Fall, 2018: What Is “Defensible Documentation?”

What Is “Defensible Documentation?”

Hannah Mullaney

Defensible documentation in the physical therapy world — what does this entail? A paper chart donned with purple gloves, yellow gown, and p99 respiratory mask? Or maybe a sleek EMR (electronic medical record) laced with the defensive skills of a black belt extraordinaire. Actually, it harkens to the diligent PT typing notes over lunch, after work, and before patients arrive the next morning.
What is documentation? It is the thorough note that a physical therapist writes explaining what happened during an appointment. How was the patient? What happened during therapy? Why should insurance pay the therapist? It needs to be detailed enough to stand trial in a court case yet succinct enough for a single person to document 6-16 appointments in a day.
The American Physical Therapy Association (APTA) website faithfully reminds practicing PTs why documentation is so important.
Health care consumers trust physical therapists to use their expert training to improve, maintain, restore, and enhance movement, activity, and health for optimal functioning and quality of life. While safety and quality of care is most important when caring for patients and clients, documentation throughout the episode of care is a professional responsibility and a legal requirement. It is also a tool to help ensure safety and the provision of high-quality care and to support payment of services.
The national organization also provides tips and tricks for making high-quality documentation.
First of all, these are the skeleton of a solid physical therapy note, with a little sample of what each part means.
  • Examination – what the patient reports (subjective, “my hip hurts right in the crease for the last 2 months”), what the PT finds using tests and measures (objective, “limited range of motion of the left hip”), and systems review (“blood pressure is 110/70 and patient is oriented to self, date, place, situation”)
  • Evaluation – what the PT concludes from the examination
  • Diagnosis – Physical therapy diagnosis is different than a medical diagnosis. For example, if a patient tore their ACL, the PT would say, “Right knee ligamentous laxity” and the MD would say, “partially torn ACL.”
  • Prognosis – patient’s potential ability to regain function
  • Plan of Care – game plan!
Defensible documentation needs some muscles to give power to the treatment. This is the evidenced-based care. Tests, interventions, and exercises that scientific study has shown to be safe and effective encompass evidenced-based care.
The ligaments and fascia that holds defensible documentation together is the risk management component. If something was not written in the documentation, it is as if it didn’t happen. Therefore, PTs need to be careful to be safe in action and documentation in every single encounter– for the patient’s sake as well as their own.
Examples of risk management in note-writing include some of the following.
  • Confidentiality — HIPAA. Enough said.
  • Incident reporting – “Mrs. J’s blood pressure dropped to 90/70 during therapy.”
  • Maintaining patient records — filling out the daily notes and re-evals every time, keeping copies of insurance records, patient test results (X-rays, labs, MRIs, etc), exercise prescriptions, and the all-important consent form.
  • Electronic health record hygiene – maintaining safe passwords, keeping other patient’s information out of sight.
  • Fraud, abuse, and waste – only giving care to patients who need it.
Whew! That’s a lot for a physical therapist to keep in mind while they do dozens of these documentations a week. However tedious it can be, it is important for PTs to stay true and keep their documentation strong. It needs to ricochet against the possible legal encounters. It needs to be armed with risk management and evidence-based care. And the tool that houses all of this defensible documentation is the electronic medical record (EMR). A defensible EMR will follow the guidelines suggested by the APTA to keep patients and practitioners safe in the current age of medicine.
 

Welcome

New Members to the bestPT Network!

Each new member benefits from and contributes to our network strength.

Let’s welcome bestPT Billing’s newest members!

