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Issue 8 - June 2004
Dr. Xavier Escobar: MVP in South Florida chiropractic
STORY By Todd Stumpf • PHOTOS BY LANCE JEFFREY
In two years Dr. Xavier Escobar, DC, has gone from a rookie to a Super Bowl MVP in the annals of South Florida chiropractic. Using philosophies and motifs gleaned from the football field (and using an actual football team to jumpstart things), Escobar has turned a fledgling practice into a multi-discipline practice that has three locations and employs six doctors (three DCs and three MDs), a physical therapist and a total of 30 people.
His multi-discipline practice, Back to Health of South Florida Inc., sees up to 500 patients per week with as many as 60 new patients coming in every month. The focus of his practice has always been sports medicine and rehabilitation, a product of a lifelong interest in competitive sports, particularly football.
Reference to the gridiron can be found throughout the practice, from his comparing his staff to a professional football team, to a poster of legendary coach Vince Lombardi hanging on an office wall.
The poster speaks of things needed to be No. 1, and Escobar quotes Lombardi along the way. “Winning,” the coach always said, “is not a sometimes thing; it’s an all-the-time thing.” It’s a philosophy to which Escobar subscribes: He aspires to be No. 1 in his market, if not his entire profession.
TIME AND PERSPIRATION
Learning to be a team player was a lesson sports taught him long ago, a lesson that sticks with him today. “My parents always encouraged me to be in team sports and said ‘It will make a difference to you when you get out in the real world,’” he recalls. “I see that I’m part of a team in the office. I wanted to get back out in the community and volunteer. I saw an opportunity to volunteer as a team doctor because nobody really did that. I did that because I wanted to give back to people from here. I wanted to go out there and show the kids — and there are a lot of underprivileged kids — that playing football is learning to be part of a team.”
Success on Escobar’s team means putting in a lot of time and sweat. He professes to working 70-80 hours per week as he builds his practice, a “sacrifice” he terms a necessity.
Along the way, he has followed a business plan, marketed in a variety of ways, keeping his focus on patients all the while.
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A successful practice requires training
Part of what has enabled Escobar to achieve success in a relatively short time has been his ability to teach. Or, perhaps better put, he has been able to “un-teach” his associates.
He refers to the training of his staff as “arduous,” because DCs come out of school having learned things one way, which isn’t always the way Escobar wants or believes they should be done.
“It’s not that they’re not properly trained; the foundation and the education are there,” he says. “You have to deprogram them from how they’ve been programmed in college. You have to literally teach them. They’ve been taught a practice-management system and diagnosis system that is [often] from the 1970s and in my opinion is antiquated.
“You have these doctors being thrown out into the modern health care system with diagnostic codes they’ve never even heard of.
Do they know how to diagnose? Yes. Do they know how to code the diagnosis? No. That’s something that must be taught.
“We recommend that they review their neurology and physiatry and things like that. It’s really simple. We just have to refresh them on the testing so they understand what the tests are. Most of them do. We also have to teach them how to make the proper referrals to the proper MDs.”
Teaching begins with hiring
It’s something he recommends all those with multi-doctor and multi-discipline practices do. Ensuring everyone is on the same page will keep a practice operating more smoothly than if everyone has his own way of doing things.
This begins at the hiring stage. Escobar maintains that the staff is a team and a team is only as strong as its weakest player. That said, he has gone to great lengths to assemble a staff of like-thinking individuals. Others have come and gone during that process. Perhaps at the temporary cost of continuity, he now has in place the people he wants.
“You go through doctors the first few years until you establish the winning team that you want to have,” he says. “You go through doctors who don’t necessarily fit with your practice [philosophy] or personality. We’ve gone through some doctors. Not everybody is a fit in this type of practice. It’s important to have continuity, but it’s more important to have right doctor for the practice.”
Escobar says once a DC is in place, it takes nearly a year to teach the basics of practicing in today’s environment, particularly where insurance is concerned. But once an associate “gets it,” he says it’s an experience to behold.
“It is like seeing a baby open their eyes for the first time, when a chiropractor gets the system we have in place,” Escobar says. “Really, they are so well prepared to provide the level of care we provide, that it just requires ‘deprogramming.’ Chiropractors in Florida are primary care physicians and held to high standards. Most of the [new] doctors have no clue about these standards of care," he says.
Usually the first month they are around the practice they look like they are going to overload mentally. But I learned before evolution comes ‘involution.’ The chiropractors all go through it, some longer then others.”
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He began with a plan, then tinkered with it, adding and subtracting and reforming it no fewer than six times. The changes were minimal, but significant, such as adding computerized notes to help streamline the practice. Or separating chiropractic billings from medical billings.
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Vital Statistics
Main clinic
Back to Health of South Florida Inc.
