and websites,
regional magazines and various news-
letters seek content to fill their pages.
You are well educated and knowl-
edgeable. Don’t be afraid to share this
knowledge with current and potential
patients so that they can view you
as an expert, and “go-to” person, for
their condition or situation. Once you
are published, share the information
on your website and via social media.
Have it framed in your waiting and
treatment area.
You can also send out press releases
regarding important events in your
practice. The local media may publish
your press release, write a short story
quoting your press release or contact
you for an interview.
ROB BERMAN is a partner at
Berman Partners LLC, a medical
device sale, service, and
marketing company. Berman
Partners specializes in new and
preowned therapeutic lasers. He can be
contacted at 860-707-4220, rob@
bermanpartners.com, or through
bermanpartners.com.
 MARKETINGMATTERS
A bigger brand
Attract news media to build your expert status.
BY STEVE COX AN D CLAU D I O G O R M AZ
A
fundamental truth about
business, including the
medical profession (and
especially when speaking of medical
clinics), is the fact it’s a never-ending
competition to excel and succeed.
With that in mind, be on a
constant lookout for opportunities
to draw the limelight of publicity to
yourself. What if you could create
that opportunity on a much larger
stage than you imagined? What if you
could have access to huge numbers of
potential patients?
It’s a noisy world out there, and
your voice must resonate above the
clamor. Your message needs to stand
out, both in content and value; and,
just as impor­tant, your brand needs to
be elevated.
90 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
To raise your brand, you must
be seen as an expert in your field.
A profoundly effective method for
achieving that status is by building
relationships with local, regional, and
national media sources. Through these
relationships you can develop a mass-
media footprint (as you begin to be
featured in magazines, cable program­
ming, and news outlets, for example).
Hijack the news
The point of building symbiotic rela-
tionships with the media is to share
your knowledge on a large stage.
Moreover, you can use your exper-
tise to educate a greater swath of
the public than just your immediate
patient base. Your knowledge can add
context and perspective to the media’s
health conversations.
The most successful doctors
develop ways to inject their ideas and
percep­tions into monthly and weekly
journals, even in breaking news
stories in real time to generate media
coverage for themselves by tapping
into public discourse.
The strategy of targeting breaking
news stories is known as “news
jacking.” Technology has created a
level playing field—literally anyone
can news jack—but it still favors
players who are observant, quick to
react, and skilled at communicating.
It’s a powerful tool that can be used to
leverage your profes­sional experiences
and enhance the quality of the news
being presented.
News jacking is indeed powerful,
but only when executed in real
time. It is about taking advantage of
K
ADOBE STOC
 MARKETINGMATTERS
To be most effective, launch your messaging
ahead of the competition and attract the
attention of highly engaged audiences by
taking advantage of breaking news.
changes that may pop up only for
a fleeting moment. In that instant,
if you are shrewd enough to add a
new dimension to the story as it’s
unfolding, the news media will write
about you.
It is only because of the emergence
of the real-time web that news jacking
has become possible in a methodical,
systematic fashion.
According to noted marketing and
sales strategist, David M. Scott, author
of News Jacking: How to Inject your
Ideas into a Breaking News Story and
Generate Tons of Media Coverage,
“We live in a 24/7/365 world, in a
second-by-second news environment,
where the most prosperous and savvy
operators realize there are new ways
to generate media attention.”
A nimble strategy
The rules have changed; the tradi-
tional public relations (PR) model—
sticking closely to a script and
campaign timeline—no longer works
the way it used to. Public discourse
now moves so fast and dynamically
that all it takes is a single afternoon to
blast the wheels off someone’s labori-
ously crafted narrative.
To be most effective, launch your
messaging ahead of the competition
and attract the attention of highly
engaged audiences by taking advan-
tage of breaking news. And you do
that by generating attention and
growing business in real-time.
Our always-on, web-driven world
has new rules for growing a business.
Advance planning is out and agile is
in.
The objective is to get in the second
and subsequent paragraphs of stories
in print. If you are clever enough
92 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
to react to breaking news quickly,
providing credible second-paragraph
content in a blog post, tweet, or media
alert that features the keyword of the
moment, you may be rewarded with a
bonanza of media attention.
As Scott says, your job is to spot an
angle and get it online as fast as you
can. You need to be astute and quick.
Your goal is to create a synergistic
relationship that benefits both the
media and you alike. Top publi-
cations, regional and community
television and radio, and national
publications are always looking for
experts to quote when big stories
break. Your goal is to create and
establish relationships with them so
they’ll turn to you when they have an
immediate need.
For example: Say your local news
channel is developing a story on the
dangers of beginning spring activi-
ties after a sedentary winter. As the
anchor begins describing the potential
health concerns, they turn for expert
testimony from a local chiropractor
regarding the possible injuries that
might be sustained and the preventive
measures people can take.
It starts with a plan
Jennifer Ashton, MD, and Rahul
Jandial, MD, PhD, are both noted
experts who regularly appear on ABC
World News Tonight and KTLA news
discussing health-related topics. You
may also know Drew Pinsky, MD,
and Sanjay Gupta, MD, who are
frequent guests in newsrooms and
now have their own shows. These
doctors demonstrate just how far
expert status can take you.
The takeaway is that these things
don’t happen randomly; you must
MARKETINGMATTERS
form bonds that let the media know
that you’re an available, competent,
informative, and reliable resource.
You can find media opportunities
on two levels: First, your immediate
sphere of business activities (such as
local associations, business affiliations,
and industry publications) and local
or personal interests and, second, in
the wider scope of national and global
news.
Stay plugged in
Develop news-monitoring strategies
that keep you instantly informed on
the local and national level. Monitor
media and journalists you may
already know, including the influen-
tial blogs and trade publications that
cover your marketplace.
There are many ways to keep your
eyes on available media opportu-
nities. You can do regular Google
searches for specific topics and who’s
94 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
addressing them. Or, you can set up
Google alerts for particular subjects.
Another option is to sign up for sites
like sumo.com to look for genre arti-
cles and who’s writing them. LinkedIn
is another resource for developing
relationships with writers, publishers,
and editors.
Develop a list of search terms rele-
vant to your practice and interests.
Search for industry terms, competi-
tors, prospects, and products, plus any
buzzwords or phrases—everything
you can think of is fair game.
Make it a priority to follow blog-
gers, analysts, journalists, and others
who cover your brand of healthcare.
Identify as many voices and relevant
trade journals as you can.
Reap the rewards
If your written voice develops a
reputa­tion for informed, insightful,
authoritative, articulate, quotable, and
timely commentary on key issues in
healthcare, journalists will learn to
seek you out for your perspective.
Maybe you won’t be the next Dr.
Oz, but if you’re interested in
networking, promoting your practice,
educating the public, engaging with
your patients (and those at large),
contributing to medical conversations,
and developing your brand, seek out
the media.
STEVE COX and
CLAUDIO GORMAZ
have worked with the
chiropractic
community for over
20 years. Many prominent medical
practices in the country have benefited
from their strategies, developed fruitful and
predictable advertising messages, as well
as creating solid branding platforms while
elevating their resident expert status. They
can be contacted through 530-492-9971,
stevenvonloren.com, or stevenvonloren@
yahoo.com.

