Competing Against Managed Care

by William D. Esteb

A story passed around the advertising industry is about a brewery in Wisconsin what watched his market share steadily decrease until to the point of almost bankruptcy. The brewer hired a famous advertising agency to help turn around the sales decline. The agency people studied the brewery facility from top to bottom. They asked questions. They analyzed the advertising of the competition. The recommendation? Advertise the fact that they used a particular type of hops in the production of their beer. "But every brewery uses the same type of hops," argued the brewery president in dismay. "True, but no other brewery has turned it into a unique quality," came the reply. History records a major turnaround for the brewer. As managed care providers pummel those chiropractors who are not members, a similar opportunity presents itself.

A week doesn't pass that I don't get calls from doctors challenged by patients who tell their doctor in effect, "You're not on my list, I can't see you any more." The script may vary slightly, but the result is that the patient is looking at the bottom line cost as a basis for making their health care decisions. (This problem isn't new. Chiropractors have long complained about patients who needlessly submit to surgical intervention because "it's covered by my insurance.") And while this may be hard to understand for someone who values their health as much as you do, finances play a role for patients who must actually pay for their care.

Having patients seduced by the low cost provider is the same problem that countless mom and pop retail stores have faced as the new Wal-Mart comes to town and opens its doors. Sadly, many small businesses succumbed to the path of least resistance, closing their doors after years of service to their communities. More and more chiropractors are facing a similar choice. Stay and fight, or make that video rental store a dream come true.

Maybe you didn't get in to the local network. Maybe you didn't want in. However, combating the chiropractic offices that did join requires a similar approach as used by the brewery and the small businesses thriving in the shadow of huge retailing behemoths. It is not business as usual. Roll up your sleeves, put on your marketing hat, and let the games begin!

First, recognize that one of your most valuable assets are your inactive patient files--people who know you, know where your office is, know your wonderful tableside manners, and know of the great results you produce. If you haven't been nurturing these patients through letters, postcards, newsletters, occasional patient appreciation days, annual check up offers, and the like, get started! Out of all the people on the planet, these are the people most likely to make an appearance in your office. It can seem like a long, one-sided conversation, but persevere. There are no better prospects. Even if you're new in practice and only have 20 inactive files, keep in touch with these patients. Forever! Think of their care as simply in the dormant stage. Keep the relationship going. Make sure every one of those patients would feel that they'd be welcomed back without an "I told you so" and be delighted to encounter you while shopping for groceries. Think long term.

Second, carefully analyze your competition. A famous marketing axiom suggests: "1. Price, 2. Speed, 3. Quality. Pick any two." This rule of thumb is helpful in uncovering the Achilles heal of any competitor. If your competitor is selling on price (such as managed care seems to be doing), than they almost always have to concede speed or quality. Whatever factor they seem to be neglecting should become a major focus of your marketing efforts. This is how small businesses have been successful in co-existing beside large retailers who can offer the lowest prices.

Third, in light of the rule of thumb above, it's time you grab a yellow pad of paper and begin taking an inventory of the unique factors of your practice. Most businesses do this as a matter of course when designing a marketing plan. You've never had one. So, let's get started. Here are some ideas and strategic observations that may help get you started:

1. Practice resources. Do you have special equipment, tools, procedures, that you can claim as yours by being the first to make them an issue? Do you take for granted what your flexion/distraction table offers your patients? Have you become numb to the patient convenience of your hi-lo table? Have you overlooked the convenience of your in-house massage therapist? Your X-ray equipment?

2. Your devotion to the patient's health. If you've decided to go solo, without some profit-motivated bureaucracy looking over your shoulder to second-guess your recommendations, you can be totally focused on the patient's health. "Our patient's don't have their problem minimized so as to fit some statistical model. We take your health seriously! It is our only concern." Your objectivity can be positioned as a patient benefit.

3. Years of experience. If you've been doing this more than ten years or so, your experience "with a wide variety of cases" can be perceived as a competitive advantage. How many patients have you helped? How many hours of post-graduate continuing education have you received? What special degrees, certification, or training have you acquired?

4. Same day appointments. Do you have openings each day for new patients? Without specifically mentioning this it is easy for a first time chiropractic patient to think they'll have to wait until next week, like getting into their medical doctor's office. If you offer same day appointments it is a marketable service.

5. Number of successful cases helped. How many headache patients have you helped? What's your success rate? If you've never thought about it or kept track, get busy! What better way to bolster a patient's confidence and create a competitive advantage than to identify your batting average? To differentiate managed-care chiropractic from patient-directed chiropractic care, you have to roll up your sleeves.

6. Patient conveniences. It may not seem relevant to where you practice, but what about parking? Is it easy? Is it free? Is there easy access for traffic in either directions in front of your office? What about office hours? Are you practicing the same hours as the managed care facility down the street? Why? Maybe it's time to reclaim Thursdays and make it your big day. How about at least one Saturday a month? Rethink the status quo.

7. Affordable care. If you want to go head-to-head, lower your overhead, cinch up your pants, and make your fee structure competitive. If you wish you were a member of a network and were excluded, why not offer care for the same cut rate fee you would have been offering as a member, sans paperwork, hassle, and second-guessing? Price should be the last thing you negotiate, but if that's the writing on the wall you're reading, then what are your other choices?

8. Patient education. Believe it or not, the very mention of the fact that you "explain everything in advance" can be a significant competitive advantage. Like many of the other points mentioned, you probably take your patient education efforts for granted. What makes your patient education uniquely beneficial to today's time-conscious patient?

9. Community involvements. Don't laugh. You'd be surprised how many fellow Rotarians, Red Cross volunteers, or Annual Pooh-Bah fund raiser contributors will seek out one of their own. Keep your community involvements to yourself and you overlook an aspect which could give others a reason for choosing your office over the next.

10. Your staff accomplishments. I bet your staff has some special training or particular skills that make your office compelling to prospective new patients. Is it a great personality, skilled with children, helpful over the phone, able to get answers, sensitivity to the needs of new patients, or professional nursing experience?

11. Doctor access. Are you accessible by telephone to answer questions? That's a competitive advantage that a lot of patients would find appealing. Your willingness to field questions, clear up concerns, and discuss issues without forcing the patient to make a seemingly irreversible commitment to show up in your office could pay huge dividends. Already do it? Well how come your current patients don't know this so they can urge their friends to call?

12. Patient testimonials. Forget the dog-eared book in the reception room--by the time those testimonials are read you're preaching to the choir! Do you have patients who would be willing to field an occasional phone call from a prospective patient who is considering care in your office? An office so open and confident, with patients willing to vouch for them, could be turned into a competitive advantage.

13. Thorough examination. Again, you probably figure every chiropractor delivers a thorough examination so it's not differentiating factor. Perhaps you need to make it a factor! How many different tests do you typically conduct? How good are you at detecting other problems that patients forget to mention? How many times have you uncovered problems that prompted you to refer out? "Does your managed care provider deliver a thorough examination, or are you rushed through like a number?"

As you can see there are many aspects of your practice that you take for granted that can be turned into irresistible reasons to consult your office. Once you assemble your list, make sure your active and inactive patients know this information about your office! Some of these items probably belong in your yellow page ad. Print the most important ones on the back of your business card. Act! You're playing catch up ball now, and every day counts.

Excerpted from
Chiropractic Patientology
Originally published in 1996
240 Pages
US $24.95

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