Chelsea Dezelia Hadfield, Adam Walsh, Dalan Abreu, Deanna Armijo, Sara Balthaser, Nicholas Blonski, Zachary Blossom, Anthony Casazza, Anthony Chavez, William Chynoweth, Roberto Cordova, Kaitlynn Craig, Renee Dupre, Lucretia Duran, Joslynn Fletcher, Allison Foulk, Micaela Gilpin, Paige Goodwin, Morgan Kerschen, Charles Kettenring,Mikaela Lazar, Ashlee Lee, Ryann Montano, Hanna Park, Christian Pearson, Alexander Phillips, Francesca Picchi-Wilson,Jane Graham, Victoria Raught, Nicholas Romero, Alicia Roussin, Sam Sanders, James Schlavin, Tomas Tafoya, Nicholas Zarasua, Michael Alicto, Kori Apodaca Cordova, Tamaya Toulouse
University of New Mexico, Albuquerque, NM
Nicole Coddington, Blake Hebert, Speight McKenzie
Julie Tran
Kathryn Gerletti
Aleksandra Gutsman

 

Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each referring friend that is in our network, we’ll credit both you AND your friend’s account $50 a month.

 

Summer, 2018: Is Physical Therapy the Worst Kept Secret in HealthCare?

I still believe physical therapy is the WORST kept secret in healthcare. Last year I wrote a blog titled “Physical Therapy – The WORST Kept Secret in Healthcare” which allowed for some great discussion by the readers on the topic of physical therapy and where we fit into the healthcare system.   This blog post followed an open discussion called the “Chelan Chat” at the Washington State Private Practice Special Interest Group (PPSIG) spring conference at Lake Chelan, WA.  The ‘Chelan Chat’ is a twist on the Annual Graham Sessions hosted by the Institute of Private Practice Physical Therapy and was moderated by Steve Anderson. This year I was asked to present an “I believe” speech, that I would like to share with everyone here as a means to continue the discussion and a call to action. Here it goes…
I believe we are in the “story” business as physical therapists. We spend countless hours listening to patient stories, stories told by other therapists, stories told by doctors, stories told by friends and stories told by loved ones. We also tell a lot of stories too about weak muscles, weak cores and my favorite the infamous sacroiliac joint slippage! A vast majority of people fail to recognize the difference between a story and fact. In fact, most people view stories as facts and as Carnegie Mellon research shows, our stories carry far more weight than facts. In reality, a story is what we tell ourselves about the facts, it is not real. Our point of view is not the truth, it is our perspective. And perspective is based on our knowledge, previous beliefs, environment, the context or space we are in, our mood, our emotions, social pressures, and so on. Essentially our perspective is based on where we are at in life when we make up the story. I believe it is therefore important to remember that our perspective is just one angle on the facts, it is not the only story. Facts do not determine our point of view, our stories do.
So, I would like to invite you into my story on why I believe physical therapy is the WORST kept secret in healthcare.
Most of you are familiar with the common phrase “the best kept secret”. Being the best kept secret is great when you want to keep something a secret, such as your favorite coffee shop, restaurant or favorite place to vacation. However, when it comes to the role of physical therapy in healthcare, I believe that we are still a SECRET to a majority of consumers. This was highlighted in 2007 by Stephanie Carter and John Rizzo when they demonstrated that less than 7% of patients with musculoskeletal conditions utilize outpatient physical therapy services and again in 2012 in the Fritz and Childs study.
So, hopefully you are sitting there asking yourselves, why are we a secret? I believe we are the worst kept secret in healthcare for four main reasons:
  1. We have an identity crisis
  2. We suck at marketing
  3. We don’t know how to sell our product
  4. We are bullies to our brothers and sisters
Despite our shortcomings as a profession, I believe we are the BEST profession in a broken healthcare system and it is our time to move into the limelight.
 

Welcome

New Members to the bestPT Network!

Each new member benefits from and contributes to our network strength.

Let’s welcome bestPT Billing’s newest members!