301 Camino Gardens Blvd #201
Boca Raton, FL 33432
Additional clinics
Pompano, Fla., North Miami Beach, Fla.
Phone: 561-394-8770 • Fax: 561-394-3651
E-mail: jesco70@msn.com
OFFICE HOURS
M-F., 10 a.m. – 2 p.m.; 4-8 p.m.
TEAM PLAYERS
Xavier Escobar, DC, owner
Mark Sencer, MD, medical director
Jeffrey Farber, MD, physical medicine
and rehabilitation
Andrew Frank, MD, physical medicine
and rehabilitation
William Vanderbrook, DC, staff chiropractor
Mark Richards, DC, clinic director
Alejandro Duran, DC, clinic director
Brett Bauer, physical therapist
Claudia Aranguren, practice administrator,
non-medical personnel and inventory
Maira Cook, Boca Raton office manager
Lidiane Cordeiro, Pompano Beach office manager
Vida Murillo, North Miami Beach office manager
PATIENT VISITS PER WEEK
(all clinics)
350 — 500 patient visits weekly
NEW PATIENTS PER MONTH
2002: 42 per month
2003: 58 per month
2004: 90 per month
PATIENT VISIT AVERAGE
PVA: 28 – 35
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Each edition of the plan has become more specific, going from idea, to paper, to reality. He has used every avenue he could think of, including becoming the medical provider for all of the sports at the local high school, a move that gives him and his practice exposure as a full-service medical provider.
“On a normal weekend, when [many chiropractors do] screenings, I would be at a football game,” Escobar says. “I wouldn’t be doing a screening; I’d be in front of 5,000 people being a doctor for athletes. That right there created a perception that I wasn’t viewed as someone trying to sell adjustments by doing screenings. I was seen as a doctor on the field making a difference with children.”
He also credits moving back to his home location with helping kick-start his practice. Of Hispanic heritage, Escobar notes the advantage of being from Latin American decent in South Florida, where the Hispanic population is large.
A VARIED MARKETING APPROACH
Knowing how to reach that population helped greatly as well. Escobar, who estimates he spends 7 percent to 10 percent of his gross revenue on advertising (with a ROI of 300 percent), has marketed in nearly every way possible, though he only attributes 30 percent of his patient base to advertising.
Among his marketing ventures was a job speaking on public television, a health column in a newspaper, a weekly radio show on geriatrics and a TV commercial. He also attended numerous “lawyer functions” and just tried to meet as many people as possible.
His patient load, Escobar says, “just grew exponentially. I just got a lot of word-of-mouth referrals from my initial patients. And they still come back to me. The retention is there.
“There is quick way to get patients. Patients want answers for their questions and fears. So being the best doctor is always the marketing tool. The patient must have confidence in the doctor’s ability to recognize what the problem is and how to deal with the problem.”
With his patient base growing, Escobar’s practice grew in kind. By his fifth month in practice, he began planning a second practice, which was open for business after one year. A year later, he opened his third location and he is entertaining ideas of opening more.
Along the way, he also opened a billing company and two pain-management centers. “The pain management clinics actually operate in the mornings out of two of my clinics — Pompano Beach and North Miami Beach, which don’t get busy until afternoons and evenings. They are separate businesses from the clinics,” he explains.
His current plan is to open an interventional pain practice, which he hopes to have up and running within a year. He credits his partner and medical director, Dr. Marc Sencer, with helping him develop plans for this endeavor. Beyond that, Escobar does not have any plans set in stone.
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Reciprical referrals build a practice
In less than three years Escobar has built a practice from nothing into one that employs three MDs and three DCs who work in three offices. The main way he did this was by cultivating referrals, which account for 70 percent of his patients.
Of those, more than half are professional referrals. It’s something Escobar has made a concerted effort to establish in his short time in practice.
Referrals from MDs have played a huge role in the early success of Escobar’s practice. “A lot of chiropractors don’t understand the concept,” Escobar says. “Medical doctors don’t refer to chiropractors not because they don’t believe what we do works, but because it’s not in their standard of care. Understanding that is important.
“For example, if you have a physiatrist [on your staff] whose specialty is rehab, other medical doctors can now refer to you as if they’re referring to the chiropractor, but they’re really referring to the physiatrist because that’s what’s in their standard of care for rehab. We do get referrals from the orthopedic surgeons and from pain management and other MDs that I refer to; you tend to refer to a group of doctors and they tend to refer back. Obviously it helps to have your systems not only driven by MDs, but to have a specialty you can get the referrals for.”
It didn’t start right away for Escobar. His network of referrals was established by his second year of practice, but it took work. It started by creating a one-way street — referring patients to the MDs — and hoping reciprocity would develop.