Natural
approach to
joint and gut
dysfunction
Chiropractors can
effectively approach
joint health through
supporting the gut.
BY HANNAH F E LL
I
nflammatory bowel diseases
can impact a patient’s overall
health and make chiropractic care
more challenging. Understanding
the connection between the gut, its
physiology, and the balance associ-
ated with probiotic bacteria and joint
dysfunction is key to successfully
treating chiropractic patients.
According to a study that examined
the gastrointestinal tract (GIT) and
musculoskeletal diseases, “Patients
diagnosed with musculoskeletal
diseases are reported to have a predis-
position to GIT disturbances that
includes dyspepsia, nausea, abdominal
bloating, and irregular bowel habits.”1
Treating the patient in a way that
targets both gastrointestinal issues as
well as joint issues, such as osteoar-
thritis, will help the patient achieve
overall health.
Joint inflammation
and gut issues
Arthritis is a growing issue among
American adults, and nearly 55
million adults are affected by this
condition, according to the Centers
for Disease Control and Prevention.
96 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
Innovative Ideas from the Industry Leaders
However, arthritis is more than a
condition that affects the joints and
tissues. In fact, according to a 2015
study, it “represents a state of chronic
inflammation that might be provoked
or aggravated by the overgrowth
of pathogenic bacteria or a lack of
immune-modulating commensal
bacteria.”2
The balance of good bacteria is
what contributes to the reparation
of this cyclical inflammation, and
without it, the immune response isn’t
being regulated. This issue creates a
cycle that further contributes to the
chronic inflammation that results
from rheumatoid arthritis. Despite a
chiropractor’s spinal adjustments, the
gastrointestinal imbalance will persist
in impairing the patient’s health.
Not all chiropractors will look at
gut issues to support joint issues,
says Ramneek Bhogal, DC, DABCI,
a practitioner of chiropractic who
does functional medicine testing and
consulting. “Chiropractic musculo-
skeletal [care] can vary in approach
from practitioner to practitioner,” he
says. “If you have a chiropractor that
does something beyond, we would
ADOBE STOCK
call them [functional medicine practi-
tioners or] nutritional therapists.”
Functional medicine practitioners
can examine the impact of gastroin-
testinal issues on joint health that a
significant number of patients expe-
rience. According to a 2010 study,
“The most common extra-intestinal
manifestation, articular involvement,
occurs in 16 percent to 33 percent
of inflammatory bowel disease
patients.”3
Gastrointestinal diseases such as
Crohn’s disease, inflammatory bowel
diseases, and ulcerative colitis have
also been shown to have adverse
affects in areas outside the intes-
tines.4 This inflammation of the
gut influences the joints and joint
health—especially when arthritis
is present in a patient. One of the
biggest concerns with gut issues is
called “leaky gut syndrome,” Bhogal
says. With this condition, the intes-
tinal lining starts to become worn
down, losing its continuity and
elasticity.
“All sorts of things happen as
a result,” Bhogal says. “You don’t
absorb food as well, you might expe-
EDITORIAL SERIES SPONSORED BY DAVINCI LABORATORIES OF VERMONT
rience direct intestinal symptoms,
gas, bloating.” These types of symp-
toms represent indications of a larger
dysfunction. Functional medicine
chiropractors take these symptoms,
often seen as independent of their
joint health, seriously. Leaky gut
can be a brought on by a number of
factors including stress, a poor diet,
and prescription medications.
The American diet also contrib-
utes to these musculoskeletal issues
because of the toll it takes on the
digestive system, says Jim Fox, DC,
who runs one of the leading func-
tional medicine providers in the U.S.
“When you look at the physicality of
people who have joint issues, they are
typically having musculoskeletal issues
and are having inflammatory issues all
over the body. Typically, this is linked
to diet,” he says.
“If they don’t change their diet
it isn’t going to fix [the issue],” Fox
says. He suggests eliminating as
many processed foods as possible
and adding healthy forms of protein
into the diet that can help assist with
rebuilding some of the gut’s connec-
tive tissue. Eliminating stress can also
help the patient.
A natural approach
A gut supportive protocol can help
a patient manage gastrointestinal
issues and support joint health. It
strengthens responses to chiropractic
adjustments and aids the patient in
holding their adjustments longer.
This support happens on a spectrum,
Bhogal says. “It could be as simple as
providing probiotics.”
Natural therapies that serve as
adjuncts to the chiropractic adjust-
ment or physiotherapies support
the patient without aggravating
the existing intestinal dysfunction.
Bhogal recommends a three-step
gut-restorative protocol. He provides
his patients with a compound that
has been shown to impact cytokine
activity and support joint comfort
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 97
Healthy gut = healthy joints
Joint Support: Perna Plus is comprised of Perna canaliculus (Green Lipped
Mussel), among other key joint supportive ingredients. Perna is a naturally
occurring compound rich in amino acids, polypeptides, naturally chelated
minerals, fatty acids, vitamins and all classes of glycosaminoglycans including
chondroitin sulfates and hyaluronic acid that occur in connective tissues
such as joint cartilage, tendons, ligaments and synovial fluid. The naturally
occurring components in Perna support joint lubrication and flexibility, reduce
joint discomfort and improve range of motion.*
The primary inclusions in CX-2 Solution™ are Sea Cucumber, Glucosamine,
Hyaluronic Acid and MSM to support joint structure and function with Meriva
Curcumin, Boswellia, Quercetin and DMG to support joint comfort.*
Digestive Support: Mega Probiotic-ND™ 25 contains 16 unique species
of microorganisms from nondairy sources. Each species has a unique
mechanism of action that works at a specific part of the digestive tract,
creating a well-rounded formula that can support a healthy GI tract.*
GI BenefitsTM offers high intensity intestinal permeability support while also
providing soothing herbs for digestive comfort. 5 grams of glutamine serve
as the foundation for this formula which also features 1 gram of the prebiotic
arabinogalactan, DGL, marshmallow, slippery elm and the clinically proven
PepzinGI (Zinc Carnosine).
Gut/Joint Protocol at A Glance
uPerna Plus: 2-4 tablets daily
CX-2 Solution: 3 capsules 1-2 times daily
u
depending on degree of support needed
uGI Benefits: 1 scoop daily
MegaProbiotic ND 25: 1 capsule 1-2
u
times daily
For more information on DaVinci Laboratories of Vermont or the Benefits line, call 800-
325-1776 or visit davincilabs.com.
*These statements have not been evaluated by the Food and Drug Administration. These
products are not intended to diagnose, treat, cure, or prevent any disease.
and mobility, such as omega-3 fatty toward improved joint health. Fox
acids (EPA, DHA, and ETA from says that providing approaches to
Green Lipped Mussel for example), both gastrointestinal and joint issues
glycoaminoglycans, or well researched at the same time can lead to successful
extracts such as curcumin, boswellia responses. “If they go along with
and ginger as well as foundational treatment protocols, working with gut
nutrients. Probiotics and prebiotics and inflammatory responses, they do
are baseline nutrients that can aid in well,” he says.
this process.5
The chiropractor can then address HANNAH FELL is the associate
editor for Chiropractic
the issues for joint pain, depending on
Economics and MASSAGE
the patient and what the patient Magazine. She can be contacted
needs. Other supportive formulas, at hfell@chiroeco.com or on
such as an intestinal permeability Twitter @hcfell.
support product including glutamine, To view the references for this article
can be used to help the transition visit, ChiroEco.com/davincirefs.
ADOBE STOCK
Success by design
Keep your patients happy with a great online user experience.
BY P ATRICK FOSTER
A
s more businesses move
into the online world,
it’s becoming common for
chiropractors to go digital as well. If
you want to succeed on the internet,
ensure you’re providing a top-notch
user experience, because if your
website isn’t easy to use, it won’t be
as useful as it could be to potential
patients and colleagues.
This is a chance to create your
digital brand and add value to how
you are already working with patients.
Whether it’s down to how your
website looks or how it works, there
are many factors that contribute to
a website’s user experience (UX).
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 99
Here’s how you can craft an online
patient experience that’s exceptional
and reflective of your professional
expertise.
An attractive landing page
When internet users are looking for
a chiropractor, most will conduct a
quick Google search and look at the
first few websites they come across.
They’ll take a look over the initial
landing pages of those first few, and
select the one that’s most appealing.
How does your site look from a
first-time user’s perspective? If it’s
unappealing, that’s bad news for your
business.
TECHTALK
Clear branding: This is needed so
that visitors know who you are and
can remember the name of your
practice—don’t be gimmicky or
cutesy. Be clear and descriptive to be
memorable.
Easy checkout: Make it easy for
visitors to see where they need to go
in order to pay for your services or
products. This should be your site’s
primary goal.
Strategic whitespace: Use whitespace
on your website to draw users’ eyes to
important features like calls to action
and testimonials.
TECHTALK
Important information: Stick to the
most important things; don’t litter
your landing page with filler content.
Tell people who you are, what you
do, and why you’re better than the
competition. Remember to KISS (keep
it simple, stupid).
If you stick to these four points
(and they can be followed even with
the most basic website creation tools),
100 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
then you’ll likely have a good-looking
landing page.
Easy means of contact
You want visitors to your site to
always have an easy way to get in
touch with the support team. Patients
will have lots of questions about
“what X means,” and “if you offer Y.”
Even if the information is available
on your site, they’ll probably want to
talk to somebody and have it clearly
explained.
Here are a few ways to ensure that
the visitors to your site find it easy to
reach you:
Live chat: If your customers can
launch a live chat at any time with the
press of a button, they can get their
questions answered ASAP.
Phone number: If you’ve got a
telephone line open for new patients
to call in with questions at any time,
list it on your site where it can be
easily found. Ideally, include it in a
banner on every page.
FAQ page: Some people feel anxious
about speaking to a support team
member (even over live chat), so for
those patients it is best to provide a
frequently asked questions (FAQ)
page. This will help save time for both
you and them.
These features should be provided
by any commercial website, espe-
cially one that’s offering complicated
medical services.
Patient alerts
Your patients will appreciate it if you
provide them with reminders about
upcoming appointments. There are
lots of variations on this strategy, all
of which can help improve your UX.
Here are a few ideas:
Cancellation notifications: If a
patient has recently tried to get an
appointment for a certain date but
found you were all booked up, you
could send them a notification if their
original choice opens up because of a
cancellation.
Appointment reminders: Nobody likes
to miss an appointment, so send your
patients a reminder the day before.
After all, no-shows aren’t good for
your practice, either.
Ask someone to try and book an
appointment from your practice’s
website. If they find it easy to
accomplish, then there’s an
excellent chance your average
customer will, too.

