This is not going to be a feel-good article. Confronting the reasons that you’re stressed out in practice, addressing why your revenue is low, and realizing that you constantly need new patients are things that you need to face head-on. The sooner you realize that the sooner you can make meaningful changes that will lead to the success you desire.
I'll address those challenges in just a moment, but I want to share a bit about my story because it offers some important lessons.
At the start of my career, I was a young, naive guy fresh out of school and eager to open my own practice. My wife and new baby motivated me to succeed, as did my passion and desire to help sick people get well with chiropractic care. I wish that I could say it was an incredible journey to success right from the start.
I really struggled my first few years in practice. Patients were not enrolling in care despite my best efforts to educate them. Patients were dropping out of care as soon as the pain went away, even though I thought that they understood what chiropractic could do for them. Patients left because I didn’t accept their insurance. I had heard every excuse there was!
The little voice that would creep into my thoughts would tell me, “You’re not charismatic enough to sell patients on care.” Or, “Maybe I should be an in-network provider with more insurance companies?” Or the pathetic voice of, “Maybe this career isn’t the right choice for me.”
As time went on, I could no longer afford rent. My financial struggles became so dire that I had to move my family into my parent’s house. I felt as if I had let my family down. I felt as if I had failed.
I had named my practice The Chiropractic Wellness Center because I wanted to provide lifetime wellness care. However, upon deep reflection, it was apparent that the way I communicated with and treated patients was incongruent with that mission.
As I analyzed what I could do differently to align with my mission to provide lifetime wellness care, I discovered that I was unclear on my goals of care. I wasn’t clear about the results patients would receive when they hired me. It was no wonder that patients stopped care when the pain stopped!
Do your patients know what results they’ll receive when they come to your office? If it’s unclear, they’ll think that you just help get them out of pain, and then they’ll leave when the pain stops. Now, if your result is to get the patient out of pain, and you send them on their way, that’s no problem as long as it’s communicated to the patient at the start of care.
However, if you want to have a wellness-based practice, take a step back and reevaluate what you’re doing. Be real with yourself and realize the issue may be that you don’t know what you even deliver. On the other hand, maybe you know what you deliver but don’t feel confident measuring the results and adjusting your treatment plan when the patient isn’t making progress.
Once I addressed this issue and became solid on the results that I deliver, things started to get easier for me. More patients started their care and stayed under care. It felt good, but it wasn’t the complete answer because I was still not getting to where I needed to be.
I continued to reflect on the issues that plagued my practice and decided that I needed to learn the latest and greatest techniques that brought other doctors success. So I learned how to do prepays. Some of my colleagues swore by it, and I was convinced it would help me out of my rut.
After some studying and a seminar or two under my belt to learn how to do prepays, I applied it to my practice. With each patient who enrolled into care and prepaid for their treatment plan, I was elated! I felt like it answered my prayers.
Then something big happened, and I still remember the gut-wrenching feeling when getting the news. Two military families who had prepaid were being transferred out of the state and had to stop care. I had the unbelievable experience of writing two refund checks for close to $10,000.
That’s when it dawned on me that I was living on borrowed money. All of that prepaid money wasn’t mine. I decided then that I never wanted to be in that situation again.
I picked myself up from the pits of despair and went to the beach to clear my head. It became clear to me that I had to start with my mindset. As I sat there on the beach, I poured my heart into how I was going to change my practice and myself. I made it my mission to study and execute a new approach that I was going to apply in my life and my practice. It was time to roll up my sleeves and go to work on the business.
I left the beach with a desire to understand why some patients stayed with my practice while others didn’t. Why some said “yes” to care, while others said “no.” I started studying behavioral psychology to better understand why people do the things they do. If I could crack that code, I could use the knowledge to help my patients make the right decisions.
Those questions continually swirled around and consumed my every thought. My practice was a great place to test different theories. With a lot of trial-and-error research, I figured out answers to many of these questions.
“...I realized that it was best to give patients three options if you offer a choice for payment. For some reason, more or fewer options make it more difficult...”
For example, I wanted to know what the most effective payment options were besides prepays? Does patient education really matter? We assume it does, right? Plenty of my patients were well educated on chiropractic and still dropped out of care, while others, who never paid attention to patient education efforts, stuck like glue to the practice. I had to ask what the heck was going on.
