This original article is featured in the June 2022 issue of Chiropractic Economics

Being a CA is so rewarding. We get to witness the miracles of chiropractic every day in practice. It feels amazing to be a part of the patient’s chiropractic journey. We cheer our patients and celebrate milestones with them, and they become part of our chiropractic family. Connecting and serving our tribe is fulfilling, but it’s not always rainbows and butterflies. Sometimes being a CA is not easy.

Let’s be real. We have stressful days in the office, just like everyone else. We juggle many different tasks, usually all at once. Awkward financial conversations with patients while the phones are ringing, responding to text messages for appointment changes, all while feeling the pressure from the line of patients at the front desk waiting to check out. Did you answer the phone yet? Darn, they’re not on the line anymore. So we ask a coworker for help, and they snap back with how busy they are too. Wait…is Mrs. Jones still in the exam room waiting for Doc? Where is Doc? We check on Mrs. Jones and let her know the doctor will be right in. Now we’re off to find the doctor. Oh, there’s Doc, chatting with Mr. Smith. We give the doctor the eye as we tap on our watch, signaling for him to speed it up. Now we’re all a bit frazzled!

Whew, adjusting hours are over, so we can run our end-of-day reports, reconcile the payments that came in that day, and put on our marketing hat. We need to post to our social media accounts and prepare for the new patient marketing event this weekend. We also need to tidy up the office, take out the trash, and lock up the office. Then repeat again tomorrow. I’m getting exhausted just listing all of this!

“I just need a few more hours in the day!” We’ve all said that at some point. Maybe you’re having one of those days right now! No matter how amazing you are at managing your time, you have a lot to handle.

What if I told you that I experienced the chaos of a chiropractic office, and I actually learned and implemented several things to free up time so that we could all focus on the rewarding part of serving our patients?

The solution is actually pretty simple. We need to focus on systems and tools that free up time.

Be Clear About the Patient’s Program of Care

When the doctor recommends care to the patient, is it clearly explained with a care plan? What is a care plan, you ask? A care plan is a reflection of the patient’s treatment plan. Care plans cover all the care a patient will need during the treatment period. They include insured and uninsured visits right from the beginning.

Most importantly, care plans are presented only after the patient accepts the treatment plan. This means that the doctor has communicated with you, the CA, about what they’re recommending for the patient before they return for their report of findings. This preparation allows you to outline the patient’s financial responsibility to your office (services and fees are clearly itemized, compliant discounts are only applied to noninsured services, and compliant terms of agreement are outlined with a clear refund policy). Care plans are even more important today with the introduction of the Patient No Surprises Act — Good Faith Estimate.

…” Our policy is to automate the way you pay us for services. You can keep a credit card or bank account on file.”…

When you have patients on care plans, there is no confusion between the patient or the office regarding the treatment protocol or the patient’s financial responsibilities.

Enrolling patients in care plans will also help them to adhere to the course of care the doctor outlined for them in the report of findings. For example, when the patient knows from the very beginning they are expected to come into the office for 40 visits over six months to reach the goals set for them, they don’t have to be constantly reminded. This frees up time from trying to sell a package of care or collect per visit. The patient makes monthly payments toward the total cost of care. Not only do patients have better follow-through, but they also reach the goal of care, which results in better clinical outcomes!

Because patients know their financial responsibilities from the beginning, there is no line of people waiting to check out at the front desk. When you see these patients, you all have more time to focus on patient care and education, a very rewarding experience!

A side effect of care plans is increased patient retention and a dramatic increase in cash collections — a win-win all around!

Create a Frictionless Payment Experience

Many CAs tell me that they dislike collecting money. Either they’re not comfortable asking patients for money, they think the patients can’t afford it, or they’re just really awkward with financial conversations in general. I can relate because I was like that too. What got me over this fear? Implementing a frictionless payment experience in the office. What does that mean? It means automating all payments. Onetime payments for per-visit services, recurring monthly payments, copays, supplements — catch my drift? All payments get automated. How?

