The CAs Role in the Report of Findings
Holly Jensen
The chiropractic report of findings (ROF) starts with the patient’s first visit, and depending on the type of practice, the ROF takes place over a series of visits. In my experience of working as a CA with Dr. Miles Bodzin, we did our ROF on the second visit. We successfully enrolled over 97% of patients into care, so I will outline that strategy in this article.
I want to start by being clear that the doctor and CA have their own roles in the ROF and work as a team to have a successful outcome. This teamwork also helps the patient have a successful outcome and turns them into a loyal patient.
The ROF is one of the most important visits your patient will ever have, which is why what happens during your patient's first few visits is critical. You may also hear these visits referred to as "day one and two." Entire seminars are dedicated to helping DCs master their communication, technique, and skills when it comes to their "day one and two" because of the ROF's importance to a practice's livelihood.
Before we get into the CA's role with the ROF, I want to ask a question. Do you know what happens in the ROF? Has the doctor taken you through the new patient process? If you do not know what is said or done during the initial consult, exam, or ROF, then I bet you're likely not having much success enrolling patients into care if your doctor expects you to review the financials with the patient. If this is you, take your doctor out for a cup of coffee to talk about this article and set some goals.
Now, let's roll up our sleeves and dive into the ROF. The goal of the ROF is to get patients to understand the need for care, and once they do, a financial conversation takes place to enroll them into care.
We want them to arrive at this appointment thinking, "I sure hope the doctor finds that they can help me!" You and the doctor want to create the feeling of hope and trust from the time they schedule their first appointment and throughout their journey in your office. It prepares them to have the right mindset to hear the doctor's findings and ensures that they show up for the ROF in the first place.
Several things happen to make for the perfect ROF, even before the visit takes place. The treatment plan and financial agreement should be prepared and outlined on a compliant document that is ready to present to patients before they arrive. Gone are the days where homemade spreadsheets or fill-in-theblank plans are compliant or even appropriate. Now that we have the No Surprises Act, we should use helpful tools like the Care Plan Calculator to show your good faith estimate.
... "We also want to satisfy the good faith estimate portion of the No Surprises Act with this document."
With today's available technology, patients love convenience. Please tell me that you have text and email reminders for appointments. Your patients need a text reminder of their appointment time and an email after their new patient appointment thanking them for coming and letting them know what to expect at their next visit. The text and email should remind them to bringtheir spouse or significant other.
If the parent, spouse, or significant other can't be there in person for the appointment, the ability to video chat helps so much. (Be sure to get a HIPAA sign-off from the patient before this video chat begins that includes another party.) It removes excuses such as, "I have to go home and talk to my wife/' from the conversation.
Using technology allows us to easily have frequent contact with our patients and do those little things that help them feel hopeful and confident that they're in the right place.
Before financial conversations occur, it's imperative that the doctor has done their job with the clinical report of findings by outlining their recommendations for care while getting the patient to agree to the treatment plan. Failing to do this will make it nearly impossible for you to successfully enroll the patient. We must have patients commit from a timing standpoint before we ever bring up finances because time and money are two of the biggest hurdles we face at a ROF.
Once the patient agrees to the treatment plan, the doctor must get permission from the patient to discuss money to avoid creating the thought, "Flere comes the sales pitch." The doctor can handle that by simply asking the patient, "Amber, all we have left to do is to go over the cost of care. We can go over that with you today or on your next visit. Which do you prefer?" Most of the time, the patient will say, "Let's go over it now." After you have the patient's permission to talk about money, the doctor should warm up the patient for the financial conversation and introduce the CA coming into the room to review the cost of care. The doctor should say, "Amber, I'm going to have Holly come in and review our program with you. I want to let you know that you don't have to agree to the payment plan that Holly reviews with you since we have other options, but I highly recommend that you do. It covers everything I recommended and will save you the most money."
Those two simple steps go miles in helping the patient not feel pressured. It also helps the person going over finances because nobody has invoked the "car salesman" feeling. No one likes high-pressure sales tactics.
I know a lot of people think there's less pressure to have this talk at the front desk, but it actually does the opposite. The patient feels rushed to make a decision, and many people appreciate privacy when discussing finances. Reviewing finances should be done in a private room where both parties feel comfortable.
During this conversation, we've found that it is best to keep it simple. A professional document that clearly outlines the patient's responsibility and any discounts applied (compliantly, of course) makes things much easier and more successful. We also want to satisfy the good faith estimate portion of the No Surprises Act with this document.
Here is an example of how that might sound:
"Amber, I'm so glad the doctor found he could help you. Based on the doctor's recommendations, we've outlined the following all-inclusive program of care. If you were to pay per visit, the total cost of care comes to $X. However, by enrolling in this program, it covers everything and saves you the most money."
Pause to let them absorb that information.
"We can take that total you see here, and you have three choices for how to pay. Our first option is with monthly payments. Our second option, which most of our patients choose, is a larger initial payment followed by smaller monthly payments. Finally, our third option is to pay in full. Amber, before I go any further through the plan, which of these options do you feel works best for you?"
That all should be said in a very clear, matter-of-fact tone. We are also assuming that they can afford the care. Going into this conversation with a poverty mindset will not get you any enrollments and may actually offend your patient.
By giving patients a choice for what option works best for them, they feel less pressured, and you aren't forcing them to make a purchase decision they wouldn't normally choose. Better yet, you aren't making them enroll and be approved for a special line of credit. Convenience is key. When you add additional barriers such as patient financing, it ultimately hinders your patient's decision because it's not the most convenient option.
Once the patient chooses the option that works best forthem, we just need to answer the common questions that come up. Not only are we forecasting the care that they need on the care plan, but we're also putting them at ease, so they know exactly what they're agreeing to and what to expect in common situations. Our offices love this step because it prevents future misunderstandings when it comes to care and money.
"Before I review the details of the program, let me answer the two most common questions we get from our patients. The first is what happens if you go on vacation and miss appointments? Rest assured, you're not going to lose that time. We'll extend the program to allow you to make up those missed visits.
"The second question is what if you need to stop the program early? Amber, you can stop the program at anytime. You're not locked into this. Just let us know, and we'll prorate the program for the care you've used. If you've paid us more than what you've used, we'll happily issue a refund. If you've paid less, you would pay the balance of the care you've used — not the entire program."
After you've addressed those two most common concerns, you can move forward by outlining the rest of the plan details. Let the patient know that you require them to leave their billing information on file when choosing a recurring payment option, and their payments will automatically be deducted (be sure that you're using a PCI DSS compliant program for storing billing information). Answer any final questions the patient may have, gather their billing details, and enroll them into the program. Keep a signed copy of the financial plan on file and give the patient a copy for their records.
Now that money is handled, you can go right into scheduling future appointments. The most exciting part? There's no need for any further financial conversations until the patient is ready to transition onto wellness!
That's how we take one of the most nerve-wracking situations and turn it into one of your most successful appointments. This will help you build a high-retention practice that is full of loyal patients!
Holly Jensen has served the chiropractic profession since 2002 as a CA and office manager, where she oversaw the operations of Dr. Miles Bodzin's Chiropractic Wellness Center in San Diego, California. For more than a decade, she has continued to serve the chiropractic community as a professional speaker and the chief operations officer for Cash Practice Systems, the software and training company founded by Dr. Bodzin. To date, she has trained thousands of DCs and CAs on how to successfully attract, enroll, and retain more patients while skyrocketing cash collections. Holly may be booked for interviews and speaking engagements at [email protected] or reached directly at [email protected]. Her inspiring story can be watched at TheCallingMovie.com.