Booking reminders: Do your patients follow routines?

Perhaps some visit every month or every six months.
Either way, around the time that you have suggested they
next visit, you can send them a reminder. They’re likely to
appreciate it and you’re likely to get another appointment
booked.

Closure alerts: If you ever have to close down your practice

for repairs (or any other reason), let your customers
know about it. They’ll appreciate your alerting them and
potentially saving them a wasted trip.
You may not think that such notifications would be easy
to set up, but you’ll find that commonly used e-commerce
solutions make it simple to offer these services. And it’s
easier to implement alert systems with an ecommerce
company than it is through an independent developer. It’s
generally more cost-effective, too.

Make time for testing

The best way to make sure you’ve got a good UX is to test
it. A simple way to do that is to ask someone to try and
book an appointment from your practice’s website. If they
find it easy, there’s a good chance your average customer
will, too. A fresh set of eyes can give you a perspective you
hadn’t considered.
There are also services that focus on researching the
best ways to improve the UX on your site. They can
then implement their ideas if you approve. You may not
have room for this in your budget, but it could be worth
thinking about in the future.

There are many factors that contribute toward a good

UX. It may be less a case of considering what will
encourage the user to make a booking and more about
what will make life easier for your patients. And that can
be why they’ll turn to you over your competitor.

PATRICK FOSTER is a freelance e-commerce blogger

over at ecommercetips.org. He has more than a
decade’s worth of e-commerce experience, and a strong
understanding of what makes sites work and what
makes sites fail. He can be contacted at patrick@
ecommercetips.org or on Twitter @myecommercetips.

CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 101

 BUYERSGUIDE

Software
Chiropractic Economics is pleased to present the profession’s most comprehensive
Software directory. The information in the resource guide was obtained from
questionnaires completed by the listed companies.
1st Providers Choice Anywhere MD ChiroConceptions
480-782-1116 805-308-0278 301-777-3710
1stproviderschoice.com auto-doc.com chiroconceptions.com
AS/PC for Windows Auto-DOC/Pilot SpineTech Pro
IMS for Chiropractic SpineTech SOAP
Paperless Office for Chiropractic Apex EDI
800-840-9152 ChiroFusion
20/20 Imaging apexedi.com 877-210-3230
866-734-6234 Apex EDI chirofusionsoftware.com
2020imaging.net Chirofusion
20/20 Imaging Atlas Business Solutions Inc.
701-235-5226 ChiroSoft
2nd Cousin Inc. 877-852-4476
abs-usa.com
413-232-3219 Patient Appointment Manager chirosoft.com
healthnewspodcast.com ChiroSoft
The Cross Platform Widget & The Atlas Chiropractic Systems ChiroSoft Billing
SYSTEM 877-602-8527
atlaschirosys.com ChiroSpring
3DRX Inc. 888-426-0007
Atlas Chiropractic System
360-909-3709 chirospring.com
3drx.com Backbone ChiroSpring
3DRX Insight 801-693-1016
backbonepro.com ChiroTouch
ABC Coding Solutions 800-852-1771
505-503-1336 Backbone Dashboard
chirotouch.com
abccodes.com BackChart ChiroTouch
eClaim.biz
608-406-2099
backchart.com ChiroVision
Abrea Technologies Inc.
BackChart COS 800-438-9355
973-353-6209
chirovision.com
freemedicalclaims.com Best Practices Academy ChiroVision
Free Medical Claims
877-788-2883
bestpracticesacademy.com ClearGage Inc.
Accentia Healthcare Services
866-367-2016 eChiroEHR 888-227-5932
accentiahealth.com cleargage.com
InstaKare
BestNotes ClearGage
866-543-6646
Accept Credit Cards bestnotes.com CoAction Software
800-476-5020 BestNotes 858-509-7787
elect-mer.com coactionsoft.com
Credit Card Processing
Billing Precision CoAction Software
866-387-1058
Acme Data LLC billingprecision.com CommVantage
248-310-3736 Billing Precision 866-399-4009
acmedatallc.com 3dpractice.com
Online Backup Service BioEx Systems Inc. Beyond View
800-750-2756
ACOM Health bioexsystems.com Compulink Business Systems Inc.
866-286-5315 Exercise Pro, Nutrition Maker 800-456-4522
acomhealth.com compulinkadvantage.com
RAPID Documentation and Practice Biokinemetrics Compulink Chiropractic Advantage
Management Software 888-507-6552
biokinemetrics.com Computer System Consultants Inc.
Acrendo Software ChiroSight 203-261-8084
800-403-2330 csctechnet.com
acrendo.com Blind Spot Mapping CSC Sky Charts
A.I.Med 530-949-1353
blindspotmapping.com Davlen Associates Ltd.
Addison Health Systems Inc. Physiologic Blind Spot Imager 631-924-8686
800-496-2001 davlendesign.com
writepad.com BodyZone.com Computerwork stations
Write Pad 770-922-0700
bodyzone.com DB Consultants Inc.
Allscripts BodyZone Rehab Exercise Protocol 610-820-0440
515-327-8850 PostureZone Digital Posture Assessment dbconsultants.com
medinotes.com Software AS/PC Complete
Charting Plus SOAPer Daily SOAP Notes Quick Charts Complete