I wanted to know the common characteristics of patients who became loyal to my practice. With my desire to never live on borrowed money again, I decided to focus on trying different business models first. I just knew that there had to be better options than selling prepays.
When it came to the way patients paid for their care plan, I had tried the pay-per-visit model, the quarterly-payments model, having patients pay for blocks of care, and many other methods. I purposely tried different ways to see what worked best. It was as if I were in a laboratory studying the impacts different business models had on patient loyalty.
One of my friends suggested that I try offering monthly payments instead of prepays. I learned that more than 90% of people preferred monthly payments, which was eye-opening. Looking back, it completely made sense. That’s really how most people decide which big purchases they can afford, i.e., cars and houses. I realized all of the other business models, including prepays, worked against what most people normally would do.
Now I say, “Monthly payments are the financial language most people use to make their purchase decisions.” Once I learned that, I decided to start offering monthly payments. However, a small part of the population still prefers to prepay. For a time, I never offered the prepayment option, but about 10% of new patients would ask for it.
In my earlier studies of what drove people’s decisions, I realized that it was best to give patients three options if you offer a choice for payment. For some reason, more or fewer options make it more difficult for people to decide.
I already knew that prepays were one option, and now monthly payments would be another. So I had to come up with a third option. I thought, “It sure would be nice to just combine the two!” I came up with the idea of offering the option of a large down payment (kind of like a small prepay), with the rest being monthly payments. Thinking about that now, I laugh because there’s nothing revolutionary about that. Again, that’s been around a long time for purchasing cars, houses, etc.
So there you have it! I started offering three payment options that covered the treatment period:
1. Monthly payments
2. Down payment followed by smaller monthly payments
3. Prepayments
To my surprise, a large number of patients chose the second payment option. They preferred to make a larger down payment to have smaller monthly payments. I loved that option because it was the best of both worlds. When the patient made a large down payment, they committed to care, just like with prepays. More importantly, their monthly payment became part of their monthly household budget.
That is how the monthly payment option blew the prepays out of the water. In my experience, one of the biggest challenges with prepays was the “re-sign.” Do you know that awkward conversation that happens when it’s time for patients to renew? Turns out, the problem was they hadn’t spent money in the practice since they’d signed up. They now felt better and had to decide if they wanted to spend money again.
Most often, they responded, “I’m feeling pretty good now. I’ll let you know when I want to come back.” Nearly every doctor with whom I consult suffers from the same problem with prepays — a terrible re-sign rate.
The monthly payment option made it so much easier to transition patients to a wellness plan because they didn’t have a new purchase decision to make. I didn’t feel like I was having to “sell” them again. And, even better, my revenue was way up!
Now, I want to be clear. It’s not just about making money. I know that you became a chiropractor to serve your community. I think we can agree that for us to serve people in our community, they need to show up and follow through with the treatment plan that we outline.
As it turns out, getting patients to show up and follow through takes a lot more than just patient education. The business model you employ in practice will impact your patient’s ability to follow through with care.
After years of applying the knowledge that I gained on understanding what drove patients to make decisions, my patient retention skyrocketed. Not only did patients complete their course of care, but I also finally felt like I was delivering on the true promise of chiropractic. My patients got great results, and I couldn’t be happier!
When I retired from practice in 2011 to devote myself to helping other chiropractors, I’m proud to say my average patient had been with me for over 300 visits. That’s 24 times the national average of 12. I left that practice with hundreds of families on regular active wellness care programs.
Doctor, I want you to be real with yourself when you answer the following questions.
If you saw an average of just 10 new patients per month and had been in practice for just five years, you would have seen 600 new patients. How many of your patients still actively see you? All 600? 300? 50? In my humble opinion, it’s not about the number of visits per week or day. The true measure of whether you’re making a significant impact is how long each patient has been with you.
Let me put it another way. Would you rather have 100 patients who only stay 10 visits? Or would you prefer to have 10 patients who complete 100 visits? Why do you prefer one versus the other?
Take a good hard look in the mirror and take responsibility. No one can change that except you.
Reach out to your successful colleagues. Don’t be afraid to try new things. Push yourself out of your comfort zone and do it now. There are patients who need you, your family needs you, and to achieve the success that you desire, you need you.
Dr. Miles Bodzin is the founder and CEO of Cash Practice Systems, chiropractic's number one technology platform for creating loyal patients. He may be contacted at [email protected] or 877-343-8950, extension 200.
