If interested in receiving this and other e-mails reply to: webinfo@ChiroViewPresents.com ChiroView Presents - Here's why I'm up 20%! This is why I'm down 20%! Before getting started, I wanted you to know that I've set up the ChiroView Presents site so you can go inside and take a "virtual tour". This provides you the opportunity to view more than 15 distinct sections, which include treatment guidelines, clinical rounds and summaries, literature reviews, clinical and outcome forms, practice tips, previous broadcasts, polling results, classified ads, and quite a bit more. Please note that selected hyperlinks have been de-activated but this information is all available once you've become a "member subscriber" and are assigned a "username and password". The tour begins by clicking http://www.ChiroViewPresents.com. Now to the topic at-hand... More than 3000 doctors responded to last month's survey as to whether your practice revenues were trending up, down, or have remained "flat". Regarding the results, more than 53% of you indicated revenues were either flat or trending downward. As a profession, that should be a concern to all of us. I then asked for reasons as to why you thought you were trending that way. More than 2400 doctors responded. Sorry for not posting earlier but it has taken longer than anticipated to read and sort each one. I will be releasing your comments in several broadcasts because there are just too many to read. If your comments were about reasons you are trending upward, I start off with the word "up", and if revenues are sliding, then the lead word is "down". Not to complicated, huh? So here is what many of you had to say. I hope you find these of interest, and of course, helpful. Up... I've been in practice for 17 years. The main reason I'm up is the majority of my patients have insurance coverage. I get them out of pain, send a note to their primary physician on what I did, and tell the patient to call if they have further discomfort. The patient's then refer, and their physician does, as well. I often hear the comment from the patients that I'm not like the DC down the street who "keeps them coming back all the time." I don't feel like a used car salesman, so I'm happier in practice, and that carries over in quality of care I provide my patients. My practice is100% referral. My best practice building idea was to abandon all "management" and concentrate on service, not services. I run a strictly 100% cash practice and engender patients who understand the quality of care chiropractic offers. I spend a lot of time educating my patients during their visits vis-ý-vis anecdotes and stories that have messages regarding how simple and inexpensive chiropractic care is for the money spent. I never advertise. I rely on patient referrals for the bulk of my new patients, The other route for generating new patients is by being connected with other health care professionals in the neighborhood. I take a vacation every three months (nothing particularly fancy or expensive). I take a three day weekend every week; I am a loyal chiropractic patient myself, eat well, exercise regularly, have outside interests that replenish what I give out the others four days of the week. I have a loving family life. I also keep abreast of new information with selected professional seminars for continuing education throughout the year. I strive to practice what I preach to my patients, not to be a goody-goody but to simply feel and look my best. Otherwise, why bother? Down... The #1 reason is the failure of the profession to communicate the benefits of chiropractic to the public at large. At the same time the purported failures [i.e. cervical adjustments cause stroke or that spinal adjustments for LBP are no better than a booklet] have been masterfully articulated degrading our image. Managed care has reduced both the fees per visit and total # of visits allowed. A very real and coordinated conspiracy to thwart our success continues by the medical, pharmaceutical, and business establishment Lack of brilliant audacious political leadership. Poor educational background of most practitioners. I've lost count the innumerable ways we have sabotaged our possibilities! Up... Greater awareness of chiropractic and our office and word-of-mouth spreading. Weekly spinal screenings. Concrete reports of findings (2 day) with videos. Being mentally in the practice is essential. Down... I have never mounted an effective marketing campaign. Given the various choices, after 21 years in a rural solo office and given my personality, I don't see there being any kind of breakthrough soon. Managed care made a big change in the community. At my absolute busiest times during the mid 80's I never did get quite to $8K/month. I went to mostly cash and downsized. I continued to treat based on objective physical findings and the idea was to get my patients well as quickly as possible for as little cost, as possible. Somewhere along the line I must have been infected with a poverty virus. At least my stuff is paid off, so 3 patients a day covers my overhead. Now at the peak of my professional competency and experience, I loaf along in a semi-retired mode and regret not reaching a bigger percentage of patients needing chiropractic care. Up... Why are we up? Because we give back to our profession by participating and supporting the ACA, FCER and our state association. We contribute to the ACA PAC and our state PAC, and each of us contributed $1000 to the HCFA lawsuit. In our community we are active members of our chamber of commerce, rotary, Salvation Army, school drug -free programs, and various charities. We