AMD Technologies Inc. Bryanne Enterprises Inc. Demandforce

800-423-3535 877-279-2663 800-246-9853
digitalams.com bryanne.com demandforce.com
PACS-in-a-BOX Phases Rehab Demandforce D3

AMS Software Cash Practice Inc. Digital Data Resources

919-570-6001 877-343-8950 732-821-7776
ams-software.com cashpractice.com ddrprofile.com
AMS MASTER MVP Program Cash Plan Calculator System Profile Deluxe

102 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

 BUYERSGUIDE
Doctorsync EZnotes Genius Solutions Inc. Infinedi LLC
800-373-1935 312-212-1602 800-645-0955 800-88-8087
wonderdoc.com eznotesinc.com geniuschiro.com infinedi.net
WonderDoc EZnotes Billing eTHOMAS Practice Management
EZnotes Certified THOMAS EHR InPhase Technologies Group
Document Plus EZnotes Documentation System
770-814-2442 Havenridge Consulting LLC 706-235-7800
EZnotesClassic
docplus.net 888-978-5222 inphasetech.com
Document Plus Foot Levelers Inc. quick-charts.com InPhase Technologies
800-553-4860 Chiro QuickCharts
DocuRehab LLC Inphonite LLC
footlevelers.com HC IT Development
718-362-6774 Foot Levelers Report Generator 800-350-7693
docurehab.com 866-920-6106
inphonite.com
DocuRehab Forte Holdings Inc. e-healthbooks.com ReminderPro
e-healthbooks
800-456-2622
E-nate Inc. Integrated Practice Solutions Inc.
emr4chiro.com Healthcare Perceptions
866-362-8388 Chiro8000 814-317-7702 703-738-6898
e-nate.com eTime Clock hcperceptions.com get-ips.com
e-nate Forte EMR Perceptions
E-Z BIS Inc. Secure Claims JFB Billing Service and Software
HealthSoft Solutions 816-228-8768
800-445-7816 FreeCHIRO.com 888-477-2656
ezbis.com 510-200-0955 healthsoftsolutions.com jfbbilling.com
E-Z BIS Office HealthSoft Doc Billing Service & Software (Altapoint)
EZBIS Basic freechiro.com/emr
FreeCHIRO HealthSoft ExEd
EZBIS Electronic Health Records HealthSoft TimeClock JTECH Medical Industries
Fujifilm Medical Systems U.S.A. Inc. 800-985-8324
Easy Billing Inc. Herfert Chiropractic Software
800-618-6136 800-431-1850 jtechmedical.com
586-776-2880 Eval Express Chiropractic Survival Tool Kit
easybillingsoftware.com fujiprivatepractice.com herfertsoftware.com
Easy Billing Professional FCRView Tracker Functional Testing Systems
Herfert Software
EZClaim G2 Software Solutions LLC Inborne Technology Corp. K & K Systems Corp.
877-650-0904 504-888-6296 800-329-3209 877-885-2635
ezclaim.com greycat.us nowmd.com kandksystems.com
EZClaim Medical Billing Software Greycat NowMD Insurance Billing Software Practice Made Perfect

104 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

Kennebec Proof Preferred Orchid Medical Spa Software Sigma Instruments
412-278-2040 800-570-0500 724-776-9500
proofpreferred.com medicalspasoftware.com sigma-instruments.com
Proof Preferred Orchid Medical Spa Software Prometheus
Kinetic Concepts LLC PayDC SilverTree Health
845-802-4433 888-306-1256 877-216-4774
themovementonline.net paydc.com silvertreehealth.com
Voom PayDC Chiropractic Software Silver Tree Health System
Life Systems Software Phases Rehab SOAPe Software Inc.
800-543-3001 800-231-0518 877-447-6273
lifesystemssoftware.com phasesrehab.com getsoape.com
ChiroOffice Phases rehab V3.1.0 SOAPe Software
ChiroPad
ChiroSuite Platinum System C.R. Corp. Software Motif
Paraphrase 888-880-8602 800-481-9060
platinumsystem.com softwaremotif.com
Lifestyle Nutrition Inc. Platinum System EMR Datacenter
800-699-8106 MyEMR Free
physicianwellnessprogram.com PostureCo MyEMR Tablet PC Edition
866-577-7297 N8Soft
LifeTec Inc. postureco.com
800-822-5911 PostureRay - Xray Digital EMR System Softworx Solutions
lifetecinc.com PostureScreen Mobile APP 800-642-6082
Spinal Decompression Marketing softworxsolutions.com
Software Practice Easy DC ChiroWrite
310-282-8882
MacPractice practiceeasy.com Stellar Chiropractic Solutions
646-305-9008 PracticeEasy DC 800-244-1279
macpractice.com stellarchiro.com
MacPractice DC Practice Fusion Stellar Chiropractic Solutions
415-346-7700
Medical Electronics Inc. practicefusion.com SuiteMed LLC
866-633-4876 Practice Fusion 877-682-7482
meditronics.net suitemed.com
Practice Perfect EMR SuiteMed IMS
MedicFusion practiceperfectemr.com
866-643-7778 Practice Perfect EMR Management TextMD
medicfusion.com Software 412-324-8311
ChiroComplete gettextmd.com
Pulse Software LLC TextMD
Microfour 908-289-9613
800-235-1856 chiropulse.com The Integration Group
practicestudio.net Chiropulse Advanced 443-438-9610
PracticeStudioX16 integrateyourpractice.com
Quick Notes
Mighty Oak Technology Inc. 800-899-2468 Trillium Technology
952-374-5550 qnotes.com 800-522-2504
charttalk.cloud Q’Notes trilliumtechnology.com
Chart Talk PDQ Thumbware Chiropractic ProScribe (tm)
Dragon Medical Doc-Q-Manager
Ventura Designs
MPN Software Systems Inc. Quick Practice 888-713-2093
800-966-1462 516-622-1992 posturepro.com
ineedeclipse.com quickpractice.com IRIS 2.0
ECLIPSE QuickPractice PowerCiser
My Receptionist Rayence Inc. Versatile Software Systems Inc.
800-686-0162 201-585-0290 800-367-8774
myreceptionist.com rayenceusa.com vssinc.com
My Receptionist For Chiropractors Only
ReportMaster Inc.
MyChartsOnline 727-449-0817 ics LLC
888-277-7710 reportmaster.com 886-432-2447
mychartsonline.com Report Master 7 Classic vitalogics.net
MyChartsOnline.com VitaLogics
RF System Lab
Nexyka Inc. 800-905-1554 WorkForce University
877-891-3657 naomi-dr.com 800-348-4557
nexysoft.com workforceu.net
Nexysoft-DC Roy All Solutions Inc. WorkForce University
855-230-9766
OnlineChiro.com royallsolutions.com Zodiac Transcription
888-932-5550 Medisoft 800-442-3404
onlinechiro.com zodiachealth.com
3D Interactive Spine S.A.M. LLC Chiropractic Transcription
800-752-3263
morenewpatients.com
Spinal Analysis Machine

Companies highlighted in RED have an advertisement in this issue. For

the complete listing of services these companies ­provide, and to view our
complete online directory, visit chiroeco.com/buyers-guide.

CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 105

ADOBE STOCK
Good debt, bad debt
Just because it’s a business loss doesn’t always make it tax deductible.
BY MA RK E. BATTERSB Y
W
hat chiropractor
hasn’t suffered from
patients or insurance
companies not paying? Accounts
receivable are not always collected
in full, and some claims aren’t
settled due to a variety of reasons.
Sometimes patients simply evade
payment, and the cost of pursuing
them is more than the recoverable
amount; sometimes they become
bankrupt, sometimes the debt
becomes time-barred, etc.
Bottom line: Sometimes no matter
how hard the practice tries, it just
can’t bring a particular patient’s
account to zero. Even after friendly
attempts at collection, a practice may
not receive the total amount owed and
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 109
MONEYMANAGEMENT
begin to suspect it never will. At that
point, certain choices exist: Write off
the account as a bad debt, or forgive
the debt entirely. Either approach
carries tradeoffs for small chiropractic
practices.
Good bad debt vs. bad debt
Business and nonbusiness bad debts
have markedly different treatments
under the tax rules. A nonbusiness
bad debt is deductible only when
completely worthless, and then only
as a short-term capital loss. Business
bad debts, on the other hand, can be
deducted even if only partially worth-
less—and used to offset a practice’s
ordinary income.
Unfortunately, merely labeling
something as a business bad debt
doesn’t necessarily make it tax
deductible. A bad debt deduction
can be claimed only if the amount
owed was included in the practice’s
gross income for the year the deduc-
tion is claimed. This is almost never
the case for cash method taxpayers
(that means most of us who report
income when we receive it). Accrual
taxpayers, however, report income as
it’s earned; if receivables have already
been claimed as income, a bad debt
deduction for uncollectible receivables
is appropriate.
Forgiveness or write-offs?
Some chiropractic practices forgive
the outstanding debts of those who
MONEYMANAGEMENT
have fallen on hard times. “Debt
forgiveness” means that open accounts
receivable will be written down to
zero, with some sort of offsetting
note explanation. Although there
is no tax deduction associated with
this adjustment, in some instances a
Form 1099-C, Cancellation of Debt,
must be filed with the IRS to record
the cancellation of debt of more than
$600.
A bad debt is defined as an account
or note receivable that proves to
be entirely or partially uncollectable
despite collection efforts. For a prac-
tice to deduct a business bad debt as
an expense on its tax return, the debt
must have been created or acquired
by the practice, or closely related to
the practice, when it became partly or
totally worthless.
Good bad debts
The IRS has denied some bad-debt
110 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
deductions, even partial bad-debt
deductions, because the rules weren’t
followed. In one instance, a taxpayer
was denied a partial bad-debt deduc­
tion because the amounts were not
charged off strictly in accordance
with the rules. An increased reserve
account did not satisfy the statu-
tory require­ment that there be a
charge-off.
According to the IRS, the purpose
of requiring a charge-off is to
perpet­uate evidence of a taxpayer’s
election to abandon part of the debt.
Therefore, a practice must eliminate
the debt as an asset on its books in
order to comply with the charge-off
requirement.
What’s more, before your practice
can charge off and deduct a debt in
part, you must be able to show that
in the year partial-worthlessness was
claimed, the amount of the worth-
lessness could be predicted with
reasonable certainty. Bad debts are
written off as soon as they are deter-
mined because the practice does not
expect future economic benefits and
it no longer remains an asset. No
way around it, the ultimate proof of
worthlessness depends on the facts
and circumstances as they existed at
the time the debt was claimed to have
become worthless.
A personal bad debt is ordinarily
not deductible. However, in those rare
cases where it is allowed as a deduc-
tion by the IRS, it would be treated as
a short-term capital loss—limited to
$3,000 per year.
Strictly business
Bad debts are written off as soon as
it can be determined that the prac-
tice does not expect future economic
benefits and it no longer remains an
asset. A business bad debt is a loss
from the worthlessness of a debt that
was either:
Created or acquired in a trade or business, or
u
Closely related to the trade or business when it became
u
partly or totally worthless.

A debt is closely related to a trade or business if the

primary motive for incurring the debt is practice-related.
Bad debts of an incorporated practice (other than an S
corporation) are always business bad debts.
After a reasonable period of time, if the attempts made
to collect the amount due are unsuc­cessful, the uncollect-
ible part becomes a business bad debt.

In the beginning
Business bad debts are usually the result of credit sales to
patients. Services that have been performed—but not yet
paid for—are recorded in the practice’s books as either
accounts or notes receivable. After a reasonable period of
time, after unsuccessful attempts have been made to collect
the amount due, the uncol­lectible portion becomes a legiti-
mate and deductible business bad debt.
Under the tax rules, accounts or notes receivable at fair
market value (FMV) when received are deductible only at
that value, even though the FMV may be less than the face
value.
When money is loaned to a customer, client, supplier, or
employee for a business reason and the practice is unable
to collect the amount after making a reasonable attempt,
it becomes a business bad debt. On the other hand, a
bad-debt deduction for a loan made to a corporation
cannot be claimed if, based on the facts and circumstances,
the loan is actually a contribution to capital.

The value of worthless debts

Generally, a debt becomes worthless when the surrounding
facts and circumstances indicate there is no reasonable
expectation of payment. To show that a debt is worth-
less, you must prove that reasonable steps were taken
to collect the debt. It is not necessary to go to court if it
can be shown that a judgment from the court would be
uncollectible.
And, be careful to note if you do this, the deduction
can be claimed only in the year the debt becomes worth-
less. Naturally, it isn’t necessary to wait until a debt is due
to determine whether it is worthless. Bankruptcy of the
debtor is generally good evidence of the worthlessness of at
least a part of an unsecured and non-preferred debt.
Note that bad debt deductions generally aren’t avail-
able to practices using the cash method of accounting.
To deduct a bad debt, your practice must have previously
included the amount in income.

CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 111

MONEYMANAGEMENT
Recovering bad debts
If you claim a deduction for a bad
debt and later all or part is recovered
(collected), all or part of the recovery
amounts may have to be included as
gross income in the year of recovery.
The amount included is limited to the
amount deducted.
Naturally, any amount deducted
that did not reduce the earlier tax
bill can be excluded. The recovery is
usually reported as “Other Income”
on the appropriate business form or
schedule.
In the event that property is
received in partial settlement of
a debt, the debt is reduced by the
property’s fair market value, which
becomes the property’s basis or book
value. The remaining debt can be
deducted as a bad debt if and when
it becomes worthless. Should the
112 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
property later be sold for more than
its basis, any gain on the sale is due to
the appreciation of the property. It is
not the recovery of a bad debt.
Besides costing your prac-
tice money, bad debts complicate
accounting. When using accrual-basis
accounting (as many practices
do), income is realized at the time
of billing, not when it is received.
Because of this lag as the unpaid fees
become overdue accounts, many
chiropractors go through various
collection procedures with the
overdue account eventually becoming
a bad debt deductible on their tax
return.
Naturally, you must be able to show
that any “bad debt” is partially or
totally worthless. To ensure you don’t
miss out on a bad-debt deduction
in the current tax year, periodically
review your records to pinpoint any
potentially worthless receivables that
might be carried on your books. It
is also wise to ensure that all failed
collection efforts have been docu-
mented should the IRS challenge the
bad-debt deduction.
As this discussion makes clear, the
bad-debt rules are tricky. Seeking
professional assistance with the docu-
mentation requirements of these rules
is always a smart move.
MARK E. BATTERSBY is a tax
and financial adviser, freelance
writer, lecturer, and author
located in Philadelphia. He can
be reached at 610-789-2480.
Disclaimer: The author is not engaged in
rendering tax, legal, or accounting advice.
Consult your professional adviser about
issues related to your practice.
Quick Tip
The power of websites
A survey of small businesses
found that about 40 percent
would choose social media as
their No. 1 online marketing
choice. Regardless, having a
website is still important:
Almost two-thirds of consumers
u
use websites to find or engage
with businesses.
The top local search engine
u
results are related to websites.
Social media does not play a big
factor in local SEO.
30 percent of consumers won’t
u
consider a business without a
website.
46 percent say a website is the
u
biggest determinant of their
trust in a company.
— The Center for Powerful Practices
powerful-practices.com
 STUDENTDC
News and business resources for the new practitioner.
Visit us at studentdc.com for more resources.
Develop good habits from the start
BY TO DD G. SI N G LE TO N , D C
I
f you’re nearing graduation,
it may seem daunting to think
about treating patients on your
own. This will be especially true if
you’re building your own practice
from the ground up, but it’s also true
if you’re joining a practice with a
group of other doctors. Either way,
you’ll need to begin with good busi-
ness habits that will help you build
your patient base from day one.
To really build your business and
get better clinical outcomes, it can
make a big difference to incorporate
nutrition into your practice right from
the start. This will help you become
a full-service provider who serves as
a primary care physician to many of
your patients. When you have a well-
rounded regimen for your patients
to follow, they’ll turn to you for relief
from a wide variety of ailments.
The three Ts
D.D. Palmer, the father of chiro-
practic, taught that there are three
Ts to consider when treating a
patient—thoughts, trauma, and toxins.
According to Palmer, the more holis-
tically you address these three aspects
of health, the greater success you’ll
have in improving your patients’
wellbeing.
When you incorporate nutrition
into your practice, you can address
the toxin element of this equation,
rather than just the trauma. This will
help you to get better results, have
happier patients (who’ll jump at
the chance to make a referral), and
114 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
increase the cash flow that you’ll need
to further build your practice.
The effects of good nutrition are
underestimated by doctors and
patients alike. When you teach your
patients how to eat the right diet and
take the right supplements, you will
be helping them combat pain, inflam-
mation, and a multitude of other
problems stemming from a nutri-
ent-deficient diet. With this in mind,
take a look at some of the tools you
can use to implement these concepts
in your practice.
Recommend good eating
First, a healthy diet will help to repair
the body, reduce inflammation, and
prevent further damage. Suggested
dietary guidelines include the
following:
Recommended eating:
uLimited use of grains and dairy
uLots of organic dark leafy greens
and brightly colored vegetables
uLimited quantities of organic fruits
uOrganic poultry and eggs
uWild-caught fish
uSparing use of organic grass-fed red
meat
uUnrefined, cold-pressed olive and
coconut oil
Acceptable eating:
uWhole-grain products
Conventional (non-organic) fruits
u
and vegetables
Conventional (non-organic) poultry
u
and eggs
uFarm-raised fish
uRefined olive and coconut oils
Unrefined
u cane sugar, natural sweet-
eners (honey, maple syrup, agave)
Foods to avoid:
Refined grains (white bread, pastries,
u
cookies, crackers)
Refined vegetable oils (soybean,
u
canola, sunflower)
Refined sugar (found in soda, candy,
u
ice cream)
All fast food and junk food
u
(anything heavily processed and
refined)
Large amounts of red meat (beef,
u
pork)
uAlcoholic or caffeinated beverages
Steering your patients away from
processed and unhealthy foods will
enhance the results you get through
adjustments and bring you more
success as a healer. With the right
nutritional protocols in place, you’ll
find that your patients are more
successful than ever before.
TODD G. SINGLETON , DC, is an
author, speaker, and consultant
in practice for more than 25
years. He has an all-cash
nutrition practice in Utah
specializing in weight loss, neuropathy,
spinal decompression, knee pain, and other
nutritional deficiencies. He teaches fellow
chiropractors how to add these modalities
to their practices. He can be contacted at
801-917-0900 or through
nutritionforchirostudents.com.
To read the rest of this article, visit
ChiroEco.com/goodhealth
 DATEBOOK

DATE EVENT WHERE SPONSOR PHONE

Aug. 19 FMT Blades Glen Falls, NY RockTape 800-553-4860
Aug. 19 FMT Blades Reno, NV RockTape 800-553-4860
Aug. 19-20 FMT Basic and Performance Newark, DE RockTape 800-553-4860
Aug. 19-20 FMT Basic and Performance Roy, UT RockTape 800-553-4860
Aug. 19-20 Case Management for Motor Vehicle Injuries Phoenix American Academy of Motor Vehicle Injuries 480-664-6644
Aug. 24-25 CEAS I: Ergonomics Assessment Certification Workshop Denver The Back School 404-355-7756
Aug. 24-27 The National by FCA Orlando, FL Florida Chiropractic Association 407-654-3225
Aug. 26-27 FMT Basic and Performance Ewing, NJ RockTape 800-553-4860
Aug. 26-27 FMT Basic and Performance Bozeman, MT RockTape 800-553-4860
Sept. 9-10 Spinal Ligament Injuries in Motor Vehicle Injuries Pasadena, TX American Academy of Motor Vehicle Injuries 480-664-6644
Sept. 9-10 FMT Basic and Performance Fargo, ND RockTape 800-553-4860
Sept. 9-10 FMT Basic and Performance Fort Myers, FL RockTape 800-553-4860
Sept. 15 FMT Blades East Brunswick, NY RockTape 800-553-4860
Sept. 16 FMT Blades Ashland, KY RockTape 800-553-4860
Sept. 16-17 FMT Basic and Performance Colorado Springs, CO RockTape 800-553-4860
Sept. 16-17 FMT Basic and Performance Stamford, CT RockTape 800-553-4860
Sept. 17 FMT Blades Hackensack, NJ RockTape 800-553-4860
Sept. 17-18 Concussions and Cranial Nerve Exam for Motor Vehicle Injuries Phoenix American Academy of Motor Vehicle Injuries 480-664-6644
Sept. 21-22 CEAS 1: Ergonomics Assessment Certification Workshop San Diego The Back School 404-355-7756
Sept. 30 FMT Blades Kansas City, MO RockTape 800-553-4860
Sept. 30-Oct. 1 FMT Basic and Performance York, ME RockTape 800-553-4860
Sept. 30-Oct. 1 FMT Basic and Performance Waterloo, NY RockTape 800-553-4860
Sept. 30-Oct. 1 FMT Basic and Performance San Jose, CA RockTape 800-553-4860
Oct. 4-6 Ergonomics: Practical Applications Certification Practicum Jacksonville, FL The Back School 404-355-7756
Oct. 7 A New Approach to Addressing Coronary Heart Disease Rockville, MD Biotics Research Corporation 800-231-5777
Oct. 7-8 Digestive Mastery Charlotte, NC Biotics Research Corporation 800-231-5777
Oct. 7-8 FMT Basic and Performance Bloomington, MN RockTape 800-553-4860
Oct. 7-8 FMT Basic and Performance Portland, OR RockTape 800-553-4860
Oct. 14-15 Impairment Rating for Motor Vehicle Injuries Phoenix American Academy of Motor Vehicle Injuries 480-664-6644
Oct. 14-15 FMT Basic and Performance Lombard, IL RockTape 800-553-4860
Oct. 14-15 FMT Basic and Performance Tampa, FL RockTape 800-553-4860
Oct. 26-27 CEAS I: Ergonomics Assessment Certification Workshop Atlanta The Back School 404-355-7756
Oct. 28 Healthcare Ergonomics Oakland, CA The Back School 404-355-7756
Oct. 28 Central Sensitivity Syndrome Sugarland, TX Biotics Research Corporation 800-231-5777
Nov. 3 Scrape, Tape, and Move Portland, OR Advances in Clinical Education 503-642-4432
Nov. 4 Common Clinical Symptoms of Chronic Fatigue Boca Raton, FL Biotics Research Corporation 800-231-5777
Nov. 4-5 SFMA Certification Course Portland, OR Advances in Clinical Education 503-642-4432
Nov. 9-10 CEAS I: Ergonomics Assessment Certification Workshop New York The Back School 404-355-7756
Nov. 11 Hormones and Cardiometabolic Function Windsor, CT Biotics Research Corporation 800-231-5777
Nov. 11-12 FAKTR: Functional and Kinetic Treatment with Rehabilitation San Diego Southeast Sports Seminars 877-489-4949
Nov. 30-Dec. 1 FMT Basic and Performance The Woodlands, TX RockTape 800-553-4860

