Category: Practice Management

Patient Retention in a chiropractic practice is defined as the number of times a patient visits your office for chiropractic care.  In order to increase your Patient Retention, you need to increase your patient’s level of understanding.  Patients will follow your recommendations for care if they have a high level of understanding about how your care is helping them.  Retention is equal to understanding.

The entire chiropractic profession needs to work together to improve our patients’ levels of understanding of chiropractic.  The best place to begin this educational process is with a new patient.  When a new patient walks into your office, their level of understanding, on a scale of zero to ten, is at zero.  As a chiropractor, it is your job to change their “Medical Model of Thinking,” and move them up the “Chiropractic Ladder of Understanding.”  As you increase your new patient level of understanding, you will also increase your patient retention level.

Patient understanding is built through patient management.  The ideal time to conduct patient management is during the patient consultation.  Some very critical decisions are made during this interaction between the doctor and the patient.  The manner in which you ask the consultation questions, how the patient answers, and the correct way you respond to their answers, builds the foundation for advancing their level of understanding.  It is important to take advantage of every opportunity to educate and teach your patient about the benefits of chiropractic care.

You continue your patient management during the “Report of Findings.”  You and your staff must remain consistent and precise with all communication during the first several patient visits.  This increases the patient’s level of comfort and confidence in your care.  This is the time that you must “reset the decision criteria.”  When you reset the decision criteria, you move your patient up a level of consciousness, so they are more willing to continue with chiropractic care.

When a person fully understands how they are benefiting from and what the advantages are to chiropractic care, they have reached the “ten” on the understanding ladder and you have increased your retention percentage.  You no longer need to sell the concept on a visit-by-visit basis.  Instead, your efforts must focus on routing the patient through their treatment plan with continued emphasis on their understanding.
Taking each patient through the following process will increase your retention rate and help move your patients from their first visit to participating in a treatment plan.

First Visit
– Patient knows they have a problem
– Patient knows there is a solution to their problem
– Patient knows and is committed to returning to your practice for a Report of Findings

Second Visit
– Patient agrees to chiropractic treatment
– Patient agrees to attend your in-office workshop
– Patient commits to returning for “treatment plan review” visit

Third Visit
– Patient knows the solution is “Corrective Care” over “Relief Care”
– Patient commits to treatment plan
– Patient has taken financial responsibility

A practice’s percentage of retention is equal to the number of patients on a care plan out of the total number of new patients seen during the same timeframe. You hold the key to unlocking the mystery of Patient Retention. Educate on the benefits of chiropractic care, educate on the specific condition and educate on the success of your treatment.  Education equals understanding.  Understanding equals retention. TAC

Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist.  He is well known for his practice management expertise, as well as new patient development programs.  He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation.  Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO.  He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.

The battle cry of so many chiropractors today seems to be, “I don’t have enough time!”  The funny thing about this statement is that everyone has exactly the same amount of time–24 hours a day, seven days a week.  Why is it that some people seem to accomplish so much, and others can barely boast about completing a few small tasks?  It all has to do with how you utilize your time and the results you choose to focus on during the time you have available. 
You need to focus on increasing your results with the same amount of, or less, effort.  One way to accomplish this is through improving your ability to complete a specific task.  You can improve your ability by developing a better understanding of time management.  Most people feel that they are already efficient with their time.  They have absolutely no idea how they could possibly fit one more activity into an already seemingly filled schedule.  The answer is simple.  If you improve your ability to perform your tasks, you will find that you have created more time.
In actuality, you are just managing the time you have always had in a more efficient manner. 
Two important factors to evaluate when seeking to improve your ability in any area are:
1. The organization of your systems
2. The training you possess for the specific jobs you are trying to accomplish
How would you go about improving these particular areas?  Start by examining the organization of the systems you currently have in place.  Look at the intended results of a specific system and determine if the system is accomplishing the task it was originally created to achieve.  If not, what has changed since the inception of this system?  Get back to the basic reason the system was created and take out any unnecessary steps.  Only keep the systems that are producing results with the least amount of time and effort.  Planning your time is critical because it dramatically reduces the chances of someone else’s planning your time with some “emergency”.
Consider your own daily system for completing tasks.  Most people waste time because of the inefficient way they plan their days.  The most efficient time management technique is a three-part system that includes a:
1. Master List
2. Production List
3. Top Five List
The Master List contains everything you would like to accomplish in the next month.  It is a strategic overview of your projects.  Your Production List is a daily listing of the specific tasks you would like to accomplish during that day.  The Top Five List is the most important five tasks that must be completed today.  Compile your Top Five List by taking five actions from your daily Production List and handwriting them on a large piece of paper prominently placed within easy view.  Focus your energy on this Top Five List.  Do not deviate from that list until all five items have been completed.  Once that is accomplished, fill out another top five items from your Production List.  By having a specific list of tasks, your attention is focused on the most important matters of the day.  It is easier to stay on track when your activities are already planned. 
The other important area of time management is training.  The better trained you are at a specific task, the more efficient you will become at completing that task.  The same holds true for your staff.  You should hold weekly training sessions for your entire staff.  Training topics should be taught and then reviewed on a regular basis.  This gives each staff member an opportunity to improve their value and become better at their specific jobs, including you. 
If a staff member thinks they alrea

