You see patients every day, performing adjustments as well as consulting with them on a variety of topics such as injury prevention, nutrition, health maintenance, and more.
How do you manage your practice to make sure you’re providing all of these needed services to your consumers while still maximizing your time—and ultimately your revenue—to maintain a viable, successful operation?
We spoke with three chiropractic consulting experts who believe in the importance of building a busy practice while still maintaining high-quality, comprehensive care in the community in which you work.
The high-volume theory
David Singer, DC, founder of David Singer Enterprises, says he began his practice 45 years ago charging $5 per visit and was able to earn a six-figure income in his first year.
“I was able to see a lot of people, and over the years I learned to grow and expand,” he says. These days, his company serves as a practice consultant to more than 800 chiropractic clinics in the U.S. and abroad.
According to Singer, the definition of a high-volume practice varies from provider to provider. “For some, seeing 20 people a day would be high-volume, for others it would be 200,” he explains. “By definition, high- volume is simply above and beyond what a chiropractor normally does.”
Singer says having a high-volume practice is particularly attractive as insurance continues to play a smaller role in chiropractic care reimbursement.
“More and more providers are moving toward a cash-based practice, and chiropractors have two options— they can sell high-ticket cash plans or they can do high-volume moderate fee schedules,” he says. “The latter is the only way you can really continue to grow. You can develop a personal injury practice, but you have to be lucky enough to be in a state that still has good insurance for chiropractic care.
If you’re in a state where people have $3,000 deductibles, you’re forced more into a cash practice model, so you need to go for a volume of people at a fair price.
“You can provide a specialty such as neurology, which charges more per visit, but if you’re not doing an advanced modality and want to survive the economics of today’s chiropractic care, consider seeing more patients while still delivering quality service,” he adds, stressing that high volume is not synonymous with poor quality.
So how does Singer suggest building a practice in which you can see 100 or more patients a day? “You should always want to treat patients the same way you want to be treated,” he says. “We used to joke about how long it takes for you to adjust your spouse or staff, and if you use that as a measuring stick, you will discover that you do it quickly because you don’t spend as much time talking.”
A common problem he sees is that many chiropractors think that to justify charging $50 they have to spend time with patients, and a lot of that time isn’t spent in the rendering of care.
“In my practice, I had 14 adjustment rooms,” Singer adds. “If I felt the patient needed anything other than adjusting, I would have the chiropractic assistants do it.” He recommends that you delegate everything other than adjusting and to indoctrinate your patients accordingly. In this model, it doesn’t take a lot of time to do a high-quality job.
“You need to reduce needless conversation. Most people prefer a clinic where you go in and out rapidly,” he says. “The largest-volume practices are interesting because there appears to be a reverse statistic: It seems that the longer a patient is in your clinic, the fewer times they go back. Obviously, when someone is in agony, he appreciates the time, but as symptoms disappear, he appreciates not being in your clinic.
One of the main reasons providers have higher volumes is because their patients go there sometimes for years because they know they won’t have to give up a lot of their time. Time is valuable, and chiropractors forget that.”
Singer says it takes effort to educate patients on the importance of saving time, but in the end the result is worth it.
“When you go to college you have orientation, so you know where you are going,” he says. “The problem is that chiropractors have no system of orientation for their consumers. These people don’t understand they need their spine orientated and they feel like they should discuss what their symptoms are.
“If I go to a dentist to have a cavity removed, I know what they are going to do and I understand why I am there,” Singer adds. If the patient knows they are coming to you to get an adjustment, and the value in the visit is the adjustment, then the time they spend going over other issues is reduced. Patients are not buying your time (unless you sell it that way), they are buying the adjustment to obtain the outcome.
Community caring counts
Brent Detelich, DC, cofounder of Physicians Business Solutions, believes in the power of community to build a successful high-volume practice.
“First and foremost, I always wanted to help as many people as possible,” he says. “A chiropractor who likes to have multiple and frequent new-patient events—lectures, screenings, and more—will build a stellar reputation. When I started in 1993, it took me two years to get to 200 visits per week, then I started community events and that resulted in 550 visits per week. Within six months, I had five clinics doing 2,000 visits.”
Detelich maintains that staff training also plays an imperative role in building a high-volume practice.
“As a chiropractor, you’re limited in what you can do,” he says. “You need to train your staff to do new-patient events, patient education, scheduling, and money collection.
Then you can grow and sustain your practice without getting burned out. You can do it yourself for only 10 to 20 years.
