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Patient retention A chiropractic way of life. In an ideal world, all of your patients would adopt a lifestyle of regular adjustments. Both they and your practice would remain healthy. But patients often drop out of sight because the pain goes away after a few adjustments or they complete the initial care plan. These patients have not adopted chiropractic as a way to keep well. Other patients, however, keep coming back. Education is obviously the key — but it's how the education is given that convinces patients to keep returning. Most DCs agree the power to attract new customers is through current patient referral and proper education. If you teach patients how chiropractic provides an enhanced life, then provide that result, the chiropractic way of life will hopefully be achieved. In that achievement, patient retention is certainly possible. Chiropractic Economics spoke with 12 practitioners about their patient education programs and their individual ways of increasing patient retention. LIFE IS A SPORT Clinic: Lange Chiropractic, Northampton, Mass.; www.langechiropractic.com; 413-582-9889 Proprietor: Kimberly Lange, DC, CCSP; drlange@langechiropractic.com Lange Chiropractic is a solo practice that sees hundreds of patients on a weekly basis. Kimberly Lange is Northampton's only active CCSP — a certified specialist in sports chiropractic — and has been practicing since 1985. To aid her patients in the chiropractic way, Lange focuses on long-term wellness, enabling the body to be more aware, heal effectively, and take care of itself more efficiently. Her Web page suggests, "Life is a sport." "Our clinic calls [the patient] within 10 minutes of being late for a scheduled appointment," Lange says. "Our staff tries to reschedule the appointment that same day if possible. If not, then we reschedule the next day, but definitely the same week." Lange also rewards her patients with gifts if they keep all of their appointments. Since Lange is a CCSP, her practice is largely sports-centered. The Lange Chiropractic Web site shows several pictures of people performing various forms of work. One picture shows a carpenter wielding a hammer, and the caption says, "You went to work; your arms went ice climbing." Lange tries to compare everyday movements to extraordinary ones, showing how important everyday wellness is to her patients. Lange also provides massage therapy, physiotherapy, exercise and fitness rehabilitation, and several other specific, personalized techniques. 6 REASONS FOR CHIROPRACTIC Proprietor: Rick Wren, DC; wren@texoma.net Rick Wren has worked mostly solo for the last 26 years, but welcomes a new associate in March 2007. Wren Chiropractic Center sees, on average, 300 patients a week, and has annual gross revenues around $500,000. Most importantly, Wren says you should re-establish rapport with patients every 26 visits. Wren's clinic does this routinely, even if its patients have been actively coming for 25 years. He says DCs have to remind patients why they are still coming when their symptoms are no longer present. Wren educates his patients about six reasons why they should continue their chiropractic care: 1. Continue progress. This helps assure a lasting recovery. 2. Prevent relapse. Continue retraining and strengthening the spine. 3. Avoid future problems. Maintenance care can help keep you healthy. 4. Save money. Regular chiropractic checkups help avoid further expense. 5. Feel good. Continue your chiropractic care so you can enjoy life to the fullest. 6. Continue to learn. Proper spinal hygiene is new for most people. Wren believes encouraging an active role in chiropractic care adds to your patients' education. "Patients should ask questions and get involved. They should learn how to become an active partner in the recovery of their health," Wren says on his Web site. "Make sure your patients fully understand the role of their spine and nervous system in the maintenance of good health." FREQUENT CALLING Proprietory: Brent Baldasare, DC; DrBaldasareAHC@bellsouth.net Affinity Health & Wellness Center is a multi-doctor practice that offers chiropractic, massage therapy, corrective exercises, a full service spa, and lifestyle advice to hundreds of patients each week. Brent Baldasare believes true health comes from within, and his practice tries to tap into that internal reservoir with every adjustment. "The initial two-day report is the most important meeting with new patients. It sets the tone, and the first impression must always be impressive and informative," Baldasare says. "They are then given a care plan they can commit to and afford. With that, the relationship begins." Baldasare has first callback procedures in place, checks how new patients are doing after their first adjustment, and at every twelfth to fourteenth visit re-evaluates the patient's condition. The clinic keeps statistics to track the ratio of missed visits, and the office manager receives a bonus for 85 percent, 95 percent, and 100 percent of kept appointments. To maintain high retention, the front-desk CA makes the first two calls to individuals who have missed appointments. (If a third call is needed, Baldasare makes it.) Patients who choose not to return are asked to meet with the billing-department head for an exit interview. In return for their time, they receive a free massage. "This process helps us find out what makes people leave — whether it's money, time, or dislike of treatment," Baldasare says. "It usually helps convert people back to us." LONG-RANGE CARE PROGRAM Proprietor: Stuart Cayer, DC; drcayer@scarboroughfamilychiro.com Scarborough Family Practice is a multi-doctor office operating with three chiropractors, as well as three massage therapists on staff. Stuart Cayer and his associates see approximately 350 patients per week, with gross annual revenues of $800,000. Cayer believes patient retention begins with the process of developing a comprehensive long-range plan at the onset of