Jon Meyer
Asbury University, Wilmore, KY
Marissa Crouse
Jessica Lopez
Mary Ann Williams & Rani Patel
Caitlin Westlake
Erika Morales & Brandon Selvey
Alex Galewski
Fenn Chiropractic, Tallahassee, FL
Maddie Larsen & Robert Neise
Health Rehab Solutions, Kalispell, MY
Martha Cernicchiaro
Anna Barkins
Sheli Peterson
Physicians Vein Clinics, Sioux Falls, SD
Allison Enoch
Ventura Spine and Disc, Ventura, CA
Jeannie Hile, Ashley Astles, Francesca Foley, & Susan Leach
University of New Mexico, Albuquerque, NM

 

Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each referring friend that is in our network, we’ll credit both you AND your friend’s account $50 a month.

 

May 2018: Imposter Syndrome in Graduate Students

Imposter Syndrome: Dealing with Feelings of Self-Doubt and Inadequacy in a Doctorate Level Program

Imposter syndrome (IS): a collection of feelings of inadequacy that persist despite evident success. ‘Imposters’ suffer from chronic self-doubt and a sense of intellectual fraudulence that override any feelings of success or external proof of their competence.  Imposter syndrome is something we have heard about from professors, mentors, and advisors. They tell us that it is a normal experience for many graduate students, especially those in the field of healthcare. They tell us that this feeling may stick with us well into the first few years of our practice. While this is a well-known and widely experienced issue for many students of physical therapy, it feels anything but “normal.”

On any given day of any given week, I’ll turn to any fellow classmate and we’ll crack a joke about how underprepared we feel for our next exam, clinic session, or rotation. It seems it is a constant feeling of under-preparedness, or lack of readiness, that weighs heavily on our shoulders.  All this, despite the fact that we have made it well into our second year of didactics, and may even have a 4.0 GPA. We perform well in the classroom, but this does little to nothing to boost our confidence as proficient practitioners of physical therapy. How can we best deal with this feeling of inadequacy?

An article from Psychology Today discusses tips on how to handle IS, and even make the best of it. First, appreciate your position as a novice. Consider that your perspective is fresh, and that of an outsider, due to inexperience. Therefore, the questions you ask may be very original, since you have not yet bulked up on conventional wisdom.

Next, try to shift your mindset from one that focuses on performance, to a mindset that focuses on what you are learning. Realize that we learn the most when we make mistakes, so stop seeing mistakes as failures or inadequacies, and instead view them as opportunities to enrich your knowledge base.

The third tip is to realize that perspective holds a lot of power. You may perceive yourself as the only one in the room who is truly experiencing IS, or that you are the person least worthy to be in the room. In reality, it’s likely that the majority of people in the room share that perspective, or have at some point in time. Realize that you are not alone with this feeling, that this is common, and that this is normal.  This third tip feeds into my personal experience in dealing with IS. Positive perspective has helped me deal with IS thus far, and will continue to in the near future. I had never heard of the term “imposter syndrome” before grad school, even though I had experienced it personally from time to time in the past. Thankfully, as mentioned above, our faculty was quick to address the issue of IS early on, during our first year in the program. Hearing this coming from faculty, in a non-judgmental manner, was somewhat comforting. In a way, simply being made aware of IS from the get go made it a bit easier to accept, process, and handle moving forward in the program.

 

The Impostor Syndrome and How To Handle It. (n.d.). Retrieved March 28, 2018, from https://www.psychologytoday.com/blog/adaptation/201611/the-impostor-syndrome-and-how-handle-it

 


 
 

Welcome

New Members to the bestPT Network!

 

Each new member benefits from and contributes to our network strength.

Let’s welcome bestPT Billing’s newest members!

Kathleen Wiemold
Korey Wiemold
Kellie Martin
Bassett Physical Therapy, Stanleytown, VA
Kenisha Dickerson
Melwood Rehabilitation, Upper Marlboro, MD

Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each referring friend that is in our network, we’ll credit both you AND your friend’s account $50 a month.

 

March 2018: Graded Imagery & Advanced Technology in the Treatment of a Patient Post-Stroke

Graded Imagery and Advanced Technology in the Treatment of a Patient Post-Stroke

Lisa Peterkin, SPT
 

With the advancement of technology comes the advancement of treatment tools that can be used in all areas of physical therapy.  Newer techniques used to treat patients after a cerebrovascular accident (CVA) have become more popular both in and out of the clinic setting to improve function.   