“You do have to make sure not to have too many staff members,” he adds. “Each staff member has to make money, and if they all under- stand their jobs and are monitored by the chiropractor and are retrained as needed, it can go well. If overhead explodes, you’re literally working to pay off debt.”
Currently, Detelich consults with 650 chiropractic practices, helping them build patient volume while increasing their return on investment and maintaining high-quality care.
“When someone does it on their own, it can take two years to double their income, but with a good coach it only takes six to 12 months to build a larger, more successful chiropractic practice,” he says. “It certainly helps to be a great communicator, have confidence, and be a good leader.”
Patient education is also key, especially in light of today’s insurance challenges in the chiropractic world, Detelich says.
“The only way people will pay with cash is if they understand why and what they are paying for,” he says. “Patient education is crucial.”
CJ Mertz, DC, is CEO and president of CJ3 Consulting. He says his success in building a high-volume practice in California 30 years ago stems from the mentoring he received as a student. Since then, he has coached over 15,000 chiropractic teams in more than 30 countries.
“It all stems from the first practice I built in northern California, when I built a practice of over 1,000 patients a week, and chiropractors saw what I was doing was unique,” he says. “The reason I eventually became a coach is that I felt blessed that I had mentors early on.” The people he was studying under in chiropractic, business, philosophy, and finance steered him toward studying what it would take to build an exceptional business in chiropractic care.
“What was even more important is that it became clear to me that every person in the world should benefit from chiropractic care, and I was able to get such a simple and profound sense of the philosophy that supported that statement,” he adds.
The average chiropractic patient is 32 years old before they receive their first adjustment. Today, the chiropractors he coaches are able to communicate to their patients and the community regarding how and why the spine and nerve system should be maintained from birth.
Mertz says that communicating this philosophy is key to building a high-volume practice.
“When I incorporated this concept into my practice, new patients would come in the same way they always did, but they also learned why their spouse and children should receive a chiropractic checkup. That’s when everything changed—I got to where 90 percent of patients, within a week of their exam, had their family coming in for an exam. My practice changed from an individual patient practice to a family evaluation practice. I was able to tap into families, including athletes and those athletes’ families, and it all circled back to, ‘Let’s get the family checked.’”
Patient education from page one
The education process starts immediately: “During new patient evaluations, I say to them, ‘Your spine and nerve system should have been maintained from birth.’ The vast majority of people deal with stress.
If we don’t understand this stress in our nerve system, it can accumulate and interfere with the ability of the body to heal. I’m simply planting the seed on day one about what occurs when stress happens so they can begin to communicate that to family members.”
Patient education also includes education about the visit itself, thus augmenting the effort of building a higher-volume practice.
“The average chiropractor is performing 75 adjustments a week,” Mertz says. He wanted to break out of that mold, and that directed his attention toward patient behaviors.
“Patients will come into an adjustment room waiting for the doctor to show up, and just that behavior tells them the chiropractor will get into a conversation with them and it will go on for a long time,” he says. He found it better to have his team come in at the start of a session to do care and a report of findings, then let the patients know that the chiropractor would be putting them into adjustment time.
“This way, people know that when you’re seeing me, you’re in adjustment time. My patients learn that I do not perform consultations during adjustments, but if they have some- thing they really want to talk about, my chiropractic assistant will schedule a call or appointment outside of the adjustment schedule.”
With techniques like this, he eventually eliminated the inconsistencies that prevent a chiropractor from seeing patient after patient. He also had patients in the adjustment area lie down prior to receiving the adjustment.
“By doing that, for even just a minute, they would have a two- or three-times better adjustment. As long as I had a patient lying down before the adjustment, I was no longer waiting for them, they were waiting for me,” Mertz says.
In summary, building a high-volume chiropractic practice appears to be relative; what one chiropractor considers high volume may differ from what another deems it to be. Regardless, achieving more patient throughput in your practice without compromising quality care takes a good deal of patient and staff education, delegation of duties, and an ability to separate adjustment time from time spent conversing with patients about other issues.
These days, mastering these skills can make all the difference between generating an average income and a great one, especially as insurance coverage continues to decrease. This trend is not unique to chiropractic, but is felt across the spectrum of healthcare modalities. While you can’t control macro trends in the industry, focus on the factors you can control in your practice.
Amy Stankiewicz is a freelance writer based in Cleveland. She has written for trade publications for more than 15 years. She can be contacted at firstname.lastname@example.org.
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