care and it shows. We love what we do despite the nuances. Rather than complain, we strive to make a positive difference with our patients, our profession and the community where we live and raise our families. That's a recipe for success and continued growth. Winners have a positive attitude! Income is up. Every patient is treated with honesty, compassion, adequate quality time, and dedicated commitment to improving my interpersonal and manual skills from week to week (even after 15 years in practice). Patient's can count on us to give our best effort and place their well being as #1 priority. I think these results are probably right on the money. As a group we are not all that willing to change. That spells death in any business. I will bet that all the doctors who are up do two things consistently. First they repeat the basics over and over. They also are not afraid of change. If they need a new piece of equipment they buy it. If they have to change a staff person they do it. If they need to change for the sake of the practice, they do it. Read "Who Moved My Cheese"? by Spencer Johnson, M.D. and be willing to change. My practice was up over 20%! The two main reasons for the increase were adapting to the changing environment and positive self-talk. In having been freed from the "insurance mentality" (that it pays for everything) that was so prevalent in the 1980's, many of my patients are finally becoming ready to accept and welcome cash -fee systems. I have capitalized on that fact with Wellness Plans. In offering more "Fee for Service" care, I have become more focused and my patients are better educated (better patients make more referrals). My staff, as well, is less burdened with the "paper-chase" and happier. As a result, they look for opportunities to bring in more new cash patients. The single most effective tool that I use to grow my patient and revenue base is the 'Health Care Demonstration'. And that idea has been around for many years. I use a combination of my own ingenuity, Tony Palermo's package, and Pat Gentempo's approach. The second tool I use to grow my practice is that I make it very easy for a patient to help a friend check-out chiropractic care. I have numerous ways of offering a complimentary consult/exam. The lost revenue is made up by getting more people at the top of the practice funnel, generating more committed patients at the bottom. It's a number game. The more people you ask, the more who will respond. Fix the problem, then release them. I have more patient referrals from this patient than I do from my long-term maintenance patients. I don't over-utilize services. Therefore, I believe more of my total bills are paid. Down... Fewer new patients with decent coverage, decreased coverage for services, failure on my part to cut my fees. This is what I tried to do to turn things around. Expand my clinical knowledge through advanced degree/certification in neurology and rehabilitation. Provide more bang for the buck by throwing in more service per patient than any other provider within a 100-mile radius. Web site developed for patients to contact me. Up... My philosophy comes from Disney- "do what it is that you do so well, that people can't help but talk about you". Being clinically competent is nowhere near enough- we all are. We need to bend over backwards in order to recognize our patients. Everyone who refers to my office is given a gift certificate good for a 1/2 -hour massage therapy session and they love it. I also let my patients know that if they have to wait longer then 10 minutes to begin treatment, that it's on me that day- no questions asked. I believe that we need to offer exceptional value in exchange for health care dollars. As a result, many of my managed care patients have chosen to remain with me and continue to refer. Learning to do paperwork better, narrative reports, written treatment programs, status reports, SOAP notes. Improving my adjusting. Being more specific, "adjusting the majors and leaving the rest alone". Showing genuine concern for the patient and getting them well as quickly as possible. Continually marketing myself to physicians, insurance companies, and attorneys. Enthusiasm - It's contagious when you're happy & excited about what you do and want to achieve. Improve communication - I constantly call, fax & talk to my patients primary physician, orthopedist, neurologist, physical therapist, attorney, etc. They in turn send me their patients/clients. A large part of my practice is now medical referral. We take damn fine care of our patients. My office is trending up mostly because I'm in my 3rd year of practice and becoming well established in my small community by doing lots of service outside of the office. I do very, very little advertising. My practice is growing due to my "purpose" to help people through chiropractic. We are in a war, let us not lose sight of that. Let "purpose" carry you forward too, so we can make chiropractic the number one health care choice in America. Here's why. I stopped sucking my thumb. I started doing all those things I thought I "shouldn't have to do after this many years in practice." I reinvested in my practice, I bought equipment, moved furniture, and got a consultant. In essence, I focused with either the same or greater intensity then I had when I started practice in 1979. I hired more staff and paid them more. I decreased uttering the negative, and started striving again. I reset goals. I developed greater certainty by going to seminars that got my creative and professional "juices" flowing again. That's it in a nutshell. Down... HMO's and new work comp laws that allow