care. "Even if patients are only interested in short-term care, they understand and generally agree that becoming truly healthy will take time and effort," Cayer says. "Regular re-exams are the next key component, as it provides objective information on changes made and gives an opportunity for the doctor to further educate the patient on the overall process." Cayer also believes the patient should have an opportunity to give input and participate in the process. Cayer's practice provides an integrated, doctor-led, customized wellness program that focuses on all three dimensions of life — physical, biochemical, and psychological. Reactivations, according to Cayer, are mostly the result of how comfortable the patient feels in your office. Cayer's office sends out mailers two or three times each year, and they average at least one reactivation each week. "Reactivations happen because those people are comfortable returning to the office," Cayer says. 8-POINT RETENTION PLAN Proprietor: Brad Miller, DC; drmiller@millerfamilycare.com Miller Family Chiropractic is a solo clinic that sees between 120 to 150 patients weekly. The clinic's average annual revenues hover in the $275,000 range. Miller prides himself on practicing "old-fashioned straight chiropractic," and notices 75 percent of his referring clientele are women. Miller has eight different retention points to help DCs and their patients: 1. Call all patients 15 minutes after a missed appointment. 2. Always serve them first and deal with other matters second so they obtain value first, feel comfortable, and want to come back. 3. Keep the office attractive and clean with routine maintenance, carpet cleaning, etc. 4. Call the next day if a patient cannot be rescheduled. 5. Allow flexibility for patients who have difficulty with set times (family, work, distance) so they do not feel embarrassed. 6. Call those that have "slipped through the cracks" after a few weeks. After one or two calls, have the doctor call or write a note of concern. 7. When the patient returns after a lapse in care, review lifestyle events (such as health, financial, or family stressors) that may reconfirm the need for care. 8. Finally, emphasize to the staff that it is a privilege to serve. Sometimes patients aren't ready to follow through, but they should always feel comfortable whether they are there for their first visit or their hundredth. "We run the office like an extended family, with lots of 'warm fuzzies' on a daily basis," says Miller. "We are always looking for ways to recognize patients, support them in distress, celebrate with them in their achievements. If one's clinic is really a place for patients to heal, feeling cared for should be an essential and ongoing priority. "This approach is not necessarily the recommendation of the high-volume consultants and may not fit everyone's mold, but it is a critical key to very long-term retention (more than 10 years) in my mind." CONSTANT COMMUNICATION Proprietors: Drs. Toby and Sheila Harmon; harmonfm@insightbb.com Harmon Family Chiropractic sees more than 350 patients a week, and employs a split DC schedule in this two-doctor, husband-and-wife practice: Toby works five days a week, and Sheila, three days. They have been in practice in Jasper for nine years. Great customer service is the most important thing to the Harmons. "We have assistants that review stretches, hand out monthly articles to patients, and discuss [the articles] with them, so we are not just small talking," Toby Harmon says. "We also send out new-patient letters." Harmon believes it is necessary to continue relationships with patients outside the office, as well as with the community. "We have a good relationship with our area chiropractors and often host yearly meetings," Harmon adds. "From that, we get referrals from area pediatricians, family practitioners, massage therapists, as well as these area professionals, and their families are patients in our office." Harmon makes sure his patients know they can call the clinic anytime to ask questions or address other concerns. If his patients are unable to address their concerns, Harmon will tell them his staff will do their best to get them to where they need to be. 4 PHASES OF CARE Clinic: Advanced Chiropractic, P.C., Venetia, Pa.; www.advancedchiropc.com; 724-941-6800 Proprietor: Kevin Smith, DC; ksmith@gmail.com Advanced Chiropractic is a solo practice, with patient visits in the low hundreds. Smith takes the time to educate his patients about the nature and cause of their problem so they can make the best and most well-informed choices when it comes to their healthcare. "Additionally, we follow up with our patients' primary-care physicians and submit regular reports to them to keep them in the loop as to how their patients are progressing," Smith says. Smith also uses a "four phases of care" treatment plan. • Phase I, acute care. The focus is getting rid of pain via adjustments, passive modalities, and massage therapy. • Phase II, sub-acute care. This is a transition phase. The patient isn't quite ready for all-out physical therapy rehabilitation, says Smith. "We slowly incorporate gentle proprioception exercises and range of motion exercises." • Phase III, aggressive rehabilitation. In this phase, the patient is given isotonic and isokinetic exercises to perform. Postural/structural correction and core stabilization rehabilitation are also done. • Phase IV, wellness. In this stage, the goal is to sustain the corrections already made. In addition to providing chiropractic adjustments (manual as well as by instrument), Smith incorporates active and passive physical therapy, massage therapy, and nutraceuticals. OPTIONS FOR PATIENTS Proprietor: Todd A. Hedlund, DC; thedlund@wellnessoneoflincoln.com WellnessOne of Lincoln offers chiropractic and physiotherapeutic services (cold laser, electrical stimulation, intersegmental traction, hydrotherapy, and ultrasound) to approximately 250 patients each week. Todd Hedlund also provides diagnostic services, such