You use a PCI DSS compliant credit card system that allows you to securely store billing information on file as your office’s financial policy. You may be thinking, “No way. Our patients won’t leave billing on file.” I’m telling you right now that they will. It just depends on how you communicate it. Patients want convenience. I mean, heck, if we could text them their adjustment, they’d love it!

Let me put it this way. When you check into a hotel, the clerk behind the desk asks, “Which credit card will you leave on file for incidentals?” The clerk doesn’t ask, “Do you want to leave a card on file?” They are very matter-of-fact when they ask which card you’re leaving on file. It’s not a question of do you want to; it’s just a question of which card.

When we do this with tact and professionalism, using a compliant document they sign authorizing their card to be charged for services rendered, products purchased, or a recurring monthly payment, they are receptive and comply. When I review our financial policy with patients, I show them the billing on-

file authorization form and say, “Our policy is to automate the way you pay us for services. You can keep a credit card or bank account on file. Which do you prefer?” Notice that I didn’t ask them if they wanted to? I asked which type of billing they are going to leave on file.

Next time the patient comes in and purchases a visit, pays a copay, or buys supplements, I say, “Today’s total comes to $60. I’m going to charge your card on file and email the receipt to you. See you next week at 3:00 p.m.”

Without automated payments, the patient stops at the front desk, you swipe the card, print a receipt, get a signature, and repeat that for every person. And if we have a patient who loves to talk, they hold up the line, we get stuck chatting, and now we’re behind! Don’t get me wrong —I’m not saying you shouldn’t connect, converse, and build rapport with patients. I’m saying be in charge of when it happens. Then you can give all your attention to the patient, and money isn’t part of the conversation.

The benefits of automated payments go beyond saving time. The biggest obstacle keeping people from continuing care is the repeated thought of money. To prevent patients from dropping out of care, you must identify and remove situations where a patient must make the decision about whether to continue care.

Think about it. Your patient comes into the office for a visit. You greet them, make them feel special, care for them, they get their adjustment, come to the front desk, and now they have to touch their wallet to make a payment.

Imagine if you had already handled the finances because the patient is on an automated payment for their care plan. You would be able to engage in more conversation about office promotions, ask for referrals, patient education, and more! How great would that feel to them and to you?

Let me tell you from experience that it feels great! When the patient makes monthly auto-debits toward their care plan, you’ve essentially removed the thought of money. I recommend automating all payments, not just care plan payments.

Cluster Book Your Schedule and Block Off Special Appointments

When I started as a CA, this was already in place in our office. It’s something that I just thought that everyone knew to do and always did. So when my career of educating and training CAs started, I was surprised to learn that this was not the case. I hear from CAs who are training on their lunch breaks or in between patients coming to get their adjustments. That’s just not ideal for learning and not efficient for your patients.

If you don’t have time in your day, then you need to take charge of your schedule. Not having a thoughtout schedule will almost always lead to feeling like you’re out of control. When the doctor can get a handle on the schedule, it allows them to enjoy the practice. It also allows the team to have a great life outside of the practice too!

When it comes to scheduling, one of the most common mistakes that I see is having adjusting hours that do not allow any timeforyou and yourteam 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. The amount of time is for you to determine based on what you are training and meeting about, but I suggest at least an hour a week. This does not take place while the employees are clocked out on their lunch breaks.

Here are a few suggestions. You want to have a set time for adjusting patients and special times outside of adjusting hours for special appointments. Special appointments may include new patient appointments, report of findings, and reexams. Patients should have recurring, standing appointments during regular adjusting hours, and they should be cluster-booked together as much as possible.

For example, if our hours for adjusting were 3:00 to 6:00 p.m., our special appointment times would be 1:30, 2:15, and 5:50 p.m. 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 the doctor’s schedule. If there aren’t any special appointments booked, then we have extra time for administrative duties.

As CAs, we have a passion for serving the patients we see in practice, and we want to work with the DC to help change the lives of those we serve. We must let systems and procedures do the heavy lifting so that being a CA is easy and fun.

Have a weekly team meeting and incorporate these ideas into your practice, and I’m sure it will spark more ideas on how to streamline other areas of the practice that help free up time. By freeing up time and reducing stress, you’ll be able to put more fun into your practice.