Traditionally, patients who have been affected by a stroke have been treated with Neurodevelopmental Treatment (NDT) techniques that include proper patient positioning and tactile cueing to progress the patient and improve their function.  Once the patient has improved strength, special awareness and normalized tone, they can begin to work with a physical therapist on more functional activities such as transfers and improved ambulation.

More frequently, now, physical therapists are including more advanced techniques such as Graded Motor Imagery (GMI) in their treatment of patients who have had a stroke.  GMI is thought to promote cortical brain activation and promote motor recovery after a stroke, specifically in the upper extremity. Within the category of Graded Motor Imagery are subgroups that include Explicit Motor Imagery (EMI), Implicit Motor Imagery (IMI) and Mirror Therapy (MT).  EMI uses the Kinesthetic and Visual Imagery Questionnaire (KVIQ), which includes 5 movements (shoulder flexion, finger tapping, trunk flexion, hip abduction, and ankle dorsiflexion) that are described to or demonstrated for the patient, then the patient is to imagine themselves performing the movement that was just described or demonstrated.  This Questionnaire is graded on a 5-point scale, from 0, where the patient was unable to imagine demonstrating that movement, to 5, where the patient could imagine it clearly. The next area of IMI incorporates Left/Right Hand Judgement, where the patient is shown 60 images of a hand in various positions, and the patient has to determine whether the picture is of a left or a right hand.  The last intervention is MT, where the patient is angled with their upper extremity next to a mirror so they have a clear view of the mirror with the reflection of their limb. The unaffected arm moves in various ways instructed by a physical therapist, and the illusion is perceived by the patient that their involved arm is moving.

The benefit of using these techniques is that they are simple to teach from one physical therapist to another, and easy for the patient to understand and be able to perform.  However, because patients who have suffered a stroke may have cognitive deficits, their lack of imaginary skills due to the CVA may influence the effectiveness of these techniques.

There have been many studies that assess the effectiveness of using more advanced technology with post-stroke patients.  The H2 robotic exoskeleton is used to improve gait in a post-stroke patient with hemiparesis who was able to walk only short distances at lower speeds.  The robot has 6 joints and focuses on improving an asymmetric, deviant hemiparetic leg during the stance phase of the gait cycle. It allows the patient to walk farther distances and have more stability in the affected leg while ambulating.  

Robot-Assisted Game Training has also been studied on its effectiveness with post-stroke patients.  Patients are given conventional therapy along with a secondary treatment that includes game training.  This includes a robotic arm that allows the patient to adduct and abduct the shoulder, and flex and extend the elbow of the involved arm.  By maneuvering the robotic arm, the patient can navigate through a gaming system on a computer and improve motor planning skills and cognition.  

While these techniques are still new and have minimal research, they open up a new world of treatment possibilities, especially in rural areas that are underserved with healthcare.  With these techniques and newer technology, patients may be able to return home sooner and have effective treatment sessions without going into a clinic, while continuing to show improvement in gross motor skills and cognitive function.

 

Bortole, M., Venkatakrishnan, A., Zhu, F., Moreno, J. C., Francisco, G. E., Pons, J. L., & Contreras-Vidal, J. L. (2015). The H2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a clinical study. Journal of neuroengineering and rehabilitation, 12(1), 54.

Lee KW, Kim SB, Lee JH, Lee SJ, Kim JW.   Effect of Robot-Assisted Game Training on Upper Extremity Function in Stroke Patients.   Ann Rehabil Med. 2017 Aug;41(4):539-546.   https://doi.org/10.5535/arm.2017.41.4.539

Polli, A., Moseley, G. L., Gioia, E., Beames, T., Baba, A., Agostini, M., … Turolla, A. (2017). Graded motor imagery for patients with stroke: a non-randomized controlled trial of a new approach. European Journal of Physical and Rehabilitation Medicine, 53(1), 14–23. https://doi.org/10.23736/S1973-9087.16.04215-5

 

Welcome

New Members to the bestPT Network!

