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How Much Should an Adjustment Cost?

adjustment-cost.jpgA common question I field coming from chiropractors, reacting to an increasingly deregulated practice environment and coming to grips with the tension faced by all small business owners is, “How much should I charge?”

The question reveals a profound misunderstanding of how business works, which is understandable, seeing that most chiropractors wanted a practice but find themselves in a small business, facing the same issues all other small businesses face—but hamstrung by little training (or real interest) in the nuances of pricing.

If you find yourself in this dilemma, you may find some of the follow observations helpful.

Not all adjustments are created equal. While insurance carriers have advanced this notion, in a deregulated environment, chiropractors who are capable of adding more value to a patient’s visit are able to charge more (and collect it) than chiropractors who are more perfunctory. In other words, all things being equal, chiropractors with a better (as determined by patients) tableside manner are able to charge a higher fee.

Naturally, this assumes that your intervention actually serves to invoke the patient’s inborn ability to heal, within the time expectations of the patient.

Turns out, some patients are less price conscious than others. Those in more affluent areas may value their time more than the money, finding that long office visits are less desirable than a precise, highly focused visit. Every patient is different.

If you’re coming off a hangover from overindulging in third-party reimbursement, and revisiting what you charge, there are many issues to consider. That’s probably not the recommendation you were hoping for, but to provide a specific price for an adjustment in Westchester County, New York versus Chickasha, Oklahoma is unlikely.

In the past, some have suggested that the correct price of an adjustment could be computed by taking some fraction of the average cost of a new home in a particular community. While this would be handy, it still makes far too many assumptions about personality, technical prowess, diagnostic skills, technique, office environment and a list too long to mention here.

As you review your published fees in light of higher deductibles and co-pays, here are few issues to keep in mind:

Rule #1: You cannot charge a penny more than you think you’re worth.

Like a thermostat, each of us has a “set point” as to what we think we’re worth. This internal reference point controls the whole show. It’s not a figure that is analytically determined by some formula based on your experience or investment of time and student loans. It’s in your gut. Go a penny above, and you won’t be able to look a patient in the eye when you say the number. Your body reveals your incongruence.

Action step: Eliminate your “stink’n think’n” about money! Remember the admonition of the cabin attendant should there be a sudden drop in cabin pressure. “Put on your own mask before helping others.” Same thing here. Chances are you don’t own a single book about wealth creation. Take the plank out of your own eye before helping patients with the speck in theirs.

Rule #2: Avoid projecting your own financial situation onto patients.

Many chiropractors who are living hand-to-mouth find it difficult to make appropriate recommendations to patients. “Heck, I couldn’t afford to pay for the care I’m recommending, they probably can’t either.” Whether it’s you who thinks this, or someone you’ve delegated this responsibility to who does, it’s an unhelpful belief. In fact, it often reveals that that you need the patient more than you think they need you!

Action step: There’s nothing that will end this unhelpful belief faster than reaching into your own pocket or purse and paying for your own chiropractic care. Once you pay for it (no more trading adjustments with your buddy!), it becomes much easier to visualize patients doing the same. Harsh medicine. But it will cure you.

Rule #3: If no one complains about your fees, you’re charging too little.

This is some classic pricing guidance that virtually all other small business owners are familiar with. Many chiropractors, especially the most self-sacrificing, are afraid to raise their prices for fear patients would raise a judgmental eyebrow, or worse, desert them. If you’re relationship is so fragile that patients begrudge an overdue cost of living increase, then you don’t have much of a relationship anyway.

Action step: Become mindful of how many patients regularly complain about your fees. If it’s been awhile, it’s probably time to raise them. Take an inventory of what you’re charging, when you had your last increase and how much the cost of living has escalated since.

Rule #4: Accept that paying for their care is part of the healing process.

Taken an inventory of your worst patients. Most share one thing in common. They either don’t pay for their care (family members come to mind) or they pay a deeply discounted fee. Yes, you have an obligation to perform some pro bono care, and I’m not talking about that. There must be a fair exchange or the relationship isn’t sustainable. Or healthy.

Action step: Make a list of the patients that you dislike caring for or worse, resent. Realize that adjusting them, while harboring these feelings, means you’re actually shortchanging them. It’s practically a form of stealing. Have the courage to refer them elsewhere. Or change your heart.

Rule #5: When the dust settles, it doesn’t matter how much you charge.

This may annoy you, but it’s true. Somebody in your community is the low cost provider of chiropractic adjustments. Someone else holds the distinction of being the most expensive. Turns out, success, is not based on how much you charge! Be careful that you don’t fall for the common, but incorrect belief that lowering your fees will increase patient volume. That may be true for products, but it rarely holds true for services. (Many chiropractors can't get inactives to return for a free visit on their birthday!)

Action step: Regardless of what you charge, look for ways to add something of value to each visit. It could be a question about their hobby, a humorous story to brighten their day, a compliment about their hair or a million other gestures that reveal that you see them as a person, not merely a spine or a condition. Regularly deliver, as B. J. Palmer termed, “The adjustment with that something extra.”

There are few topics as emotional as fees. Many of us link our self-worth to what we charge, further complicating the matter. But know this. Chiropractic care, even when its delivery isn’t especially artful, is far more valuable than a 20¢ pill that fools the body. It may not be as convenient. And it may not offer the “fast, fast relief” that many demand. But it is far more valuable. Help patients understand the difference between short-term price and long-term value. Then, honor their choice!

Comments (2)

Dr. Matt Green:

The part that is still ringing in my ears is, "Turns out, success, is not based on how much you charge! Be careful that you don’t fall for the common, but incorrect belief that lowering your fees will increase patient volume." No... I'm about to open my own practice and I really think that lowering my fees will drive in more business. Ahhhh. Back to the drawing board.

Have you ever estimated how much money your family spends on pain medication per year? If not, calculate it now. (Take care to include over-the-counter drug costs, which alone can reach monumental sums.) Chances are you’re spending more on covering up your pain with drugs than it would cost to treat your family to a year’s worth of preventative chiropractic care!

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From February 13, 2011 8:24 AM

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