Package the care to suit the patient
By Mark N. Charrette, DC

Patient retention is an issue facing every chiropractor in practice today. Too often, patients disappear from care without explanation, leaving you to wonder if they moved, could no longer afford treatment, or were dissatisfied with your care.

When patients do not complete the full course of care, they may not get the best results. This could damage your reputation (as well as their health) because some patients might complain to other people in the community that you did not help them, without mentioning they did not follow your advice.

KEY: CHOICES

Giving patients choices is the key to patient retention. Different patients have different needs, and chiropractic care does not have to be a "one size fits all" proposition.

To succeed, a patient-retention plan needs to meet your needs as well as those of your patients. You will retain more patients if you give them a choice in what kind of care they receive, without, of course, abdicating your responsibility to act as the expert.

You can learn a lot about patient retention by examining how other businesses approach the topic of customer satisfaction.

Many doctors believe thinking of their practice as a business will compromise the quality of their patient care. They are afraid that seeing chiropractic as a business will mean treating their patients like numbers and destroy something sacred in the doctor/patient relationship. Borrowing ideas from the business world, however, can actually lead to improved patient care and better results.

You can find a solution to your patient-retention problems in a familiar source — franchise businesses such as McDonald's and Starbucks. Franchises standardize everything about a business: the goods and services offered, the prices, and even the décor.

The customer knows what to expect in a franchised company. It doesn't matter what city a McDonald's is in, you can always order a Big Mac. At the same time, there is choice within the standardization. Starbucks has more than one type of coffee drink; McDonald's sells more than just hamburgers.

Standardization and choice both contribute to the incredible success of franchise businesses.

You can reap the benefits of offering standardization and choice by creating care packages. Begin by creating custom packages for the three types of patients chiropractors see the most — acute, rehab, and wellness. Each package should have an estimated cost and program of care — modified by you for each patient.

When patients come in, explain the packages you offer, and help them choose the one best for their condition. Once patients choose a package, invite them to schedule the necessary number of visits that day.

ACUTE CARE PACKAGE

The acute care package is designed for patients who are injured and/or in pain. Although the primary goal is to get rid of the pain, the package can also reduce inflammation, minimize injury, and prevent injuries from worsening.

The acute care package involves passive care — making adjustments, using heat and ice therapies, providing passive traction, and utilizing ultrasound.

Acute care is probably the most concentrated package, lasting two to four weeks. When the patient completes all the visits in the package, you should re-evaluate him/her to see if the acute care needs to continue. If the patient has finished, he/she has the option of moving on to rehab care.

One of the major reasons patients drop out of care is that they don't know how to evaluate their progress. When they begin to feel better, they drop out of care.

One way to combat this is to start each visit by asking, "How do you feel today?" This teaches patients to evaluate their progress. But, be sure they know you are evaluating their structural and functional improvement also, not just how they feel.

In most cases, insurance pays for care that relieves the patient's pain or restores function (acute and rehab care), but rarely pays for preventive (wellness) care. Your patients should be made aware of this up front.

REHAB CARE PACKAGE

Once a patient has completed the acute care package, the next step is to offer a rehab care package and get commitment. Rehab care focuses on your patients' abilities to perform the general activities of daily living, such as work tasks, dressing themselves, driving a car, or picking up their child.

Active patient involvement increases as you and the patient work together to bring the patient back to normal. During the rehab phase of care, use rehab equipment that offers simple, pain-free exercises that help improve the cervical spine, postural deficits, and extremities, and instruct your patients to perform these exercises at home.

Insurance companies are particularly concerned with gaining quantifiable information about whether or not the patient's condition has improved. The duration of rehab care is highly dependent on the patient's circumstances, but on average, lasts an additional two to eight weeks after acute care. Once you have determined a patient is finished with rehab care, he/she can move on to wellness care.

WELLNESS CARE PACKAGE

The wellness care package is for patients who are interested in maintaining or improving other aspects of their health through chiropractic care. The type of wellness care a patient receives should be based on their age, goals, and the amount of time they are willing to commit.

During wellness care, patients receive adjustments to align their spine for healthy movement and may receive counseling about diet, exercise, and ergonomics. Once patients have experienced the results of chiropractic care through acute or rehab care packages, they are more likely to become a wellness patient.

HOW CARE PACKAGES AFFECT YOUR PRACTICE

Offering care packages doesn't require you to change your methods of practice. If you use a certain adjusting method, offer massage, or recommend custom-made orthotics, you can continue to do so within the scope of your care packages.

When you create your care packages, customize them to suit your preferences and meet your patients' needs. You can still practice exactly the same way, except now you are clearly defining your methods of care so your patients understand why they are necessary. Both you and your patients can continue to have choices within the standardization of the care packages.

Care packages benefit your patients by letting them know up front how much time and money they have to commit to getting well. Having care packages eliminates some of the uncertainty. It reassures patients that your primary goal is to get them well, and they don't have to accept care they don't want.

Care packages are more beneficial to you because they help standardize your care and leave you more time to give special attention to your patients. Having patients make an up-front commitment will not only improve patient retention — it will also bring in more referrals from your satisfied patients.

Mark N. Charrette, DC, a member of the Foot Levelers Speakers Bureau, has taught more than 1,000 seminars worldwide on extremity adjusting, biomechanics, and spinal adjusting techniques. He can be contacted at mncdc@aol.com.