Escobar, for instance, began referring players from the local high school football team (for which he is the team doctor) to orthopedists. He used his lunch break to make these in-person contacts with MDs, referring one patient at a time. Soon, the orthopedists began referring back.
“When you start referring patients to [medical] doctors, they start recognizing that you’re accurately diagnosing them and making the proper referrals,” Escobar says. “They know you’ll treat the patients properly and give them the proper standard of care. The first year was difficult, because that’s when you refer out and establish your reputation. If you establish a good reputation, you’ll get referrals back.”
Escobar believes the fact he has MDs at his practice enhances the likelihood of other MDs referring to him. Acknowledging a “birds-of-a-feather” mentality, he says the trust level is going to be that much higher.
Many of the same basic concepts can be applied to patient referrals. People will refer their friends, loved ones and colleagues to someone with whom they’ve enjoyed their relationships.
“I have found that accurately diagnosing the patients’ problems and getting the patients better is the best for retention and word-of-mouth referrals,” Escobar says.
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“My long-term plans are to just keep working,” he says. “It’s difficult to plan that long, because of the legal changes that can occur. My goal is to maybe not to see so many patients, but be in more of a management position, focus on running the practices, and make sure the other chiropractors are properly doing their jobs.”
GOAL: OFFERING SOMETHING DIFFERENT
During his entire brief-but-successful mission to build, Escobar has maintained a goal of offering something different. He sites the multi-disciplinary nature of his practice as the thing that sets it apart. While the practice offers adjustments, it also provides physical therapy and full medical services.
“A lot of chiropractors say they do physical therapy, but they really don’t do true physical therapy,” Escobar says. “I get a lot of the patients that go to the guys around me with back pain and they come in here afterward to get the real diagnosis.”
Escobar’s foray into physical therapy didn’t happen completely by accident, but a chain of events certainly played a more major role than any single decision. ”When I was in high school and college, I always had a lot of interest in athletic training. I was a personal trainer. I knew I wanted to get into rehab,” he says.
After he graduated and returned to Florida, he took a position as director of neurological rehabilitation at the brain injury center of Ocean Hyperbaric Center in south Florida. “I did this for six months while my office was being built out,” he says. “My first 200 patients in the neuro lab were severely brain-injured and came from all over the world. They had astounding results from the therapy. I feel honored to have done that work and to have given some small contribution back to the really sick.”
The work he did at the center also earned him the recognition of researchers at Life University, who came down to the center to videotape his protocols for severely brain-damaged patients. “I only had my license a week when I figured out how a new piece of physical-therapy equipment affected the body,” he said. The researchers wanted to capture
that information.
Within six months his new office was ready to open and he left the neurological rehab center. Within one month of opening his office doors he was seeing 20-30 patients a day in the mornings.
“I initially started with the intention of having a chiropractic practice with an MD in it. It really just evolved into a physical therapy practice. It pretty much just followed the protocols which I learned. It all just meshed together pretty well. I originally intended to start a
chiropractic practice that incorporates physical therapy. Now it’s really a physical therapy practice that incorporates chiropractic.”
He explains that he has one physical therapist on staff and the doctors who work for him are physiatrists who supervise all the physical therapy and create the PT care plan. “A physiatrist is the best match, in my opinion, for a chiropractic multi-discipline clinic,” says Escobar. “These MDs are more aligned with chiropractic than any other specialist. Of course, we refer to neurologists and orthopedists whenever it is appropriate.” Nearly three years into his practice, he’s glad he “stumbled” the way he did. And while he would like to think he has some secrets or profound insight about how or why he became successful, he says it really came down to old-fashioned work ethic and elbow grease. Other than that, it was a matter of staying true to the patients and profession.
“Just be a chiropractor who has the patient’s health as the main priority, not their insurance and what you can bill,” he advises, emphasizing, “treat the patient, not the insurance company. There are no get-rich-quick schemes. Get ready to work and sweat and stress, be ready to sacrifice some things in life to achieve success.”
Todd Stumpf is a freelance writer from Akron, Ohio. He can be reached at TStumpf22@yahoo.com.
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In a nutshell: Escobar’s secrets to success
Escobar’s success can be summed up in eight “secrets.”
1. Know what you want. Write a business plan that reflects your vision of success. Refine it until it works for you.
2. Pick a winning team. Team members should share your philosophies and vision.
3. Train your associates. Help them learn the ways of the “real world.”
4. Work hard. Be willing to sweat, stress and sacrifice to build your practice.
5. Build on what you know. Let your passion guide you.
6. Know what you don’t know. And then ask for help from someone who does.
7. Market. Dedicate a budget to your marketing efforts. But aim your marketing at achieving your business plan.
8. Refer to MDS. What you do unto them, they will do unto you.
9. Put your patients’ health first. Don’t practice for what you can bill. Practice to keep your patients healthy.
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