For a searchable list of more seminars and show dates or to submit your event, visit ChiroEco.com/datebook.

116 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

 ADINDEX
Ace Massage Cupping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Activator Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56-57
Advanced Medical Integration . . . . . . . . . . . . . . . . . . . . . . . 122
Aspen Medical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Atlas Chiropractic Software. . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Bintz Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Biotics Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
BIOTONE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Blue Ridge X-Ray. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
BrainCore Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Breakthrough Coaching. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
CareCredit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Cash Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
CBD Clinic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34, 125
Chiro-Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
ChiroFusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
ChiroHealth USA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
ChiroPlanet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Chiropractic Business Academy. . . . . . . . . . . . . . . . . . . . . . 123
ChiroSpring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
ChiroTouch. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cover Tip, 71
Chirowealth Learning Systems. . . . . . . . . . . . . . . . . . . . . . . . . 9
ClearGage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Cutting Edge Lasers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
DaCrema Botanicals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Daiwa Health Development. . . . . . . . . . . . . . . . . . . . . . . . . . . 37
DaVinci Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96-97
Da Vinci Medical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Dee Cee Labs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5, 92
Drucker Labs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Eclipse Software. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Erchonia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7, 55
Essential Formulas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18, 83
Everyway4All. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
E•Z Bis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
EZClaim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
EZ Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
FCLB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Fenix Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Florida Chiropractic Association. . . . . . . . . . . . . . . . . . . . . . . 98
Foot Levelers. . . . . . . . . . . . . . . . . . . . . . . . Cover, 15, 128, Insert
Foundation for Chiropractic Progress. . . . . . . . . . . . . . . . . . 81
Genius Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Greens First. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
GW Heel Lift. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Hill Laboratories. . . . . . . . . . . . . . 126-127, Back Cover Rollout
HydroMassage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Impac. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84-85
118 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
Infinedi LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Belly Band, 68
Kinian. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125
KLaser. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
KMC University. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Life University. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
LiteCure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
LZR7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Massage Magazine Insurance Plus. . . . . . . . . . . . . . . . . . . 108
Material Gurl. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Medical Billing Professionals. . . . . . . . . . . . . . . . . . . . . . . . . . 95
Medical Compliance Specialists. . . . . . . . . . . . . . . . . . . . . . 125
Medicfusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Miracle Wave. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Multi Radiance Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
NCMIC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
OnlineChiro. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Ortho-Dynamics Laboratory. . . . . . . . . . . . . . . . . . . . . . . . . . 111
Parker Seminars. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106-107
PayDC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Performance Health. . . . . . . . . . . . . . . . . . . . . . . . . . 13, Outsert
Pettibon Institute. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Pilot Lasers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
PracticeStudio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Pro Massagers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Profession Co-Op . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Pulsed Energy Technologies. . . . . . . . . . . . . . . . . . . . . . . 58-59
Quick Notes Chiropractic Software. . . . . . . . . . . . . . . . . . . 104
Rebel Herbs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Relief & Recovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
RockTape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30, 50
S.A.M.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
SDO-Orthotics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Sigma Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . 46-47, 113
Singleton Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Softworx Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Solutions4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Sombra. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Standard Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3
Stem Cell Institute. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101, 124
Synergy Therapeutic Systems. . . . . . . . . . . . . . . . . . . . . . . . . 66
The Joint. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Thomas Tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
TruGen3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Ulan Nutritional Systems, Inc.. . . . . . . . . . . . . . . . . . . . . . . . . 115
Vetrolaser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Vevazz Bed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Volume Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Ward Photonic Systems. . . . . . . . . . . . . . . . . . . . . . . . . . 24-25
 PRODUCTSHOWCASE
Software Wellness
Easy Billing Professional The Erchonia Zerona-Z6 laser is
4.0 provides quick reports, specially designed for non-invasive fat
easier pay, easier screens, loss for body circumference reduction.
and easier navigation. It has a function that calculates and sends The laser is applied externally and has
patient demographics and has a simple import function to create been proven through multiple double-
claims. It also features simplified tabs for easy appointment blind, multi-site, placebo-controlled
setting, claims query, and electronic processing. Its new quick clinical trials to emulsify adipose
reports feature enables the user to create group reports by date tissue. It maximizes coverage and
for transaction summaries, sales tax, various payment reports, offers an overall better treatment for your patients.
and more. 321-473-1251 • myzerona.com
800-618-6136 • easybillingsoftware.com

