In our office for our cash patients depending on what their DX codes are we typically recommend out 10PKG visit plan. Then our doctors reassess their progress at the end of that, sometimes they have the patient follow up with another 10PKG or if they are progressing well they recommend the 5PKG we offer. The 10PKG plan is usually recommended when our doctor wants to see the patient 2 times a week for 5 weeks, the 5PKG is for once a weekers or our patients on maintenance care meaning they just need to come in either when they feel they need it, once a month or once every two weeks. A lot of insurance carriers only approve a set number of visits usually 12-20 visits per year. If they are Medicare then they are only covered for the DX codes initially given, and if the DX codes change we have to treat it as a "new injury" and therefore a new case and all treatments must reinforce a treatment plan for those specific DX codes, along with their day sheet must reflect areas effected by their specific DX codes so we have to make sure that when they come in if they are being seen for an issue in their lower back only areas on the body related to that location are circled, if they have a complaint elsewhere we either cannot have it marked on the day sheet or if it is really bothersome to them treat it but again, as a new injury. I think they too are only allowed something like 8 visits per injury without a re-exam progress report. We are fairly new at taking Medicare and are working through a lot of the red tape still so I may have been off on some of my thoughts of what Medicare patients/treatments are required.
As for X-rays, we pretty much have all of our personal injury clients get them, if a patient has had major bone break injuries, head trauma, recent bad fall we recommend them.
The facility I work for and have been with for about 8 months now is a little different and I kind of agree with you on the alternative energy medicines. Our practice is a bit of a clusterfuck in that department. First off we share our office space with another practice that used to be combined with ours but due to tensions and adversarial minds they split but decided to stay in the same space. The other practice has a chiropractor who also incorporates her nutrition plan of Ideel Protein into her scope of treatment, a massage therapist and an acupuncturist. Our practice has two chiropractors and a massage therapist. Our doctors also specialize in Neuro Emotional Technique -- NET. I've provided a link to goes over the basics rather than summarize. I'm not sure how much I believe in it and I also feel like it drives away some prospective patients because of their skepticism leading them to think that we are just a quack practice. Certainly a lot of our patients like and believe in NET but I agree that perhaps some of the more alternative energy treatments should not be included in a chiropractic practice.
One of the things our practice does is we have several other practitioners in and around the area we are in that get together once a month to talk about wins/losses/successes and failures. Usually the first hour is dedicated to the front office staff, giving them time to talk about what their Docs do that works really well for them to keep things running smoothly, what doesn't work, organization tips, helpful hints for other CAs (Chiropractic Assistants) as well as talk about areas they feel need improvement and their ideas/plans to remedy the issue. Then the doctors switch staff and have the front staff do NET with doctors that are not the ones they work for - this is mostly so the staff if they have something that is bothering them they can voice those concerns and get NET treatment without worrying that their boss will hear their complaint (i.e. my boss is a real passive aggressive bitch that constantly stresses me out) and not worry that they will be reprimanded for their thoughts. Then after that is completed and all the stress/issues have been given NET treatment to the staff the doctors work together for a couple hours testing new treatments they've heard about, talking about the staff (I'm sure) of where they as doctors feel need improvement or are good things that happened etc. While I don't believe in the NET part I do think it is helpful to have a support network of similarly practicing doctors get together and share their experiences to help each other out. We've come up with a lot of good things from this, for our practice we used to have a really long packet of new patient paperwork and one of the other practices had a new patient sheet that was just two pages that covered everything our 6 pages did. Another Doctor printed up what looked like credit cards or prepay cards that were actually gift cards for a new patient appointment, report of findings and also a half hour massage ($160 value), he went through the lines at all the big box stores on Black Friday night and asked people if they were interested, got their name and phone number and swiped the card on his iphone credit card accessory (it didn't do anything) but the visual for the recipient was here is your prepaid office card, just bring this with you to your appointment, when they came in his CA would swipe it on their credit card machine and say something along the lines of 'looks like you've got a $160 credit on here for new patient exam, report of findings and a half hour massage' and then set up the follow up report and massage appointments. While I do feel this is a bit of smoke and mirror type business practicing it was effective for his office. But it's ideas like that that they share and help each other's practices out with.