L-jach article in the MILLION DOLLAR CHIROPRACTIC (IV£«fl>O) focuses on the top surveyed issues facing chiropractors today. Recruiting new patients, retention, profitability, marketing and staffing are each a determining factor in the growth, potential and success of the practice. The subject of this issue's profile is Dr. Steve Querio, an extremely successful chiropractor who has practiced in Green Bay, Wisconsin, for the past ten years. Dr. Querio is originally from Iron Mountain, Michigan, and attended Northern Michigan University. A 1993 graduate of Palmer College in Davenport, Iowa, Dr. Querio is licensed to practice in Wisconsin, has been a member of the American and Wisconsin Chiropractic Associations since 1993, is board eligible in orthopedics, and has recently acquired a medical facility, which now combines chiropractic, walk-in medical treatment, occupational medicine, and physical and massage therapy. In an interview with The American Chiropractor, Dr. Querio answers our Million Dollar Chiropractic (M$C) questions about his successful multidisciplinary practice where "developing a comprehensive health care practice based on a functional model is our vision." What influenced you to become a chiropractor? Querio: As with a lot of chiropractors, I have a story to tell. I was about thirteen years old and I injured my low back. I had always been interested in the sciences as long as I could remember. So, I knew that I would eventually be in some type of health care field. Following my injury, I visited a local chiropractor, Dr. Gerry Abbeglen, who did a fantastic job and later got me interested in chiropractic. The rest is history! What type of practice do you have? Querio: My practice life has been an interesting and exciting experience. I began my chiropractic career without the incorporation of any physical therapy procedures. Over time, as I slowly used some various rehab, I experienced the great benefit that the combination of adjusting and rehabilitation has had with my patients. So, I continued to advance my practice. I started by adding massage and physical therapy. After some time, I decided to bring a medical physician into the practice. Two friends, Dean Lois, M.D., and Dave Andrews, EA.-C, and I recently had an opportunity to create a new company by taking over a medical facility and adding chiropractic and physical therapy to it. This combined facility began March 1,2003, and we are having a great time. My partners direct the medical division and I direct the chiropractic and physical therapy divisions. I can't say that every step in this conversion has been an easy task. We've had to handle a number of difficult starring issues such as the overall merger of our staffs, combining two different software systems, and changing a large number of procedures. We use a professional coach who has helped us a great deal in making this a smooth process. It was an eye opening experience for me with the different types of issues that a medical facility faces as compared to a chiropractic office. In one aspect, our facilities are quite different in that medical clinics treat a variety of conditions that don't typically walk into a chiropractic clinic. But, on the other hand, we're similar in that we all try to provide great care and all have the same business concerns. As far as our practice mix, we are presently trying to develop our chiropractic, occupational and physical medicine, and physical therapy areas. I partnered with a company that specializes in ► PERSONAL: Married to wife, Lisa for 5 years and has 3 children; Nikki, age 10; Luke, age 3; and Emily, age 11/2. Recreation and Leisure: I enjoy spending time with my kids. I also enjoy traveling and watching Green Bay Packer football. Professional Affiliations: Wisconsin Chiropractic Assn., American Chiropractic Assn., Green Bay Chamber of Commerce Seminar Attendance: Wisconsin Chiropractic Assn. license renewal seminars; Breakthrough Coaching seminars & various other seminars Vacations: I have been trying to take more rime off in the form of extended weekends and love to travel to warmer climates in the winter. PRACTICE PARTICULARS Clinic: We are located across the street from a hospital. We utilize 9000 sq. ft., which is an entire floor of a 5-story medical office building. We are quickly running out of room. Office Hours: Our chiropractic division is open 8 A.M. to 6 P.M., Monday, Wednesday & Friday; Tuesday and Thursday, 8 A.M. to 5 RM. Our medical division is open 7 A.M. to 7 PM., Monday through Friday and 8 A.M. to 1 RM., Sat. & Sun. Techniques: Gonstead & Diversified Staff: Dr. Querio's office employs approximately 30 employees. The professional staff includes 2 D.C.'s, 2 M.D.'s & 1 RA. in the urgent care, 1 occupational M.D., 1 RT, 1 RT.A., 1 massage therapist, a nursing staff, and a lab and X-ray staff. The office also has administrative staff in management, reception and billing. ► working with multidisciplinary practices to bolster our occupational medicine area. We also have a mix of reimbursements that range from general insurance, managed care, company contracts, and cash. M$C: Please describe the size, location and physical appearance of your practice facility. Querio: Our clinic is located on a fairly busy street in Green Bay. We are in a medical office building, across the street from a local hospital, and