 

Each new member benefits from and contributes to our network strength.

Let’s welcome bestPT Billing’s newest members!

 
Ehrum Khan   
PT Max, Philadelphia, PA 
Alicia Molloy
Jesslyn Scholl
Morgan Helser
Joshua Castro
PT Max, Philadelphia, PA
Katelyn Smitherman


Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each friend that you refer that joins our network, we’ll credit you $50 each month the office is contracted with us through the first year!

 

August 2017 bestPT Newsletter: Persisting Problems with Leftover Prescriptions

August, 2017 Newsletter

Leftover opiods are a common problem after surgery.

by Lindsey Tanner

CHICAGO — Surgery patients often end up with leftover opioid painkillers and store the remaining pills improperly at home, a study suggests.

The research raises concerns about over prescribing addictive medicine that could end in the wrong hands…

 


 

6 New members joined bestPT  in July 2017.

Each new member benefits from and contributes to our network strength.

 

Let’s welcome bestPT newest members!

Samantha Monahan of Bassett Physical Therapy, Stanleytown, VA

Sopia Polanco of Bit-By-Bit, Fort Lauderdale, FL

Christa Johnson of Comprehensive Hand & Rehabilitation Waterford, MI

Shalaina Russell of Kalispell Rehab, Kalispell, MT

Michele Kurkowski of Kiwi PT, Highland, MI

Norma Garcia of Two Trees Physical Therapy & Wellness, Ventura, CA


 Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each friend that you refer that joins our network, we’ll credit you $50 each month the office is contracted with us through the first year!

July 2017 bestPT: PTA, the 1st choice for a 2nd career

PTA: First Choice for a Second Career

Many PTAs began their work lives in other occupations but have come to find a home in physical therapy.

While their individual reasons may vary, many of these professionals are resuming their studies as older students focusing on a second career that is more satisfying than the work they had previously done.  Work that is emotionally fulfilling, stimulating, varied, all the while being educationally affordable and serving a hot job market.

(by Eric Ries,  at PTinMotion)

 


6 New members joined bestPT  in June 2017.

Each new member benefits from and contributes to our network strength.

Let’s welcome bestPT newest members!

Lauren Sahagian of Big Sky Pediatric Therapy, Austin, TX.

bigskyfriends.com

Colleen Lafferty of Bit-by-Bit, Ft Lauderal, FL.

bitbybit.com

Sarah & Linzie Schwindt of Health Rehab Solutions, Kalispell, MT

healthrehabsolutions.com

Adrienne Martinez of Prime Therapy & Pain Center, Riverside, CA.

primetherapy1.com

Bruce Wihongi of Kiwi Pt, Highland, MI

kiwiptmi.com



June 2017 bestPT: 10 Easy Ways PTs Can Promote Fitness

10 Easy Ways Physical Therapists Can Promote Fitness

Unlike many medical providers, physical therapists have ample time to talk with patients, to learn about their lives and to educate.

This extra time gives physical therapists (PTs) the opportunity to do more than help patients heal from injuries and regain mobility–they can also help them learn to pursue wellness, achieve greater fitness and possibly avoid injuries in the future.

And we’re not just talking about sports physical therapy. PTs can work with all patients to help them achieve the optimal fitness level for their level of ability.


Welcome New Members to the bestPT Team in May

7 New members joined bestPT  in May 2017.

Each new member benefits from and contributes to our network strength.

Let’s welcome bestPT newest members!