BUDGETING & PLANNING
Budgeting includes short- and long-term plans

Look beyond next year!

This article was written to help you on budgeting for your chiropractic practice.  We’re starting now to develop your practice’s 2003 budget.  It amazes me how many doctors spend more than they make.  We are fortunate to drive luxury cars, live in large homes, take great vacations.  But, we must do this only if it fits into our budgets.  Debt can create stress; and stress can cause us to make improper decisions.  By removing debt, we remove most of our practice stresses.  My father used to say that the key to being successful is to spend less money than you make.  Unfortunately, many doctors do not follow this age old wisdom.  Budgeting can make life less stressful, if done properly. 
A good budget encompasses all the financial details of running your practice.  Good budgeting goes further and projects how those details will help achieve your and your practice’s larger, long-term goals.  The dual purposes of operational and strategic planning lie at the core of this article. 

Look to the future

Chiropractic practice budgeting is more than a series of annual targets.  The effective planning process considers strategic issues for the coming five, or even ten years.  The first key is to remove or eliminate debt.  Before your accountant, your manager or administrator can “run the numbers,” you must decide where you want them to run to in the coming years.  If your budgeting and planning efforts don’t project beyond the coming year, schedule such planning sessions.  Otherwise, it’s like building a bridge from one riverbank, with no knowledge or concern for what’s lurking on the opposite shore.  That’s exploring, not planning.
Strategic questions like, “What do we want to be doing in five years?” produce natural operational questions like, “What will we do next year to put, or keep us on that path?”  My goal, as a consultant, is always to help my doctors grow, while keeping their prospective overheads under control.  You can grow your practice while maintaining a certain percentage overhead.
This strategic planning step involves questions about internal (physician goals) and external (competition and other market forces) factors like:

• Do you want to make the practice larger?
• If so, how?  Should you add physicians—physical therapist, nurse practitioners, massage therapist, another DC, an MD—or increase your geographic market, perhaps with an additional office?  Should the practice introduce new services you’ve referred out in the past?
• What competitive threats exist—or are likely to develop?  How can you react to them, or eliminate them, by acting now?

Budget protocols

Next, begin the traditional budget mechanics.  Start using the budget framework to attach numbers to the agreed ideas and goals.  We’ll look at the different budget components in greater detail in the coming months:

