The Three Ways To Grow A Practice
by William D. Esteb
As belts continue to get cinched up, and doctors adapt with growing consternation to the effects of managed care, it's a time to return to the fundamentals of growing a practice. Those who make a living obfuscating chiropractic success skills, or making practice growth habits unnecessarily expensive to obtain, are discovering that efficient insurance billing is no longer the answer.
The fact is, there are only three ways to increase your take home pay in any business, whether it's a major long distance telephone company, a pizza parlor, or a chiropractic office. I wish it were more complicated, but it's not.
1. Get more customers: We're on pretty safe ground here. When you get more patients, the practice grows. If you can control your overhead, and collections remain on target, you stand to take home more money. That's a pretty big if, since most doctors find their overhead expenses rise alongside their increased patient volume. However, in its purest form, increasing the number of customers seems like the easiest way to enlarge the bottom line.
This simple idea has captured the imagination of just about everyone in chiropractic. Everyone from table manufacturers claiming their devices will increase productivity, to seminars, promising that you'll have so many new patients you'll need a waiting list, knows that growing your practice by seeing more patients is an easy idea to understand. Generating large numbers of patients willing to pay and stay, may be one of the most difficult ways to grow a practice, but it certainly is compelling. Doctors bred into believing that humanity is best served by having an endless stream of patients to adjust, are easily taken in by this approach. "If I just had enough new patients, my problems would be over," they muse as they gaze out the office window. But by the looks of their trophy case of inactive patients, an objective observer might suggest that these doctors have already had enough new patients.
Increasing the number of new patients can almost always be improved 10% to 15%, just by implementing better procedures and putting more control mechanisms in place (recalls, asking for referrals, or financial incentives). To double the volume (or more) often requires more risk-taking, change, and discipline than most doctors are prepared to make. "I don't feel comfortable doing that" or "It's just not me." That's no problem because there are two other ways to increase your take-home pay.
2. Increase the transaction amount of each customer: In other words, just increase the amount of money each patient spends on a typical visit.
Of course the easiest way to do this is to increase the price of an adjustment. Recent history bears this out. That was one of the apparent contributions of "insurance equality." In the states that scope of practice laws permitted, the age-old adjustment came increasingly accompanied by anything from $20 ice packs to largely unattended $45 interferential-electro-ultrasound-gizmo treatments. Apparently what insurance equality meant, was that the cost of a chiropractic office visit could equal that of a medical doctor's office visit. Kind of makes you wonder how those chiropractors who went to jail for simply detecting and correcting subluxations paid the rent, much less ever got a patient well!
While the money was good, the heady days of easy insurance money did little to advance the impact of chiropractic. If anything, it insulated both the doctor and the patient from reality. It diminished a patient's sense of responsibility and it distorted the value of an office visit. More and more doctors are recognizing this, as major medical deductibles soar, managed care organizations exclude them, and patients slink into the office as cash patients.
No matter how hard you try, 1985 is gone. And it's not coming back. Yes, increasing the amount patients pay on each visit can boost your income, but there is a price to be paid. Some are paying it now as they alternately stare at all the files that prove how many new patients they "bagged", and an empty appointment book.
Don't despair. There's still one more way to grow your practice. It's my favorite.
3. Increase the number of transactions per customer: In a profession in which its members claim to treat the "cause" of a patient's problem and not the symptoms, there sure is an overwhelming desire to experience the affirmation that relieving a patient's symptoms seems to produce. Most doctors prefer the challenge and psychic rewards that come with new patients.
In all too many offices, once a patient experiences symptomatic improvement, they are discarded or abandoned like a jilted lover. Oh no, they're not booted out the door or barred from making future appointments. In small, subtle ways they are ignored. They have to wait for the "emergency" symptomatic new patient. There is less and less to talk about. No progress examinations or reports are conducted. And there isn't a "please" or "thank you" to be heard as the doctor barks orders at the patient to perform "horizontal aerobics" on the adjusting table. No, the patient has become part of the expected volume and is often taken for granted. So they leave. And make room for another more fulfilling type of patient: one that is hurting.
With the big, juicy checks showing up less frequently in the mail these days, it behooves doctors to concentrate less on making a big killing during the early stages of care. Instead of expensive diagnostics and two or three therapies, look for ways to extend the relationship over not just months, but years. It's the difference between running a stressful "emergency room" chiropractic clinic or a predictable "preventive dentistry" chiropractic office.
If I were a doctor interested in maximizing the number of long-term patient relationships in a practice, here are some things I'd do:
Stay in touch. This is probably the most overlooked aspect of maintaining long term patient awareness and interest. I'm not talking about the computer program that spits out a form letter when someone thinks of it. I'm talking about newsletters, office brochures, postcards, announcements, mailgrams, and anything else you can send through the mail. And not just quarterly when a new staff member has the time or interest! At least once a month every patient who still resides in your area should get something from your office. It can be a letter, a reminder, the synopsis of a late-breaking research project, tips for shoveling snow, or the announcement of some accomplishment by another patient. Staying in touch in this way increases the top of mind awareness patients have of your office, and demonstrates in a very tangible way that they would be welcomed back should they decide to return. Key point: keep at it. Don't abandon your efforts after 4 months because there aren't lines in front of your clinic! Like compound interest, your efforts will eventually be rewarded.
Become more interested in the patient. Patients aren't interested in your vacation, your new house, your kid's spelling bee win, the weather, or who won the game last night. The most important thing you can talk about with a patient, is the patient! What made Johnny Carson such a good talk show host was that he was sincerely interested in every guest. Like Carson, make a commitment to learn something from every patient you encounter. With the diversity of patients you see, their backgrounds, jobs, and ages, you have an exciting opportunity to learn about the world, without leaving your office. There are few other ways to more powerfully demonstrate how much you care, than to have a genuine interest in the lives, attitudes, challenges, and knowledge of those you encounter.
Create a financial incentive to remain under care. The airlines do it. They encourage loyalty by rewarding their most valuable customers with special offers, free travel, and a host of other benefits that prompt many frequent flyers to consistently choose one airline over another, sometimes regardless of schedules or cost! Many doctors are fearful that making special offers would cheapen or devalue their care. Nothing could be further from the truth. Perhaps free offers and special deals for new patients could lead to such an allegation, but the people we're talking about already understand chiropractic, respect you, and want what you offer. Yet, without a corporate expense account to pick up the tab (insurance), most of your best patients would appreciate some type of gesture on your part. Be creative.
Reserve VIP adjusting times. I hate waiting. In fact, I've never met anyone else who enjoys waiting. However, most patients have to wait, especially during the peak hours of the day when everyone wants to get adjusted. When you're in pain, and its relief means enduring the wait, the choice is easy. Yet, with their symptoms gone, waiting is so distasteful for today's over-committed generation, many patients simply size up the number of cars in your parking lot before deciding to pull in. Here's a bold idea: pick one or two times each week that last an hour or two, that are reserved for your "20/20 VIP Club." Membership is limited to those who have already had at least 20 visits in your office. During the times you set up, you guarantee that for club members, no office visit will take longer than 20 minutes--or it's free!
It must be comforting to be continually reminded that chiropractic works and that you did indeed choose the right profession by seeing a constant stream of sick patients getting well. And while there's a whole lot more to chiropractic than making money, you'd probably make even more if you implemented ways to encourage more of your patients to adopt a chiropractic lifestyle like you enjoy. If you did, you could ignore the pressures of managed care, sneer at the bureaucrats in Washington, and laugh all the way to the bank.
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Originally published in 1995
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