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Welcome to The Health & Wellness Practitioners Podcast! Dr. Danielle and other guest experts talk about everything from getting your practice started, developing your clinical skills, growing your practice YOUR way, and dealing with the real stuff life burnout and work/life balance. Whether you’ve been practicing for decades or just started your journey, you’ll find something here for you!
DR. DANIELLE: Welcome everyone. So I am back with another guest on the podcast today. This is Dr. Jessica Allen and she and I connected through Facebook. We had a conversation over the course of a few weeks, actually. And then I thought let's talk about this on the podcast, because one of the things I've been wanting to help people with - have been helping people with - for seven, eight years now is creating their own definition of success and practice and letting that be whatever it is for the individual intrinsically, and not feeling that sense of pressure that so many of us feel to have the high volume practice that we've been told forever is the way to be successful, especially in chiropractic, but it also applies to acupuncture and all of our other allied professions too. So on that note, Dr. Jessica, if you'll introduce yourself and share a little bit about what you do, we'll just take it from there.
MEET DR. JESSICA ALLEN
DR. JESSICA: Hi, so I'm Dr. Allen and I currently have a practice in the mountains of Western North Carolina. It's a beautiful area and I have specialized in having a low volume practice where I can really invest my whole heart and soul into my patients. And I mostly work remotely for a set of third party companies doing utilization review and peer review. And that is a type of work where you can help make decisions regarding patient care and preauthorizations and appeals and also do review of entire cases to make sure that the correct patient is getting the correct care.
DR. DANIELLE: I get what you're talking about because I have worked in utilization review in the past. I think it was 2014-15. And so I know that realm, but for people that are like, what in the world are you talking about? Can you give them like the utilization review simplified version?
DR. JESSICA: It's kind of tough to break it down, but most of us know what goes into asking for say like 6 or 10 sessions of chiropractic care yeah or an MRI or referral to another type of specialist. So when you submit that request to an insurance company, sometimes it can get taken care of by a nurse and it gets done and over with really quickly. Sometimes there's more questions about how much care has the patient completed so far, is there any type of complicating factors that might not have been really clear within the documentation? So for those circumstances, they call upon a doctor that has the correct specialty and also sometimes has to be in the correct location in order to speak with the treating provider to help sort out any complicating factors or anything else that might go into how this decision should be made.
DR. DANIELLE: Okay. So how in the world did you get started doing this work?
DR. JESSICA: For me, it came out of necessity. I graduated chiropractic college in 2010 and married a wonderful man that works for homeland security. So through his career, we've relocated several times just to get him closer to whatever airport he happens to be working at. So after a few moves, I thought there has got to be something that a person can do with a collection of chiropractic licenses. I have a full wall of all these really cool papers, but as far as opening and closing offices and trying to do relief work for people and house calls and I've tried a lot of different models I got pretty exhausted. And so I reached out and got some training. It was from a team of medical doctors and lawyers and that opened some doors, but it was still, it was like a year before I really had a handle on utilization review and peer review as essentially a career.
And then when March of 2020 happened, there were a lot of friends that reached out and said, Hey, I I've seen that you do a lot of remote work and you upload pictures of you at your computer at four in the morning. So like, what is this about? So that's when I started helping other chiropractors learn how to do this work too, and just recently formalized this into an e-course that is much more available to people other than just being limited to my schedule.
UTILIZATION REVIEW AS SUPPLEMENTAL INCOME
DR. DANIELLE: So besides the obvious differences of working individually I'm assuming having the ability to set your own hours when you're doing utilization review, you can work really whenever you want to as long as you're getting the work done on time, what are some of the other advantages or reasons why someone would choose this career path?
DR. JESSICA: The relocating factor was huge. I can pick up and move. I've lived in Nashville, Tennessee, I've lived in Tampa, Florida, I've lived in Dallas, Texas, and I haven't had to sell an office or leave a job since beginning this career. So that's been a huge advantage. And then schedule is also a big one. I have two kids that are busy in school and sports, and I'm able to do everything that they need. My husband travels for a living, so it's all up to me. If there's someone that falls and needs to go to the ER, it doesn't matter if there's 30 patients on the schedule, I have to deal with it. There's no one else. So that has been a massive game changer for me. Where I normally work kind of 9-2, but if there's something going on that afternoon or as something that I want to do during those hours, I can work early or late. And as long as I get everything turned down on time, there's no hard hours that I need to work.