1. Revenue budget.  Looking at past data and projecting forward, how much revenue does the practice expect from cash payments?  And what about managed care plans, prepaid HMO contracts, patient co-pays and self-pays, receivables on the books and the prospective sale of any assets.  What about PI or Worker Compensation?  Well-researched revenue budgeting explores all likely income sources.
2. Expense budget.  The health care services you render cost money to provide.  You must meet fixed, variable and “semi-fixed” expenses to keep the doors open and the revenue coming in.  One objective is for your overhead never to exceed 50%.  Have your accountant provide you with P/L’s on a regular basis.  Have each category earmarked by percentage.  (Example:  Advertising should comprise in the range of 6%, employees in the range of 25%, etc.)
3. Capital budget.  Small and mid-size practices (even many larger ones) rarely develop capital budgets.  Nor should they.  If a practice doesn’t own its office (even though a related partnership often does) many traditional capital expenditures fall outside the practice budget.  Plus, by borrowing funds for capital purchases, like new clinical equipment, you essentially transfer them into regular budget items.  But, for larger practices, capital budgeting can be an important part of the overall process and an alternative to borrowing.  This should be part of your overall planning and should be done carefully, with your accountant, as part of your tax planning.
4. Profit plan.  This integrates the revenue and expense budgets to show net income for the practice.  Some groups even start the budgeting process by deciding what take-home pay their doctors should receive, and then work back up the line to project the revenue needed to produce that profit.  One of my mentors, Dr. Larry Markson, taught me a long time ago, “Pay yourself first.”  I have always followed this philosophy.
5. Cash budget.  The cash budget details the anticipated cash flowing through the practice.  Net charges and actual revenue don’t march in step.  Rarely do clinics collect what they bill out.  You need to calculate what your collection percentage ratio is.  I provide this to my clients on a monthly basis.  If your practice bills $500,000, and you collect $300,000, then you have a 60% collection ratio and a $300,000 practice.  Prepaid contracts, workers compensation, and outside referrals can create a significant short-term difference between what you’re due and what you actually receive.  And cash outflows, like malpractice premiums and meeting travel, may vary significantly from month to month.  By knowing what you anticipate as your collection percentage, this budget protocol helps you stay on top of your practice’s monthly cash needs.
6. Balance sheet.  The balance sheet puts all the revenue and expense data together and projects the practice’s assets and liabilities—essentially, a snapshot of the practice’s financial health—at the end of the budget year.
7. Review; revise.  After you put the collected information into an initial draft, the crucial review process begins.  Are the numbers accurate to the best of your forecasting ability?  Are the forecasted results good enough to support the practice and meet the needs of the physician/owner(s)?  If you project these numbers into the future, will the practice likely stay on track toward achieving its long-term goals?  Was anything inadvertently left out?

Project some problems

Consider the financial implications of falling a little short—or a lot short.  Remember, a fall is a fall.  Falling, of any nature, is not a comfortable situation.  Yet, it happens.  That raises the issue of whether a budget should represent your best projection of what will likely happen, a “stretch” goal to strive for, or a near worst-case scenario that will still meet your needs. 
Regardless of the approach you choose, it is your responsibility to work with your accountant to run some good, bad and middle-of-the-road scenarios, so you know what to expect if the unexpected happens.  Computers break down, employees get sick, and even doctors can miss work.  You must plan for the unexpected.  Remember, if you carefully gather your information, project reasonably and don’t get blindsided by external changes, budgeting shouldn’t provide too many surprises.  And that’s the point of the entire process.
Your goal should be to maintain your overhead at 50%; every month you should evaluate your P/L.  Many doctors get into financial crisis because they do not have an effective budget or savings system.  I recommend to all my clients that they save 10% per week.  Call it, Tithing for Success.
The road to SUCCESS is always under construction.  Success is not our birthright; we must work and plan.  Throughout our journey there will be obstacles, so be prepared.  Periodically, you may make a wrong turn.  Get back on track.  Financial freedom takes time, energy, effort and, most of all, discipline.  With proper preparation you can build your future by starting today. 
Good luck; I’ll see you “At the Top”. TAC

Dr. Kaplan is the CEO of MBA, Inc., one of the nation’s largest multi-specialty consulting companies.  Dr. Kaplan ran and operated five  of his own clinics, seeing over 1000 patient visits per week.  He is the best-selling author of Dr. Kaplan’s Lifestyles of the Fit and Famous, endorsed by Donald Trump, Norman Vincent Peale and Mark Victor Hansen.  He was a recent commencement speaker at New York Chiropractic College and regularly speaks throughout the country.  For more information about Dr. Kaplan or MBA, call 561-626-3004.

