Resource Centers:(News, information, and tools to support your practice)
August 2010
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Communicate confidence
By Bharon Hoag
What are outcomes? Essentially, they are the cumulative results of your treatments.
What is compliance? It is the degree to which patients accept and follow through on your recommendations — such as the number and frequency of visits; performance of prescribed out-of-office activities; and the willingness to adjust habits and lifestyle practices that may have contributed to the existing problem or which potentially might block the treatment’s efficacy.
One reason a patient enters your reception area in the first place is because he or she hurts and wants to end the pain. Unfortunately, many patients don’t comprehend that chiropractic is not a one-way process; that while you can skillfully diagnose and treat conditions, they also have a role to play — and that means keeping to an appointment schedule and following recommendations for growth, change, and recovery.
Why would they not? After all, it is they who hurt; not you. There is a clear breakdown in logic when someone goes to a clinic seeking relief and then fails to do what is necessary to achieve that relief — what you call outcomes.
There can be fault on both sides, and often it relates to you not understanding some of your patients’ key issues and how to balance these with the patient’s responsibilities and their own recommendations.
In dealing with the problem of patient compliance, the two greatest noncompliance drivers are time and money.
The high cost of pain
It is said if you want to see what’s important to people, look at their calendars and checkbooks. You need to not only recognize what is important to patients, but also examine your approaches to see if perhaps you are unconsciously responding and operating from a position of fear — fear that the mention of money and/or extended time commitments will drive the patient away.
The result: You dance around these subjects and, as a result, fail to secure a firm commitment to treatment from the patient. Who can blame the patient for a lackadaisical attitude when he or she doesn’t understand what’s ahead or what it’s going to cost.
And who can fault you for driving away income by not being upfront in the first place?
Many people can. The downside is that it is expensive for both. The patient stands to have the pain endure, while you do not generate the revenue that could and should derive from the case. So how do you get around this dilemma?
Be courageous, be clear
Nothing is ever gained through delay and evasion, other than the patient is conditioned not to pay or be faithful to the visit schedule. Address the taboo time and money issues at the outset. Establish your value proposition, which should equate the patient’s improved physical (and often mental and emotional) well-being through the treatment you provide. And be firm about their need to commit to a schedule of visits and the importance of timely, consistent payment.
Whether you are dealing with a cash patient or an insurance case, don’t wait until the patient visit to deal with the financial issue. If it is an insurance case, get the policy details at the time of the first appointment phone call and have the front office get the coverage information from the third-party payer before the patient arrives.
The likelihood is that
What have you done? You’ve psychologically minimized the financial impact on the patient and essentially set an expectation for the number of visits involved.
There is really no difference when dealing with a cash patient, so long as you are clear about the value you are delivering. You absolutely must deal from a posture of confidence, and confidence is communicable.
Communicate, don’t just talk
Once you have cleared the financial air to your satisfaction, make sure your patient concurs.
Do that by demonstrating you understand the patient’s physical problem fully, and that you know how to treat it and how long it is going to take.
Many doctors feel they must bring patients to their level in order to establish understanding. That is incorrect. You need to go to the patient’s level, and tell them what they want and need to hear.
Do not talk in terms of subluxations, sympathetic/parasympathetic, or autonomic charts — that is doctor talk. Talk to your patients in a language they understand: You have a backache, you got it when you slipped/fell/twisted/slept wrong/had an accident, here is what happened, and here is what we are going to do about it.
If you have a clinical software system that features graphical displays, sit them down and show them a spine, tell them a little about what it does, and show them what is amiss.
Alternatively, you might refer to a wall chart. The point is visual aides are powerful tools and dramatically reinforce your diagnosis, as well as your patients’ ability to understand the physical issues.
Tell them what you do will alleviate the problem and what you recommend they do between visits that support the in-office treatment. You may want to explain how chiropractic differs from conventional medicine and surgery in employing natural methodology, helping the body to heal itself, versus intervention. Explain that treatment and recovery occur in parallel.
It’s not just the money
The fact is there are direct and fundamental relationships between payment and compliance, and between compliance and outcomes. It is a straight path, virtually mathematical in its truth.
Compliance has much, if not everything, to do with understanding. And often, understanding is best conveyed in pieces. Most of you have standard protocols you follow, but rather than stating that the patient is in for "X" weeks of visits, you can say, “…let’s do two weeks of treatment, twice a week, see how your body responds, and then decide where to go next.”
The constant should be, “You’re here because you can’t do something, and we want to get you back. Here’s what I’m going to do, and here is what you must do. You must do it so you don’t undo what we achieve in the office and after you’re well, here’s how you can avoid repeating the problem.”
You have your own way of presenting, but the fundamentals are solid. Don’t shy away from the ticklish issues of money and time; instead, build understanding of the problem and the path to recovery.
Communicate confidence in the efficacy and value of your treatment and allow the patient to share in that confidence. When you do, you are more likely to have a compliant patient, and the patient is more likely to have a successful outcome.
Bharon Hoag, chief consultant of ACOM Health Chiropractic Consulting Group, has worked in the chiropractic profession for 11 years and taught for eight, developing his unique “nondoctor” approach through ownership of four clinics and management of up to nine. He can be reached through www.acomhealth.com.
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