DR. DANIELLE: So tell me a little bit more about how would someone know that this is the direction that they would want to go? How would they know that it's for them?
DR. JESSICA: If you enjoy talking to people, which I think a lot of chiropractors do, like we at least have to build rapport with patients. We might not discuss a lot of deep things, but we at least have to be conversational with a lot of our patients. So if you enjoy speaking with people, but could also put a clinical twist on it, that would be a really good indicator that you might do well in this industry. Because doing lots of phone calls either to providers that you have to discuss their request, we talk to lots of different providers, but there's also lots of conversations with nurses that you work with and medical directors and other companies. So it's a lot of communicating,
DR. DANIELLE: I would think also people that find that they are - how do I say this - too introverted for the regular chiropractic practice or hands on practice which I'm like delicate about saying, because there are ways you can practice if you're extremely introverted that will set up boundaries for you. But that’s a real thing. Some people don't realize like how draining and exhausting it is to work with people hands on and do it every day or even one or two days a week. It can still be very draining for someone that's highly sensitive, someone that is empathic or like senses, feels energy and hasn't mastered yet how to protect themselves. And it could take a long time to grow a business. It can take years to get your practice to where you want it to be financially. So I'm assuming that this is an option. It was an option for me when I was doing utilization review to help people bridge that gap as well.
DR. JESSICA: Absolutely. Both building a practice and then trying to taper down into your retirement. Those are the two biggest areas. There seems to be a sweet spot from, I find that I don't have a ton of clients between the ages of like 40 and 50, but I've got everybody everybody on both sides that either they're wanting to build a really niche practice like house calls or if they're wanting to taper back on their hours, but not necessarily on their paycheck.
GETTING STARTED WITH YOUR NEW VENTURE
DR. DANIELLE: So how does someone go about getting started doing utilization review?
DR. JESSICA: I have found that I didn't get anywhere within the industry until I was able to communicate to these companies that I had some training. I just wrote a blog post about it that I spent almost two years and submitted hundreds of job applications with my clinical resume saying, I know how to use a selection distraction table, and I know how to use an activator, and I'm also licensed in acupuncture and they'd be like, that's awesome - can you write, and can you turn stuff in on time? We don't really care what you've done clinically, I'm sure you're an amazing person. So once someone was able to show me that there is a different way you need to communicate with corporate people, that was how I got a lot of doors open. And from there it was repetition. Very quickly I gained a reputation of being caring in the industry. I did my absolute best to connect with the eye - I've never spoken with someone as nice as you, and I've never spoken with someone who actually explained why a decision had to be made in a particular way. So it didn't take too long, a couple years, and then I knew I was in a position where I could also give back to this industry in helping people learn how to navigate through gaining remote work, and then also how to effectively make the correct decision and communicate that with the provider so that there's no more reputation of peer review doctors being like evil people on the other side of a screen.
DR. DANIELLE: Yes. That's definitely a thing, isn't it? We villainize the person who's making the decision on the other end of the phone and that's tricky because that person is also just doing their job as oftentimes they've been told how to do it. It's cool to hear you say that actually, that you're kind of like you're bringing a different dynamic.
DR. JESSICA: Absolutely. I remember clearly going to a CEU conference. It was at this phase where I felt like I had really made it and I had really, I had accomplished everything that I wanted and I was going to this conference just pretty relaxed. And I can't remember what the doctor was actually talking about, but I remember he had like a two minute tangent on how evil peer review doctors were and their only goal was to deny care. And none of 'em even read the records and I was like, I didn't know what to do. Because I kind of wanted to hide in the corner, and then I kind of wanted to be like, no, no, no, that's not me.
DR. DANIELLE: Yeah. What made you decide to create an online course to help people get started in utilization review?
DR. JESSICA: So I was picking up a lot of friends that wanted to get into this industry, and then there were some friends of friends and then friends of friends of friends. And I found pretty quickly that even though everyone has their own specific story, their own background, their own specific goals for a remote career, that the bulk of the information is the same. You're going to be looking for the same type of information on the records, whether it's a PT note or an acupuncture note, or a note from an orthopedic surgeon, a lot of the insurance companies use the same guidelines to create the standards. So there's only so many sets of information that you can be pulling from notes. There's only so many guidelines you can pull the rules from.
