e Power of Mar Practice rt Coach SANNA. DC A TAC Exclus ve Interview ent oj Some background information on Dr. Sanna: Dr. Mark L. Sanna is the president t Breakthrough Coaching, LLC, a leading resource for personal coaching to chiropractic and muitidisciplinary practices nationwide. He is also a second-generation chiropractor, who literally grew up with chiropractic. When he was a child, his family vacations consisted of attending the Parker Success Seminars throughout the country. So, as he puts it, "I have been blessed by knowing and being raised by some of the greatest chiropractic minds of the last half-century." After having practiced chiropractic in a high volume, multi-doctor facility in. the heyday of insurance reimbursement, in the 1980's, he began to feel frustrated,; like many doctors, with the tightening of reimbursement and the limitations placed on his ability to give patients the care he felt they required. This caused >, him to explore alternatives, beginning \ with adding rehabilitation to his practice. ; Dr. Sanna has stated, "After several I years of fumbling with rehab procedures and protocols on my own, I attended a 300-hour diplomate program in rehabilitation offered through the American Chiropractic Association. The addition of rehab expanded my practice paradigm and encouraged me to explore additional means of diversifying the services we offered to our patients." It was then that he developed the idea of a chiropractic-driven, multidiscipli-nary practice he calls the DC/MD practice, as opposed to the MD/DC practice that had been espoused by practice management gurus previously. Rather than disguise the fact that chiropractic had a primary role in the practice, he developed a model in which the disciplines of medicine and physical therapy worked in a complementary fashion with the chiropractic care. Through years of refining the program and its protocols, he has developed the Breakthrough Coaching Multidisci-plinary Practice System which, today, employs over a dozen professional consultants and sen<es tens of thousands of patients through its hundreds of members throughout the entire country. The success of the Breakthrough Coaching DC/MD model led him, subsequently, to form Corporate Health of America, (CHA) an Occupational and Industrial Medicine Program. With a nationwide corporate sales force, CHA has had tremendous success marketing DC/MD multidisciplinary practices to industry on behalf of chiropractors across the country. In an interview with The American Chiropractor (TAC), Dr. Sanna (MLSJ shares the knowledge he has gained from his experiences with multidisciplinary practices. TAC: How do you define a multidisciplinary practice? MLS: Multidisciplinary practice is a business model that provides financial stability through a diversification of services and a consolidation of location. For decades, chiropractors have expanded the services they deliver to their patients by adding disciplines such as physiotherapy, nutrition, acupuncture, or massage therapy to their practices. By combining the disciplines of traditional medicine along with alternative medicine under one roof, the chiropractors further expand the menu of services they provide, and this increases their exposure to a greater percentage of the healthcare market in their community. This diversification creates increased revenue streams for the practice, creating stability in a highly competitive arena. No longer must the chiropractor feel that the entire success of the practice rests on his or her shoulders. We refer to this as "peddling your bicycle up a hill syndrome". The moment the solo chiropractic practitioner stops peddling, the bicycle begins to roll back down the hill! In today's competitive healthcare marketplace, the chiropractor must peddle faster and harder than ever before, simply not to loose ground. A multidisciplinary practice removes the burden of being the only one responsible for the success of the practice from the shoulders of the chiropractor. TAC: With your years of consulting practicing chiropractors, what attracts you to the multidisciplinary format of practice? MLS: There is a well-defined scope of practice between chiropractic and medicine. Medicine excels in crisis healthcare and chiropractic thrives in the very large spectrum of non-crisis healthcare and well care. By combining the two throughout the entire spectrum of health and wellness. In my years of experience in multidis-ciplinary practice, I have witnessed countless lives saved through the combination of chiropractic and traditional medicine. I can remember being asked to come into the examination room by the medical doctor working in our practice. He had located, through palpation, an abdominal mass that I surely would have missed in my workup of the patient. Thanks to the combination of both of our diagnostic talents, the patient was able to receive life-saving emergency medical care, as well as chiropractic care, that helped guide his healing process. TAC: What's the typical procedure that you go through once a chiropractor tells you that he or she wants to go mul-tidisciplinary? MLS: A chiropractor should go through