Analgesic
Orthotics Biofreeze Professional combines characteristics
The Comfo-Arch is a three-fourths users love from regular Biofreeze in an optimized
length molded featherweight arch that formula of key ingredients. Multiple research studies
is excellent for sport, work, and casual in pain relief, cold sensation, skin blood flow, and
shoes. These inserts work well in shoes user experience led to this professional formula. It
such as women’s flats that offer little to delivers a longer-lasting effect and a more satisfying
no support. They can also be useful in patient experience with a smoother application, and
youth athletic shoes like soccer cleats. it is free of parabens and propylene glycol.
To modify the Comfo-Arch, simply use 216-731-1280 • performancehealth.com
scissors and sandpaper to adjust to the desired length.
630-665-3113 • bintzco.com
Posture Device
The Active Posture is a door
Marketing mountable posture exercise system
ChiroHealthUSA with a unique head harness that
is a provider- helps the body maintain proper
owned network designed with doctors in mind. Our network posture while engaging in a variety
model allows you to offer legal, network-based cash discounts of rotator cuff, scapular stabilization,
to under-insured and “out-of-network” patients who are and resistance therapy exercises. This device helps fight “upper
members. Members covered by Medicare and federal programs cross syndorme,” which is caused by a hunched back posture.
are eligible for discounts on non-covered services. The network The Active Posture can easily integrate into your practice to help
approach to discounts reduces the risks of compliance and OIG combat these issues.
violations related to inducements, improper down-coding, dual 877-445-5020 • hilllabs.com
fee schedules, and potentially inappropriate time-of-service
discounts.
888-719-9990 • chirohealthusa.com Supplements
Recent findings have outlined the intimate
connection between leptin (released by adipose
Vitamin tissue) and the potential for joint destruction.
Liquid D 2000 provides a concentrated dosage The nutritional supplement, Metabolic Arthri
of vitamin D. Healthy vitamin D levels offer the Benefits, offers two clinically proven ingredients,
body support in numerous areas including blood Oralvisc and Perluxan, which provide specific
sugar, metabolism, bone health, immune health, support for patients with metabolic challenges
cardiovascular health, autoimmune responses, and who also need joint support. This one-capsule-
neurodegenerative disorders. This product is soy, per-day formula supports leptin balance and joint integrity,
milk, and egg free. providing maximum comfort and mobility.
720-287-2155 • shop.biogenetix.com 802-872-1922 • davincilabs.com

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

To search for more products, or to submit a product, go to ChiroEco.com and click on “Products and Services.”

120 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM

Software
Chiro Quick Charts is designed to
allow patients to check themselves
in, and allow chiropractors to
input patient history as well as
input other subjective information.
Doctors can quickly form SOAP/exam notes, which can be seen
in travel card layout, for up to five visits. The software’s features
include: scheduling, billing, e-claims, certified EHR, and travel
card view. It supports HIPAA 5010 and ICD-10.
610-820-0440 • get.quick-charts.com
Scheduling
CalendarSpots.com is an online
scheduling software that allows
chiropractors, receptionists and staff to
collaboratively manage schedules, client
appointments, and room availability.
Clients can conveniently book appointments online in real-
time, with email notifications and reminders sent automatically
to both clients and staff. CalendarSpots.com also features
integration with newsletter applications, as well as reporting on
client history and staff performance.
877-848-5029 • calendarspots.com
Wellness
The Herbal Vapors Multipack is a sampling of
ayurvedic formulas. Based on the ancient Dhum
Pan therapy (smoking medicinal herbs), Herbal
Vapors is a modern upgrade that vaporizes
the essence of the herbs without combustion,
chemical additives, or synthetic ingredients,
and uses only pure plant extracts. This new
and unique system skips digestion and delivers
the beneficial phytochemicals directing into the blood stream
through the lungs.
812-762-4400 • rebelherbs.com
MACRA toolkit
Best Practices Academy will be sure
your practice is ready to migrate from
fee-for-service to the new value-based
payment system. The MACRA law
outlines the requirements and timeline
regarding Medicare payment system
changes, with the performance year as
identified in the proposed rule beginning
January 2017. This 16 module on-demand series provides a
detailed explanation of the new payment system and how the
chiropractic physician can implement appropriate activities
and work processes that support performance in a value-based
payment system. Modules include MACRA, MIPS, Advancing
Care Information, and QRUR, covering all the bases.
877-788-2883 • bestpracticesacademy.com
CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 121
Detox topical
Chelation works best when
ethylenediaminetetraacetic acid (EDTA)
is introduced into the body without going
through the GI system. While IV chelation
is optimal, it is invasive, expensive, and
time consuming. Transdermal application of
EDTA bypasses the gastrointestinal system
and absorbs directly into the body through the skin. While the
concentration of EDTA is lower, it is still effective at a fraction of
the cost of IV treatments. Kelacream, provided by THM Detox,
is a nontoxic topical that allows you to provide chelation without
the need for IV sessions.*
714-794-9643 • thmdetox.com
Pain relief
NuOxy Complex is a natural product
providing benefits like NSAIDs without
toxic side effects. It is a fully balanced
combination of phyto-cannabinoids,
including CBD. Cannabinoids interact with
the body’s ECS receptors to bring about
homeostasis. Balancing the ECS serves to
reduce inflammation and pain.*
800-987-4931 • nuoxyco.com
Posture correction
Pettibon Rehab equipment is your postural
correction solution for patients both in
your clinic and at home. Designed for the
nervous system to restore spinal curves,
these products also build muscle strength,
endurance, ROM, and flexibility. Our popular
Therapeutic Wobble Chair that anchors into
the Pettibon Vibration Platform. Other popular
items are Cervical Traction, Fulcrums, Pettibon Body Weighting,
and Y-Axis Traction Units, to name a few. Implement billable
therapeutic exercises and procedures, based on your therapeutic
goals today.
888-774-6258 • pettibonsystem.com
Continuing education
Whether you are a student
seeking an affordable way to
prepare for your board exams, or a
practicing doctor looking for low cost and informative continuing
education courses, Chiro-Resources was made for you. Our
online continuing education courses are accredited by PACE
and approved in all states allowing online CEUs. The courses
are designed to be applicable to your daily practice and enhance
your knowledge to improve patient care. Classes are self-paced,
and can be taken as many times as needed to pass. NBCE and
SPEC reviews are also available.
910-377-7463 • chiro-resources.com
122 CHIROPRACTIC ECONOMICS • AUGUST 18, 2017 CHIROECO.COM
 ADMARKETPLACE

CHIROECO.COM AUGUST 18, 2017 • CHIROPRACTIC ECONOMICS 123

 CHIROPRACTOR WANTED PRACTICE FOR SALE
KELLEY PETERSON CHIROPRACTIC, INC. PRACTICES FOR SALE in AR, AZ, CA, FL,
DBA HealthSpring Chiropractic in Pleasanton, GA, IL, MI, MS, NM, NY, OH, OR, PA, SC,
CA. Doctor’s degree in Chiropractic and CA TN, TX. I have new doctors who want to
License req. Mail resume to 5673 W. Las Positas buy your practice. $300.00 for Practice
Blvd., Ste 215, Pleasanton, CA 94588 or fax to Analysis. For more info contact Dr. Tom
925-225-0505. Morgan, VolumeDC@aol.com, 770-748-6084,
www.VolumePractice.com
EQUIPMENT FOR SALE
INFRARED COLD LASERS $575 New
Infrared Cold Lasers. Priced thousands below
cold lasers with similar specs. Three 808nm
diodes/200mW (combined output). Recharge-
able. Animal Use Only. Quickly treat joints,
wounds, muscles, and pain. Lots of extras.
Acupuncture red laser (650nm/5mW), Dr.
Daniel Kamen, D.C.’s animal chiropractic
technique DVDs (horse and dog). Professional
carrying case, user manual, charts, points,
and treatment formulas. Call 800-742-8433.
www.vetrolaser.com. We also sell Class IV veter-
inary lasers. Cost: $3495. www.vetrolaser4.com
LASER EQUIPMENT FOR SALE LZR7 laser
with 750mW Acu-Tip, 5 Erchonia lasers $500 &
up, Bemer Pro, Aspen Lasers, Body Lights in-
frared & red, K laser 12W, Zerona Laser, Multi
Radiance laser, Lipo Light, Vevazz, Terra Quant
Pro laser, Cutting Edge MLS laser, Spectra Vi-
sion $500, ASA Balance, Norland Apollo Bone
Density Machine, Apollo Lasers, LZR7 lasers
750mW -100W. Call Dr. Randy 530-642-9680.

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