are in a small medical area in the city. We presently utilize 9000 sq. ft., but would really like to grow into approximately 12-15,000 sq. ft. by next year. Green Bay is a city of approximately 100,000 people. Brown County has a population of about 250,000. M$C: What's the income service level that you provide annually? Querio: When we took over the medical facility and added the chiropractic and physical therapy, we had to rethink the numbers because we made so many changes. We cut over $700,000/year in expenses! We've been running the new facility for approximately four months now, and we have been fairly consistent with what we thought we would produce in service. We certainly have qualified for this article series and hope to have tremendous growth in the future. : Doyouhaveamarginfonnula orsetprofitstandardfor the business? Querio: I think one of the most important things you can do in a practice is to track the office statistics. We try to monitor various stats so we always know what direction the practice is going. Some of these statistics include number of new patients, patient visits, performance of staff, financial stats, etc. Some of the standard formulas that we set as goals include collections, where we feel that our practice should be at approximately 80% of services; our Accounts Receivable should not be greater than 2.5 times our monthly services; and we want to keep our cancellation/reschedules below approximately 13%. Due to the fact that we now have urgent medical care in our clinic where patients may come in for one visit, this significantly alters our previous patient visit average for the overall clinic, so we are coming up with some new numbers. M$C: Do you have someone to whom you attribute your success? Querio: Without question, I attribute my work ethic and determination to my parents. I grew up in a middle class family and they always taught me the value of hard work. They always encouraged me to never give up. Over time, now, I've learned that working smart is just as important as working hard. I learned a great part of my technique from Larry Troxell, DC. I certainly consider my present mentor to be Mark Sanna,DC. He has incredible vision and is taking Breakthrough Coaching to the forefront of the chiropractic profession. I must also acknowledge my coach, Charlie Schuster, DC, who has helped me through this massive transition of practice. I am surprised he has an ear left after all of the phone calls I've made! Tell us about your family. Querio: I have been married to my wife, Lisa, for five years. I have three great kids; Nikki, Luke and Emily. Nikki is the social butterfly and I'm sure she'll be on Star Search someday. Luke is my "shadow" and goes wherever I go. He's very strong willed. Emily is my little princess. M$C: What marketing strategies do you use to attract new patients and to keep current patients? TOOL KIT To give you a dear idea of what a million dollar chiropractor uses to run his practice, we've asked Dr. Steve Querio to share with us some specific products & equipment he uses to reach his practice's goal of bringing health into their community. READING MATERIAL: I am an avid reader, but I have my favorites. Some of my favorites are Developing the Leader Within You by John Maxwell, The Power of Focus by Les Hewitt, and Dig Your Well Before You're Thirsty by Harvey MacKay. TABLES: • I have 3 types of adjusting equipment. These are Zenith Hi/Lo tables from Hessco, Flexion/Distraction tables from Chattanooga and my sets of Gonstead tables are from Hessco. You can reach Hessco by calling Sue at 1-800-237- 5652. C HESSCO) See advertisement on page C2 See advertisement on page 5 DIAGNOSTIC EQUIPMENT: • JTech testing equipment for muscular strength testing, range of motion testing, and functional capacity evaluations. Our occupational department has an EMG machine/NeuroMax from? • Our medical area's diagnostics include ECG, spirometry, and a fully functional lab. UTECH ZEVEX- REHABILITATION EQUIPMENT: • Our active rehab area is equipped with various equipment ranging from bands, wobbleboards and thera-balls to higher tech strength equipment from Fitness Plus. We also have passive therapy equipment such as ultrasound and iontophoresis from Hessco. NUTRITIONAL SUPPLEMENTS: • We have been using supplements from Phytopharmica. COMPUTER SOFTWARE: • Our office uses Eclipse software for scheduling, billing and practice management. This software is from HNA. X-RAY EQUIPMENT: •Our radiology department at the new facility has used a Gendex system. I previously used a Bennett high frequency system. Thanks to all the sponsors! Querio: I have always felt that a combination of internal and ~ external marketing was necessary. However, I feel that you r must always start with internal marketing and plan your ex- ~ ternal marketing off that. With that said, our clinic has mainly used patient and professional referrals as a source of our new patients. We have added a fulltime director of sales and marketing, which has helped greatly. She mainly works with the occupational area, but we have been having very good sue- cess with this. Marketing is really a relationship game. I As far as keeping the patients we have.. .1 think that if you give patients service that exceeds their expectations, they'll be patients for life. M&C: Obviously, every doctor, at some time