a screening process before being considered a candidate for multidisciplinary practice conversion. He or she must have achieved a level of success as a chiropractic practice before attempting to convert their practice to the multidiscipli- I nary model. Our rule of thumb is 100 office visits, seen on a consistent basis, before we will accept a chiropractor into our multidisciplinary program. Those doctors who have not yet achieved a consistent level of 100 office visits a week, typically, join our program as chiropractic members until they've reached this threshold. Multidisciplinary practice is not for everyone. Approximately half of our members choose to remain chiropractic practices, integrating the procedures and protocols of active care, without adding a medical doctor or physical therapist to their practice. We interview the chiropractor employing a very thorough business-oriented questionnaire to determine if there is a correct fit between our program and the doctor's goals and vision for their practice. We also assist the doctor in selecting the right professional staff members for their team. This consists of a series of interviews and training sessions between the medical doctor and physical therapist candidates and our coaching staff. It also includes a series of interviews and training sessions with one of our staff medical doctor consultants, who introduces the professional staff to their respective roles in the multidisciplinary practice, including the team approach to care. TAC: Are there any warnings you have for a DC trying to "convert" to DC/MD on their own? MLS: Converting from a chiropractic to a multidisciplinary practice is not unlike stepping from behind the wheel of a prop plane into the seat of a 747. You don't want to do it on your own. There are many consultants who will gladly sell you, at a very dear price, a box filled with all of the forms and information they feel is necessary to create a multi-disciplinary practice. This is not unlike receiving a box filled with all of the pieces required to build a 747. Soon you are sitting on the runway, with 747 parts scattered all around you, trying to determine which part fits where! Multidisciplinary practice is a highly complex, highly regulated business model, and it requires on-going, one-on-one personal attention. It is not the time for a chiropractor to try to "wing it", or re-invent the wheel. It is essential that a chiropractor considering converting to a multidisciplinary practice consult with an expert who has been there and accomplished the goals that they seek to achieve. A consultant should have national expertise, and should be endorsed by a nationally recognized association, such as the American Chiropractic Association. There are many mom-and-pop "consultants", who would like to convince you that they have the expertise you require-buyer beware! Your consultant should provide personal coaching with unlimited access by all professional and paraprofessional staff members. He or she should have run a successful multidisciplinary practice, using the systems that they are teaching you. All of the forms, materials and procedures provided to you should pass HCFA and other government regulatory requirements and should be updated on a regular basis. In our program, we also hold live national teleconferences on a weekly basis to keep our membership informed of procedural updates and to create a sense of unity and standardization among the doctors in our program. And we provide our members with seminars featuring world-class expert speakers, who Continued page 30... ...from page 29 provide continuing education for all members of the professional and para-professional team, including chiropractors, medical physicians, physical therapists and support staff members. Our open-door policy invites any chiropractor and his entire staff to attend one of our regular seminars alongside our members so that they can experience our program first hand. Finally, chiropractors should never enter into an agreement through which they promise to pay a percentage of their practice revenues to a consultant. At the first sign of a percentage agreement, the chiropractor should head in the opposite direction. Your consultant should be able to inform you, in advance, of the entire cost of participating in their program, and there shouldn't be any hidden or unexpected costs to pay in the future. TAC: What type of financial investment can a chiropractor expect to make for coaching or multidiscipii-nary "conversion"? And do you assist the doctors to cover costs? MLS: Along with the 100-office-vis-its-a-week threshold, there is a finan- cial threshold for considering multi-disciplinary practice conversion. The doctor should have a financial cushion of approximately thirty thousand dollars, prior to beginning the conversion process. The reason that most new business ventures fail is due to under capitalization. Multidisciplinary practice is a highly profitable new business, and must be treated as one. A practice's overhead will increase by eight-to-ten thousand dollars a month, so it requires a financial cushion to bridge the start-up