This original article was featured in the August 2021 issue of Chiropractic Economics

I’m often asked if I would have done anything differently when I first started out in practice many moons ago for higher retention. I am 100% sure that the one thing I would have done differently was to get a mentor much earlier on.  Why?  You just don’t know what you don’t know!  Had I learned certain things earlier on, it likely would have allowed me to avoid some of the challenges that I faced and made my eventual success in practice come so much sooner.

So, let’s go through a few simple things that I still see that many chiropractors just don’t know.

If you don’t have time in your day, then you need…

To take charge of your schedule.  Not having a well thought-out schedule will almost always lead to feeling like you’re out of control.  When I finally got a handle on my schedule, it allowed me to finally enjoy practice and have a great life outside of my practice. 

When it comes to scheduling, one of the most common mistakes that I see is having adjusting hours that do not allow any time for your employees to train or have administrative time when patients aren’t there.  This is absolutely vital if you want to have a well-oiled machine.  Your team must have time every week to train and if it’s not scheduled, then it won’t happen.

Another issue is that when you don’t properly manage your appointment times, you’re setting your patients up for disappointment.  Even if you’re just starting out and not that busy yet, you’ll want to plan for the day when you will be busy. If it takes you seven minutes to adjust someone but you spend 25 minutes chatting, what’s going to happen down the road when you’re busier and your schedule simply does not allow that?

Here are a few suggestions for you: you want to have a set time for adjusting and special times outside of adjusting hours for special appointments.  Patients would have their recurring, standing appointments during the adjusting hours and they would be cluster-booked together as much as possible. Built into those blocks would be longer appointment times for re-exams. 

In my practice, I would have special times set aside for our new patient appointments and the report of findings would be outside of the adjusting hours (these would all be stacked around the adjusting hours).  For example, if my hours for adjusting were 3-6 PM, my special appointment times would be 1:30, 2:15, and 5:50 PM. The team would know to book the 5:50 or the 2:15 first so that there wouldn’t be any blocks of empty time in my schedule. If there aren’t any special appointments booked, then you’re free to leave the office!

If you don’t have success then you need…

To implement business strategies that will bring you success. Now, this is a generalized statement. There could be many reasons that you may not have success. A method that I believe any practice type can apply to achieve long-term success is to focus on patient retention, or what I like to call patient loyalty. 

Practices that focus on retention and achieving patient loyalty are not dependent on new patients and have steady recurring revenue. Not only do loyal patients lead to better success, but they also protect you when times are tough!

The doctors that we work with that had successfully implemented our recommended retention principles saw less than a 3% drop in income during the first shutdown of the pandemic.  Those that had not fully embraced the retention principles saw a 50% decrease in income.   Read that again.  A 3% drop versus a 50% drop – which would you have wanted?  Having strategies that help weather storms will help the practice remain successful for years to come. 

If you don’t have high retention then you need…

To learn more about the principle of retention.  In summary, to build a high retention practice, you need to focus on a patient journey that implements the retention principle.  When you do this, each patient will have a much greater chance of becoming a loyal patient.

So, what are the retention principles that need to be implemented?

• Loyal patients need Feedback
• Loyal patients need Frequent Contact
• Loyal patients need Forecasting of Care
• Loyal patients need Frictionless Payments

We refer to these retention principles as the Four F’s.  Feedback, Frequent Contact, Forecasting Care, and Frictionless Payments are all required if you want to truly build a practice full of loyal patients.

If you don’t have the easiest way to streamline family plans…

You need software that allows you to encourage lifetime practice members full of families. If having a practice full of families is something that you want, you need to implement strategies that encourage that behavior. 

We put patients on convenient, customized, and compliant care plans tailored to each family member’s needs. We then make the payment experience frictionless by having one auto-debit for the entire family.  By automating their monthly payment, you really remove almost all the friction in the payment process.

The software to do this should allow you to link the family members together, automatically split that one payment, and properly allocate the dollar amount amongst each family member’s ledger.  This is critical in order to keep your patient ledgers accurate.

If you’re using a payment processing program or your EHR’s recurring payments feature, you want to ensure the auto-debit is being split correctly between each family member.

For example, if the monthly payment is $275 for a mom, dad, and one child, you want the correct portion of the $250 allocated to each of their ledgers.   Maybe it should be $125 for mom,  $100 for dad, and $50 for the child.  You would want each of those amounts posted to their respective patient ledgers– not just $250 posted to one of the ledgers.

You need to make payments easy for your patients and easy for your team members.

If you don’t have profitable plans…

Then you need to figure out how much on average you need to collect to be profitable.  We refer to this as your Target Collection Level. Here’s what I mean: anytime you sell something, the first thing you need to know is, what is the cost of that “thing”?   As chiropractors, our “thing” is an “office visit”.  So, what does it cost you to perform an office visit?  If you don’t know, that’s a real problem.  That’s like trying to price t-shirts for sale and not know your wholesale cost of the t-shirts.

If you don’t know your cost, here’s how to calculate it.  Take your monthly overhead expense (excluding any personal expenses you run through your company such as car payments, etc) and divide it by the number of office visits you see in a month.  For example, if your monthly overhead runs $15,000 and you see 600 visits per month, you would have a cost of $15,000 divided by 600 which equals $25 per visit.

Knowing that it costs you $25 to see a patient, what do you think you should be collecting at a bare minimum to see a patient?   If you want to have a 50% overhead, then you need to collect $25 divided by 50% which equals $50 minimum per visit.

Knowing this makes it easy to build care plans where you know they will be profitable.  The care plan should average at least $50 per visit.  Anything less, and your profitability goes down.

And there you have it. Some of these tips may have been things you didn’t know, but now you do!   Had I come to know these concepts earlier, I have no doubt I would have succeeded much sooner in my career.  I certainly hope you found some insight in these tips and are now ready to upgrade your practice!

Check out our other articles!