employers to choose the patient's "health care provider" for their injured workers. At one time I was "swamped' with referrals from a local family practice- MD's and PA's- until the head of the largest HMO personally visited the head MD and told him, in no uncertain terms, that he was referring to DC's too much, and would he please stop. Stop he did! He called me personally to apologize, but he said they could "shut him down" if he didn't cooperate. My observation for essentially no growth in 1999 is because external marketing (newspaper/yellow page advertisements, spinal screenings and telemarketing) yielded far less new patients (approximately 75% drop). New patients are opting for pain relief only. A 65% drop in PI cases which is probably secondary to the insurance industry's fraud campaign implemented through their own media, as well as outside media, i.e.,20-20, Dateline and billboards, resulting in a negative perception of chiropractic and soft tissue injuries. Up... No longer forgiving every other co-pay that comes in the door, even if it's only $5. They have to be a long-standing patient and truly in need before we forgive their co-pays. This alone has increased monthly revenues 5%. Ensuring that re-exams are asked for and authorized by payers. They were often forgotten in the past and can add up to an additional $20 every 6th visit or so. I concentrate on Personal Injury and Workers' Comp because cash patients do not pay a fair amount for my time. I advertise constantly and those ads concentrate on Personal Injury. I send out newsletters every 2 months. I educate my patients about chiropractic and do my best to make them aware of the fact that chiropractic works for other problems. My practice includes specific upper cervical, full spine diversified, acupuncture, physical therapy procedures and nutritional and herbal remedies. I write an extremely good narrative report which increases referrals from attorneys. I have a good recall system for patients who miss appointments. I have a good reactivation program for patients who haven't been in for awhile. My office is clean and modern and furnished with good quality furniture and equipment I leave the lights on in the office all night so people can see inside that it is a professional looking doctor's office. We make multiple appointments rather than one at a time. We changed our hours and are open at times most convenient for patients. We never put off a new patient. We always see them as soon as possible on the same day they call. All calls from the office are forwarded to my cell phone. Focus on internal marketing. We hired a patient advocate part time who does quality control, sends thank you notes, organizes patient appreciation week, and tracks referrals. Have been involved in a networking organization called Business Network International [BNI]. It is a referral organization of1500 chapters that meets weekly. People learn about each other's occupation and I teach them how to refer patients to me. Up...Down...Hmmmm! In some cases things may not be as they seem. Our reply to your question was "flat gross revenues for '99", but this is because after several years of going really working hard, we decided to take a little more time for ourselves. At a certain point you simply can't grow without extending hours, cutting time per patient, or adding personnel. These choices can be counterproductive in both quality of life and net revenues when you are in for the long haul. Raising prices would mean $$ growth, but we generally do that every couple of years, rather than annually, especially with the low inflation rate. For some, bigger is not always better. Up... No sales talks on repeat visits. Instead I try to give them tons of useful, helpful information for living in their body successfully. All decisions regarding treatment are made only for the benefit of the patient, and they know it. Down... More doctors in the sandbox and fewer managed care plans letting you in. Please rate this broadcast 1-5 [1=I'm putting you to sleep and 5=great stuff]! And don¼t forget to give me some feedback on this or any other issues previously discussed. In closing, I would like to express my gratitude to the following associations and business partners for supporting and promoting this weekly broadcast. And in return, would respectfully request that you consider visiting these sites to take advantage of their products and services - 1. Foundation of Chiropractic Education & Research http://www.fcer.org 2. American Chiropractic Association http://www.amerchiro.org 3. International Chiropractors Association http://www.chiropractic.org 4. International Chiropractors Association of California http://www.icacweb.com 5. Back Talk Systems, Inc. http://www.backtalksystems.com 6. Anabolic Laboratories http://www.anaboliclabs.com 7. RKS Marketing Resources - Effective Web Sites http://www.rksmarketing.com/chiro 8. LSI International http://www.lsiinternational.com 9. ClaKen Software, Inc. http://www.claken.com 10. Myo-Logic Diagnostics, Inc http://www.myologic.com 11. National Association of the Professions http://www.nap-assn.com 12. Posture Pro V - Posture Imaging System http://www.posturepro.com 13. ChiroCode Desk Book - 2000 http://www.chirocode.com 14. Stanley Greenfield, RHU - Financial Consultant http://www.stanleygreenfield.com 15. Monday Morning Chiropractic Assistant Program http://www.chirohelper.com 16. Chiropractor Directory ‚ Links ‚ Web Pages http://www.ChiroWeb.net Please remember to tell others about the broadcasts so they, too, can become a "member subscriber". All they need to do is click http://www.ChiroViewPresents.com.