So I found that not only was I repeating myself a ton, but I was actually losing track of who was where and who wanted what. And so I found that creating an e-course that just covered everything A to Z beginning to end, resume advice, companies to contact, covering each major type of review that you could do, specifics that might go along with each type, and review of the guidelines - I just sat down and got it all done and all out there. So then everybody has access to all the information that they need.
DR. DANIELLE: That's pretty amazing. And it's unique as well. Tell me more about where people can go to learn more about your course, where is the best place for them to find it?
DR. JESSICA: The website is NonClinicalChiropractic.com, and that was also kind of a journey in and of itself. I know we've got a little bit of time to talk, but I started out wanting to speak with all different types of doctors. I thought, well, if every single chiropractor wanted to go fully remote tomorrow, I'd have a big job on my hands and there wouldn't be enough work to go around for everybody. But I quickly found that even though I've built really valuable relationships with the medical doctors that I have brought through this industry, there are some resources out there for medical doctors to get trained, and there's nothing that targets chiropractors. And I think we are the most versatile type of doctor that these companies can pick up because it doesn't bother us to deal with a physical therapy or an acupuncture request that's in our same wheelhouse.
But we can also address more advanced needs, a lot of imaging requests and even injection requests and some things that are a little bit more clinically significant. I don't want to say serious, but we have a wide range of issues that we can deal with. And we have a really high dose of common sense and then a big advantage is we have a really good clinical knowledge, and then most of us have a really good business sense too. So the majority of people within the medical profession graduate school and they go get a job somewhere, they don't know anything about renting office space and overhead and hiring staff and all that kind of stuff. A lot of them work for a big system. Even if they have their own office, they're still part of a system.
So we have both frames of knowledge to utilize while also being very versatile. And I think that gives us a unique opportunity and to find that there were no resources that were specific to that, it became a need at that point in time, this was something I needed to share and needed to focus on my roots to help my colleagues as best as I could.
DR. DANIELLE: Is your course only available for chiropractors or is it open to other types of health and wellness practitioners as well?
DR. JESSICA: It's open to other types of health and wellness professionals. I've had two cardiologists, I've had a pain management doctor, one internist take the course, I've had a couple PTs take the course, a couple DPTs, and then also one nurse practitioner who was just really dead set on wanting to know everything that she could about this industry. One thing I've gotten a lot of feedback on is doctors that don't have board certifications and then doctors that are not yet five years in practice and they're wanting some resources too. So that's going to be like hot off the press coming really soon on how they can still utilize some form of remote work while they're gaining the board certification and, and the five years in practice.
DO YOU HAVE WHAT IT TAKES TO DO UTILIZATION REVIEW? PROBABLY!
DR. DANIELLE: Interesting. Okay, cool. So are there other requirements besides having five years in practice for someone who is a chiropractor, let's say, that they need to have to be able to do utilization review?
DR. JESSICA: One thing that's important to know about being in chiropractic that's another advantage is that our board certification is built into our specialties. So I'm sure a lot of us are aware that there's lots of medical doctors that have to take years to get their board certification because not only do they have to go through school, they have to pick a specialty, then they have to get trained in it, then they can get board certified in it, where we have chosen our specialty at a much earlier phase and therefore every chiropractor is board certified. So that's a huge advantage. You're not going to get a lot of flexibility with being a peer reviewer until you've hit that five year in practice mark. All of these companies want people who have been around the block a couple times before you start advising other doctors on how to do their jobs.
So as far as being the person who really signs off on the decision, those requirements are a bit rigid. But what a lot of companies are going to is a system where the report is broken up into pieces. And so there's one provider, one doctor that will get the report ready, and another doctor that will be the one that does the phone calls and does a little bit more of the logistics. So especially when talking about someone that's really introverted and wants another option, drafting is a huge growing industry right now. And it's because each insurance company that the work indirectly comes to, so each insurance company is going to send work to an independent review organization and the independent review organization is going to have you. And they all have their very specific requirements of what a report needs to look like, what it needs to say, what language needs to not be in there. And it's just turning out to be a better system if there is a panel of people dedicated to dealing with the Blue Cross requests or the Cedric requests or any multitude of companies, they all want their reports in a really particular way.