New Patients are the lifeblood of any chiropractic practice.  New patients are critical for your expansion.  An important factor to consider when talking about expansion is the quality of care you offer your existing patients.  The primary reason to treat patients is to better their health.  By focusing on the health of your current patients and following some simple acquisition rules for new patients, your practice will do well and flourish. 
The most common new patient acquisition method is patient referrals.  Did you know that every patient you see in your office presents an opportunity for you to market to eleven new people? Eleven is the average number of relatives, friends and acquaintances that an individual would feel comfortable referring to you.  Everyone knows someone that is having a problem with headaches, backaches, stress or sleeping disorders.  It is important that you incorporate this philosophy into your everyday practice and learn how to ask for these referrals.  By doing so, you will be working smarter—not harder—and capitalizing on this opportunity.  This will successfully grow your practice. 
Another new patient acquisition method is marketing.  First, let’s describe the word “marketing”.  Marketing, by definition, is the function of getting the word out about your practice or business.  We must “market” in order for chiropractic to expand.  We must have an ongoing stream of new patients continuing to get well.  Even the most philosophical chiropractor, must realize that marketing is critical in order for the field of chiropractic to hit the percentage of the population necessary for us not to market. 
Talk to any one of your instructors back in school and they will tell you that chiropractors treat about 8-10% of the population.  In reality, what you will find in your investigation is that this percentage has remained relatively unchanged for the last 50 to 75 years.  This means that there has not been a dramatic change in the percentage of people seeking out chiropractic care over the years.  We are treating 8-10% of the population, currently.  We must get to a higher percentage, if chiropractic is going to become the number one health care choice. 
Chiropractic is currently not the number one health care choice.  This is because the public does not understand what we do as chiropractors.  They are not aware of the benefits we offer.  In order to change this, we have some work to do.  We have to create market penetration so the public understands chiropractic.  The only way for this to occur is with systematic application of tools introducing chiropractic to the public and the public’s accepting it. 
When discussing marketing, there are two major categories to work on in order to improve your new patient enrollment:  Internal Marketing and External Marketing.
Internal Marketing is any activity you can do inside your practice to improve the number of new patients you receive on an ongoing basis.  This would include asking for referrals, conducting In-Office Workshops, holding Quality Control Consultations, and offering specialty programs.  Most internal marketing programs are simple to implement.  They, typically, follow a very systematic approach and are easy to duplicate.  If they are scheduled and held on a weekly basis, your practice will expand.  Unfortunately, the biggest obstacle to their effectiveness is the fact that they are not conducted on a consistent basis.  If they are scheduled, then cancelled or postponed, no growth benefits will be realized.
External Marketing activities are held outside your office.  Some examples of external marketing activities are screenings, lectures, Patient Appreciation Days, health fairs, direct mail, television commercials, radio advertising and print advertising.  Most of these activities require the doctor or staff member to physically leave the practice.  While there is generally an additional cost associated with external marketing, you usually reach a much wider audience with your message.  External marketing activities should be planned carefully so the cost of the activity does not outweigh the benefits you receive. 
It is important to realize that marketing a product like chiropractic, which is not well understood by a large percentage of the population, works better when you use a variety of tools to communicate your message.  There are many programs designed to help ease your level of work, while moving the concept of chiropractic into the public and helping overcome the fears that an individual might have about chiropractic care.  Choose your programs based on your patient needs and the needs of the community in which you practice.  This will help ensure that you grow your practice successfully. TAC

Dr. Maurice A.  Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist.  He is well known for his practice management expertise, as well as new patient development programs.  He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment.  Dr. Pisciottano has become a noted authority on the topic of Chiropractic Analysis and Treatment Systems.  He travels the world over conducting speaking engagements on the topic.  Since graduating from the Palmer College of Chiropractic in 1989, Dr. Pisciottano has built a successful multiple office practice in Western Pennsylvania.  Dr. Pisciottano regularly teaches continuing education courses at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO.  He can be reached at Pro-Solutions for Chiropractic, 1-877-942-4284.