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What Would You Charge?

no-sale.jpgDear Bill,

I value your insight as a patient’s point of view, and wanted to get your opinion on fees. As I move to more of a cash based practice, and cannot rely on riding the tail of the insurance industry anymore, I am having a difficult time re-setting my fees.

My difficulty consists of my new patient fees. I perform a "hands on" exam as well as a sEMG/Thermal scan as well as a digital posture analysis on most patients. I also usually perform a front and side view full spine X-ray (two films 18-36 inch), on most adults and occasionally on a child, depending on the situation. I currently charge $180 for the X-rays and $45 for the exam for a total of $225. I was previously with a management group who thought this was too high and recommended keeping it under $100. They thought it might be a barrier to new patients. Their logic was to remove the money barrier so that they can have more money to give chiropractic a chance.

It's no wonder that my Chiropractic Opportunity weeks (where new patients are free) are so successful, but make me feel cheesy. Bill, what would you charge? And would you do any "free" promotions? I have also done the bring-in-something or charge-a-nominal-fee-and-donate-it-to-a-local-charity thing, but that also made me feel creepy. I would rather just donate on my own. Please offer your opinion!

Cheesy and Creepy

Dear Cheesy and Creepy,

Setting fees is suddenly a new experience for chiropractors as they disengage from the “price fixing” influence of insurance companies. Many find themselves in the same place as plumbers, hair stylists, lawyers, consultants and others who deliver services rather than products: “How much should I charge?”

Regardless of what you decide, here are some things to consider.

It used to be that one of the many distinguishing characteristics of chiropractic was that as a ratio, a relatively small amount of money was used for diagnostics and the lion’s share of the money was spent on addressing the problem. As chiropractors rubbed up against the allopathic mindset of insurance companies that changed to more closely resemble the medical model. Thus, I would tend to agree with your consultant that a high entry fee could pose a barrier to entry.

I’ve often asked established chiropractors, who long ago paid off their X-ray equipment, why they need to extract so much up front for these pictures (other than the fact that they could when insurance companies were picking up the tab). In light of the fact that few patients specifically request X-rays, the practice of charging $180 for them may suggest some rethinking.

What you charge is also a reflection of the type of relationship you hope to have with patients: a short-term episode for symptomatic relief, or an ongoing, long-term connection with people who see chiropractic care as a valuable adjunct to promote good health? Incidentally, if it’s a matter of income, I’m certain that I’ve generated considerably more income for my seventh chiropractor (I saw for eight years) and my ninth chiropractor (whom I’ve seen for four years and counting) than the first one who front-loaded expensive X-rays and diagnostics on the first visit of a six month relationship back in 1981.

Those who feel threatened by this observation will claim that they deserve to be paid for their education, the risk they assumed by buying an expensive piece of equipment and the skill necessary to produce beautiful radiographs. And I would agree. But be careful that you don’t miss the larger picture. Because while an artfully delivered series of adjustments that saves a life, prevents a risky surgery or avoids the need for dangerous drugs is worth a million bucks. But it’s a sum difficult to collect in the real world. And that’s what’s in play here: what will the market bear?

Since your experience of offering “deals” seems to produce an uptick in the number of appreciative patients, before you settle on a new fee structure you must abandon one other holdover from the Insurance Era: that an adjustment is an adjustment is an adjustment. In other words, insurance companies pretty much treated adjustments as a commodity. Identical. Paying the same to you as those delivered by the tentative new graduate who just opened down the street.

Similarly, the first visit you described, complete with videos, consultation, X-rays, sEMG scans, touch-and-tell physical examination and sending the patient home with some BioFreeze and a water bottle with your logo on it, is perceived and valued differently depending upon countless details too numerous to mention here.

So, here’s the rule of thumb when it comes to setting your fees. If no one complains, they’re probably too low. If everyone complains, they’re probably too high. If some complain, but others don’t, they’re probably just right. That said, is $225 on the high side? I’ve seen higher. Would $100 be on the low side, probably.

I’m guessing your entrance fee isn’t the real problem. More likely, erosion in the number of new patients you’re getting these days is producing doubt. Hesitation. Lack of certainty. If that’s true, better than tinkering with your fees would be to address the cause, not the symptom. You (and your staff) might want to ruminate on the answers to questions such as these:

    What would it take to increase the way patients value what I do?
    How could I be more present with patients and become a better listener?
    How could I regularly exceed the expectations of those who begin care?
    In what ways, other than adjusting them, could I be of service to patients?
    What question(s) am I most afraid of being asked by one of my patients?
    How can I banish judgment and show up more curious about patients?
    If I had an unplanned need to begin chiropractic care how much would I pay?

Price is the last thing you want to negotiate. Sure, you must adapt to the realities of today’s marketplace. But before you lower the fee for your service, look for ways to enhance its delivery, increase its relevancy and heighten its perceived value.

As for offering something for free or deeply discounted, in a word, no. Pro bono work? Absolutely. Different motive. Using financial inducement to motivate patients is not only unwise, it’s a form of symptom treating that overlooks the underlying cause.

Comments (1)

Chris Sande:

Thank you Bill. Someone of your stature finally said it. I see so many promotions around my area for ridiculously low/free initial exam and adjustments. I see the gurus promoting their new patient marketing tactics doing the same, only to set them up for the big "pitch." I have been guilty of doing the same in the past. But I finally realized from a P.R. standpoint, I was shooting myself and chiropractic in the foot. If we as chiropractors want respect and authority, we need to act like we deserve it. Begging for patients is not the way to achieve that. Putting yourself to a higher standard is.

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From June 5, 2009 9:32 AM

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