So if you can have someone in charge of making sure that the report looks the way it needs to look, then it doesn't really matter what specialty that person is. Because if you have an orthopedic surgeon in Rhode Island that can only do calls on Tuesdays, that's not really helpful for getting all of the reports that need to be done at a certain time. So for people who are not board certified and haven't hit the five year mark yet, you can still get a lot of experience drafting the report. It just won't be your name at the bottom of it.
WEIGHING THE DISADVANTAGES OF EXTRA INCOME
DR. DANIELLE: Okay. Totally throwing you a curveball here, but what's the disadvantage or what do you not like about this field of work?
DR. JESSICA: I am not the type I don't like to be tied to my phone and I don't like to be in front of the computer. I'd rather be outside. The majority of my day, I love not being in front of a computer and when the weekend comes and I can let my phone die, that is. I live for Saturday mornings. Just like being a kid. But it's a necessary evil there's no way around not having a computer and a phone where you're doing remote work. So if I could beam myself to these offices and talk face to face with people, that would be cool. But that's really the only disadvantage I can think of - I have an under my desk elliptical machine so that I can keep my feet moving while I do this work, because sitting still in front of the computer is not my thing. But other than that was great.
DR. DANIELLE: I actually had considered a walking treadmill - not a walking treadmill - a walking desk I think it's called.
DR. JESSICA: Yeah, treadmill desk.
DR. DANIELLE: Yeah. But I just felt like it was too much sensory input for me to be walking and trying to keep myself on the treadmill and not fall off of it while also like actually focusing on what I was doing. I think though, some people are able to utilize them part of the day and then sit other parts of the day. So it might be at the treadmill desk depending on what the activity is that they're working on. But it just didn't fit for me, but I have never heard of an under the desk elliptical.
DR. JESSICA: Oh yeah. Gosh, I can't even think of what mine is called, but you can find them on Amazon. And they don't have any type of motor. I considered a treadmill desk too, and that was the thing that intimidated me was that you couldn't just stop walking, you had to like press the off button. And so if I was really distracted by something, I was afraid that I was going to trip and fall, so I put this little foot pedal thing under my desk, and if I'm really thinking about something, I can do all kinds of miles. I don't have any jitters and I don't feel like I need to get up and do some laps outside. I can just sit down, get my work done and then move on with my day.
DR. DANIELLE: Okay. Do you have anything else that you want to share with people who are listening, watching later about utilization review, about your course, about success and practice?
DR. JESSICA: So success and practice. I call it a positive feedback loop of happiness when it comes to my utilization review and practice balance, because the skills that you gain from objectively looking at other doctor's documentation and reviewing guidelines, you take that back with you to your office, and you're going to know better how to document. And so if you are used to getting denials from Medicare, that's not going to happen anymore because now you're going to know what Medicare is looking for in a note. And then also which I think is a huge theme to your just philosophy on life and the people that you connect with is decreasing the volume, but increasing the quality of connections. So because I'm not in a position where I have to see 20 people in a day before my overhead is met, I can see 10 people in a day if I want to, I can see no people on any particular day if I want to. And that way I'm working with only the people that I want to, and the people that value the amount of extra time that I can put into a visit. There's times when I'm with a patient for 30 minutes, and if you were to do that in a typical office setting you'd end up at work until nine o'clock and half your people would leave because they would be waiting too long. And that just doesn't happen with the situation that I've been able to build for myself.
DR. DANIELLE: I hear you. Thank you so much for everything that you've shared. Tell us again, where people can go to learn more about your course.
DR. JESSICA: The website is NonClinicalChiropractic.com. I'm also on Facebook. It's still called Non-Clinical Consulting for Physicians on Facebook, I didn't tailor it specifically to chiropractors on Facebook because I have built a little bit of an audience, but website is NonClinicalChiropractic.com, and my email address is all over the website for anybody that wants to ask any questions.
DR. DANIELLE: Awesome. Thank you again so much.
DR. JESSICA: Thank you.