or other in his practice, experiences problems with patten t reten tion. How do yon handle such problems ? Querio: I think that patient retention starts on Day One. The patient has to feel comfortable with you and your staff. I also feel a good report of findings is essential. I tell it like it is, good or bad. I've never been the type to pressure the patient into care. I've just given good reports of findings and the patients usually understand the need for the care. When the patient makes the decision to complete a plan of treatment, they will usually follow through. If they start to fall from care, it's important that you talk to them about it immediately. We all knoiv that an efficient staff is a crucial component of a successful practice. Tell us about your staff (How ► Continues ^ youpnd them, train them, whatquali-ties you look for). Querio: As everyone reading this knows, a staff can make or break a practice. I've found that I would much rather hire someone who has a positive personality and passion over knowledge. I can teach anyone anything; but I can't teach someone how to have passion or how to be friendly to people. You either have it or you don't. Unfortunately, in this practice transition, my partners and I have had to make some tough decisions and release a lot of employees. It never is a fun thing to do, but, if you want a successful practice, you must have the right team in place. I've also learned that keeping a staff member on the payroll when you know they should be released is a huge mistake. Poor staff members are a slow cancer in a practice. Get rid of them. Take it from me, I've made (and learned from) every mistake in the book. I feel that the staff we have now is the "right team". We are all working well together and we can see the positive effects of it. They are working really hard and no practice runs well without a good staff. M8C: Do you enjoy your ivork? How do you feel about going to work in the morning? Querio: I am very fortunate to have two great partners. We all have our different strengths and work great together. They were chiropractic patients prior to our partnership, too. It's been very exciting to start this new venture and, although it has been challenging at times, I go to work every day with a big smile on my face. The challenges drive me. I would be bored without them. I think, if you start going to work with a frown on your face, it's time to take a hard look at yourself. 1VI&C: With your practice being multidisciplinary, can you give our readers your advice about setting up and maintaining such a practice in today's healthcare system ? Querio: The business of healthcare today is becoming more and more complex. Certainly, with multidisciplinary practices, there are a great deal of legal requirements. My advice for anyone who wants to move into this type of practice is to get sound legal, accounting and management advice. Don't try to do this on your own! You should find an ethical and knowledgeable management group. Research this, as I did, and you'll be happy you did. Also, find an accountant and attorney who are well versed in health care issues. Don't just go out and hire your attorney friend who practices PI and divorce law to try to set up your multidisciplinary healthcare practice. M$C: Other than traditional chiropractic care, do you include any other type of services or products in your clinic which further help your patients as well as bring in additional revenue to your practice? Querio: This is another area that our clinic is expanding. We have used orthotics from Footlevelers and have had good success. Due to the fact that we treat a variety of conditions in our medical and chiropractic departments, we use a multitude of orthopedic devices from Hessco. These include everything from pillows and knee supports to casts. We also utilize some nutritional products from Phytopharmica, which is based out of Green Bay. IVf&C: Any final words for our readers? Querio: I truly believe that this is a new era for our profession. I've found that every health discipline has its own problems but, if we can put our differences aside and try to become a collective chiropractic voice, there are significant opportunities out there. Patients are looking for what we have to offer. If you can keep the positive picture in front of you, you will go far. Don't listen to the negative people around you. Remember, no one ever built a statue for a critic. You may contact Dr. Querio at 920-497- Our sincere thanks to Dr. Querio and his Staff at Fox River Healthcare, S.C., of Green Bay, Winsconsin. Editor's Note: Doyou have a million dollar practice that you d like TAC to highlight in our Million Dollar Chiropractic column? Contact TAC's editor Jaclyn Busch Touzard by phone/fax: 1-305-716-9212 or email: Iiiclyn(< ijvnchiwpractor.com. We want your inspiring story! Contact us today! Dr. Varma evaluates a pa-tients'wrist (see above photo 1) in the occupational medi-cine area. Rick O'Reilly, D. C. and Tenielle Zutz, P.T. (see photo 2 above), perform active therapy with patients in the room. The physical thera- pist evaluates a patients'cervical range of motion with com-puterized testing equipment (see photo 3 above). Dave Andrews, P.A.-C, Dean Lois, M.D., Steve Querio, D.C., and Parveen Varma, M.D., work as a multidisciplinary team at Fox River Healthcare, S.C.