as foot-gait analysis, nutritional analysis/scan, surface EMG, and high frequency x-ray. Hedlund's annual gross revenues are around $850,000. "A relationship with a new patient begins with education up-front about their condition, and they are given options for care so they can make the choice," Hedlund says. "They are then motivated to make changes in their life, as well as their back care, and then — most importantly — the patient is held accountable." Hedlund believes a DC must have the entire staff buy into the vision of the practice to reinforce what the DC and the patient wants. Hedlund says a clinic must be second to none as far as staff and appearance. Hours should also be convenient, so they eliminate any excuse patients come up with for not making their appointment. Healthcare workshops, according to Hedlund, should teach patients how to maintain their health outside the office (stress management, nutrition/exercise, and ergonomics, for example). "Once you've built a relationship with the patient and have earned their trust, most (about 80 percent) will become lifetime patients and increase your PVA," Hedlund says. DIRECT MAIL Proprietor: Tom Potisk, DC; tpotisk@aol.com Potisk Chiropractic Office treats several hundred patients per week, and has gross revenues in the seven figures. Potisk's clinic is made up of three full-time DCs and opened in 1984. Potisk, who was named DC of the year by the Wisconsin Chiropractic Association in 2006, is amazed at the response direct mail generates from established clientele, both active and inactive. "[The mailers] work particularly well when we include personal pictures, like me with my wife and three children, for example," Potisk says. "We also call those [patients] we haven't seen or heard from in a few months — not to specifically get an appointment, but to show concern for how they are doing." When contacted, many of Potisk's former patients ask for an appointment. Those who do not are assured they are always welcome back to the clinic, whenever they need continued care. PERSONAL 'TOUCH' Proprietor: Chris Clem, DC; clemchiropractic@aol.com Clem Chiropractic, a two-DC clinic, sees approximately 250 patients per week. Clinic revenues were in the area of $355,000 for 2006, and are on target for $420,000 in 2007. Chris Clem recently added a second chiropractor, his brother Derek. Clem believes DCs should have an active, hands-on approach. "After the second unsuccessful attempt at rescheduling [an appointment], I personally make a call to find out the real reason they have missed," Clem said. "We send out invitations for checkups, and if/when patients choose to discontinue care, we don't disparage their choice." Clem does, however, schedule the departing patient for a complimentary three-month checkup to make sure they are doing well and are still happy with their choice. "If every doctor had every past patient coming in for three-month checkups, they would have a waiting list. It also helps to reaffirm that we are their chiropractor, by constantly staying in touch with them," Clem said. FUN-FILLED OFFICE Proprietor: Matt Hubbard, DC; drmatt@healthyimpressions.com Matt Hubbard wears a lot of hats — doctor, author, wellness coach, host, speaker, and trainer. He is a regular guest on radio, television, infomercials, and wellness educational programs across America. Hubbard's clinic serves approximately 580 patients a week. Convoy Village Chiropractic has gross revenues in the neighborhood of $700,000. "I keep my patients coming back by making the first 12 visits the most powerful, and our health class (wellness workshop) educates our patients of the benefits of long-term chiropractic," Hubbard said. "All of this is set around a fun-filled, action-packed office designed for our patients' success." 30 STEPS TO OUTSTANDING CARE Proprietor: Shawn Shapiro, DC; drshapiro@portcitychiro.com Port City Chiropractic is a solo practice with approximately 200 weekly patient visits. Port City also provides periodic healthcare classes, aimed to teach returning and potential patients how chiropractic and its stress-reducing effects can help relieve pain and help patients live life to the fullest. "People have this blank stare when I tell them they should come in to see me without any pain," Shapiro says on his Web site. "The truth is what I do has little to do with pain. My real job is to restore the proper nerve flow from the brain through the spinal cord, and then out to the rest of the body." Shapiro prides himself on patient care and wellness. On a first visit, Shapiro can check more than 250 aspects of a patient's health in less than 15 minutes. "The first visit is the first step of what we call '30 Steps to Outstanding Patient Service,' which is a way to empower, encourage, and reward the patient for taking the chiropractic road to restore their health," Shapiro says. "We have a dynamic spreadsheet that all staff members monitor to make sure patients get everything to which they are entitled out of our clinic." Along with chiropractic care, Shapiro's clinic also provides orthopedic inserts and custom-fitted cervical pillows. |
Clinic: Wren Chiropractic Center, Sherman, Texas; 
Clinic: Affinity Health & Wellness Center, Orlando, Fla.; 
Clinic: Scarborough Family Chiropractic, Scarborough, Maine; 
Clinic: Miller Family Chiropractic, Arcadia, Calif.; 
Clinic: Harmon Family Chiropractic, Jasper, Ind.; 812-634-6363 
Clinic: WellnessOne of Lincoln, Inc., Lincoln, Neb.; 
Clinic: Potisk Chiropractic Office, Milwaukee, Wis.; 
Clinic: Clem Chiropractic Center, Auburn, Ill.; 217-438-6324
Clinic: Convoy Village Chiropractic, San Diego, Calif.; 
Clinic: Port City Chiropractic, Portsmouth, N.H.; 
John V. Wood is an Emmy-award winning journalist, as well as a nationally published freelance writer. He lives in Willow Spring, N.C., and can be reached at 919-632-1827 or by e-mail at Advertising | Classifieds | Cardpack | Datebook | Past Issues | Chiro History
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