 

 

Ingrid Cruz and Gordon David of Prime Therapy and Pain Center

Riverside, CA.  www.primetherapy1.com/

Jeanne Cunningham and Lisa Dennis of Big Sky Pediatric Therapy,

Austin, TX.   www.bigskyfriends.com/

Christopher Leck of Health Rehab Solutions,

Kalispell, MT. www.healthrehabsolutions.com/

Amy Adler of Bit-By-Bit Therapy

Fort Lauderdale, FL.  bitbybittherapy.com/

Jennifer Huyser of Northland Pediatric Physical Therapy,

Pleasant Valley, MO.   www.northlandpediatricpt.org/


Five ways technology is improving the physician-patient relationship

Few things are as perplexing to healthcare providers as the challenge of nurturing more meaningful, intimate relationships with patients in an era of rising healthcare costs.

Vendors have rolled out a number of healthcare technology solutions to address these challenges, such as app-enabled patient portals, but much of the time, these tools simply serve as data repositories — underutilized by both the patients whom they are intended to serve as well as the physicians who are supposed to be using them.

However, some physicians aren’t hesitant to adopt technology.

 

May 2017 bestPT: How do you introduce new concepts to existing patients?

 


How do you introduce new concepts to existing patients?

Have yhttp://bestptbilling.com/wp-content/uploads/2017/05/How-to-Introduce-a-Patient-to-New-Concepts.pngou ever returned from a seminar itching to use all kinds of novel assessments and treatments on your existing caseload?  Should you apply these concepts to the care your provide your current patients?
It depends.  Some patients may be excited for your latest and greatest, others may lose confidence if your new explanations and education are too different from what was already working.

With some patients, you can tell them about the new treatment you’re planning to learn prior to attending a seminar and they’ll be excited to have it applied.

Perception can often dictate the reality.  The excitement associated with a new technique may result in  your patient experiencing a placebo effect, but be careful they may experience the negative nocebo effect instead.

To hear Dr. E discuss this in greater detail:

Mechanical Diagnosis and Therapy Helps Uncover Causes Hiding in the Spine

Most musculoskeletal pain is manageable conservatively. In fact, 92 percent of all musculoskeletal pain is mechanical in nature, and 82 percent of these are rapidly reversible.
Only 5 to 8 percent of the musculoskeletal cases Jones, PT, Dip. MDT and his peers see at the Center for Orthopedic and Sports Physical Therapy need their care escalated.

 


Welcome New Members to the bestPT Team in April

We’ve continued to add new members to our community this April. Each new member benefits from and contributes to our network strength.
11 New members joined bestPT  in April 2017.

Let’s welcome the bestPT newest members!

  1. Ahmed Abualala of Melwood Rehabilitation Center, in Upper Marlboro, MD.
  2. Sara Styles, Kelly Tennyson, and Kimberly Nicholson of Health Rehab Solutions.
  3. Glenn Hamilton of Asbury University in Wilmore, KY.
  4. Samantha Lenox of Mike Walsh Physical Therapy, in Milford, DE.
  5. Leah Larkin of Equilibrium Balance Performance Center  in Ventura, CA.
  6. Chastity Eaton of Bassett Physical Therapy, in Stanleytown, VA.
  7. Brenda Gonzalez, Jerry Parks, and Ted Stebens of Kulagy Physical Therapy.

 

What Do Successful Practice Owners Have in Common?

So many struggling  physical therapy practice owners focus all of their attention just on the critical tasks that must be done and, often times, little else.   Things like compliance, providing a support team, ensuring the clinic is equipped and functional, getting patients documented, and paying the team and the suppliers consume all of the owners time and attention.  

This means that some areas of the business, such as financial control, performance reporting, marketing, sales management and having a plan for growth, get little or no attention.  The result is a gentle, persistent decline in the practice size, turnover, profitability and value.

Click to read more about the 15 things successful practices owners have in common.  

KEY HABITS FOR SUCCESS IN 2017

What are the habits that a physical therapist needs to accelerate their progress towards success? Working with some of the most successful clinic owners in the country, and by identifying what they want to achieve, Erika Trimble has identified what the 10 key successful habits are for clinic owners who want to live their professional dreams.

To read more, click here: Success Habits of Business Owners in 2017