Q: I practice overseas. I recently attained my goal of 50 new patients for the month . I had 261 patient visits, working 3 days a week. I cannot make money on x-rays or ala carts as the country health laws won't allow it. there is only money on hi volume. I attained the above numbers by lowering my fee's by more than half. I think I must see 100 new patients a month to make a living to be able to save something. I think I made about 1,500 dollars this past month after taxes. I have averaged 25 new patients a month for 3 years. What does my numbers translate to in US money and services performed? if I added x-rays, mini exam, adjustment and 1 or 2 therapies, what are the numbers on just the first visit? How do I correct my errors? Am I wasting my time here? I hope these are specific enough questions to answer. A: Thanks for the e-mail and question. The funny thing is your question is no different from the questions I get from DC¼s here in the states. With the advent of managed care and the more volume means more money routine .. the averages of income and hard work is the same whether you are in NYC or there. So .. think about it. If you have the ability to see these many new patients and actually adjust that many people per month you have the ability to sustain a maintenance practice if you work it well. Before I give you the numbers you requested .. let me go over a point. Managed care insurance programs are almost the same. Limited visits and limited income your name in an insurance book that draws patients in but they stop once the insurance benefits stop .. this is the rule here. Rules are meant to be broken .. therefore you have to spend some quality time with these new patients .. at least the ones you feel you can converse with .. and let them understand the value of chiropractic and the potential with corrective care that may be sustained within a six or twelve month period. Yes .. their insurance benefits and co-payments will help initially .. but if they see the value of the care and its potential for their health and wellness .. they may have to pay the difference after their benefits run out. I understand you lowered your fees by half to compete .. that may be well and good to get them in the office to begin their educational process and let them have a taste of chiropractic but once they understand the concept and wish to continue you make it happen. They can continue paying a similar co-pay .. maybe a little more .. but over a sustained period. Try to get their credit card on file if they have one .. and schedule them for a longer period of time with a less intense visit schedule. This is maintenance care which offers both the patient and you a less stressful existence. If you have access to my webpage: http://www.mindspring.com/~chirosmart check under Practice Tips and you¼ll find a financial worksheet form that can be changed and tailored for you. I am sending it along with this e-mail .. at the bottom. There are no easy answers to make money in this profession .. like any other business .. business is business. If one of our big time consultants would take over your office for a month .. make no changes with your budget or staff .. except make major changes with report of findings ... financial options with existing patients .. marketing the patients and community you have access to for new patients with less restrictive financial restraints .. they would add or keep your same total visit numbers which are good but request the money they and you both feel you deserve .. therefore raising your income substantially. If a patient is under an insurance umbrella .. fine they have some coverage but not all they need. If the insurance allows them to pay a portion .. co-pay .. fine they have this for awhile but it ends and they must pay afterwards. If the insurance co-pay or their out of pocket expense is lowered by you which affects your bottom line .. you can rectify this by requesting they pay the actual office visit amount but over an extended period of time. Let¼s say they make weekly payments for 3-6 months .. be sure they are clear they owe for the services rendered and if a credit card is available have it on account as getting the money once they are through with care is the tricky part. The form I am sending after this will help if you tweak it a bit As far as numbers. Here in Atlanta .. let¼s say the average office visit is $30. An examination is $75 and x-rays on average is $60 .. usually more. If you are part of a managed care network .. these fees are meaningless as there is a global payment for the first visit no matter what you do. Take four x-rays .. do an hour examination and adjust and they may pay $60 or less. Each adjustment with or without therapy may range from $30-60 .. they may pay as little as $5 a visit to a total fee of $30 give or take a dollar or two more or less. They may allow you only 4-12 visits and it is up to the DC to educate the patient to sustained care and their responsibility for payment. Financially .. depending where you practice in the US .. the fees and payments as well as the managed care programs vary. Some states still have good coverage but they are getting less and less. It is becoming more and more a cash practice as in the past. So .. again .. whether you are in Timbukto or Chicago the game is the same. Have a Great Day Dr. M