period. It, typically, takes a practice three-to-four months to show a profit and master the new business model. A practice that is under-funded during this period of transition will place itself under undue financial pressure, until the return on their investment is realized. We work with several nationally cre-dentialed financial institutions that are experts in providing solutions to the startup capital needs of chiropractors seeking funds to establish a multidisciplinary practice. TAC: Do you have a particular chiropractic success story about a clinic you've turned around by helping them to incorporate the DC/MD format? MLS: I am very proud of all of our members; and the sense of community that exists among Breakthrough Coaching members is our greatest achievement. While it is difficult to single out just one, there is a success story that I would love to share with you. One of our members is a husband-and-wife chiropractic team in the state of New Jersey. The husband is also a distributor for a nationally recognized piece of medical equipment, and he would exhibit his product at our seminars. One day, while standing in the hallway during one of our seminars, one of our members asked him why he was standing in the hall; and didn't he know what was going on in the seminar room? The doctor responded that he was down on practice, and that practice had become a day-to-day struggle for him and his wife. He related that it Continued on Page 48 ...from page 30 was more enjoyable and profitable to travel around the country representing his product, than to be in practice; and that he was actually considering dropping out of practice all together. After being coaxed into the seminar room, a light bulb went off in his head. The doctor got the big idea and joined our program. I receive almost daily calls from this chiropractor and his wife, thanking us for the difference we have made in their practice and their lives. They are now debt-free, net over one hundred thousand dollars a month, and have a new excitement and joy for practice again. They are helping greater numbers of patients than ever before and have achieved the lifestyle that they dreamed of when they entered practice. TAC: What is the income service level for a DC/MD practice? In other words, what is the gross income level you project for these DCs? MLS: Today, the most successful chiropractic practices generate one million dollars in revenue, and it takes significant focus and energy to do so. The minute the chiropractor takes his or her eye off the ball, the profitability of the practice suffers. However, the entry-level multidisciplinary practice conservatively generates a million dollars a year and an established practice can generate three-plus million dollars and more a year. When undertaken systematically, with the advice and guidance of a professional coach, this can be accomplished without increasing the time demands or stress placed upon the chiropractor. In fact, a chiropractor practicing in a DC/MD clinic does what he or she loves to do the most-adjust patients! Everything else is delegated to another member of the multidisciplinary team. TAC: And how large a facility is necessary? MLS: No major renovations arc required to convert a chiropractic practice to a multidisciplinary practice. The multi-rooms off a central-hallway-layout of the typical chiropractic practice can easily be converted to serve the space requirements of the multidisciplinary practice. A room for active care, including high-tech, low-tech or a combination of both forms of rehab equipment can be created from one typical 8-by-10 adjusting room. The medical doctor requires a room for patient examinations, and space should be devoted to the equipment used for diagnostic testing. This typically consists of computerized range-of-motion and muscle-testing equipment, electrocardiogram, spirometry and neurodiagnostic testing equipment. The smallest facility we have ever converted is 900 square feet and the largest is 12,000 square feet. TAC: Where do you see chiropractors fitting in to the health care paradigm in the future? MLS: The future for chiropractic is brighter than ever before. The worker's compensation system of our country is woefully ineffective, with over sixty billion dollars a year being spent on a system that does not adequately provide for the health and welfare of our nation's workforce. This fact has the government's attention, and pending legislation will virtually mandate the type of care delivered in a chiropractic-based DC/MD multidisciplinary practice. With virtually no unemployment, there is no lack of patients in the workplace. If you want to know where your new patients are, they are at work! Those chiropractors who have embraced the new paradigm of practice are being welcomed into industry with opened arms. Mark L. Sanna, D.C., can be reached at Breakthrough Coaching, LLC, by calling 1-800-7-ADVICE. * Editor's Note: TAC invites your feedback on this article. Be sure to fill out our Fax Back Survey on page 3, and fax or snail mail to us (see our contact info on page 2). Or, now you may fill it out and send it to us online at: www.amch iropractor. com
