February 2010

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Build a better practice

You most likely became a chiropractor to help people; not to crunch numbers or lead marketing efforts. But running an efficient practice not only helps you make a living, it frees you up to treat patients — which ultimately leads to success.

By Laura Laing

As the national debate over healthcare rages, one thing is certain: You are expected to be more than just healers.

With diminished insurance coverage and growing competition for patients, nowhere is this new reality more obvious than among chiropractors — and being business savvy is a must for any practice.

We talked to a few successful chiropractors and business management gurus to get the skinny on a few lucrative office strategies.

Pay attention to these details, and you might find your office running more smoothly — leaving you feeling less overwhelmed.

Put it in writing

“Majority of chiropractors who call me are struggling because their office manager of 14 years has left and they don’t know how to turn on the computer,” says consultant Kathy Mills Chang.

That’s where a standard operating procedure (SOP) manual can help.

When each process’ steps are outlined in writing, anyone can slip into the position of a vacationing staff member or someone who has resigned. “I could win the Powerball and leave, and no one is in the lurch,” Mills Chang explains.

Alicia Burke, DC, of Absolute Health LA in Los Angeles has put this process to the test with detailed job descriptions and an employee handbook for reference. “If it’s not on paper, it won’t happen,” she says. “You really have to spell it out.”

While delegation may be difficult to do, it’s crucial for maintaining a schedule that puts patients first.

“Seventy-five percent of delegating problems are because they don’t think someone can do the job as well as they can, and they don’t feel they have time to teach their staff how to do things,” says Maria Marsala, a strategic business advisor who owns Elevating Your Business.

But when your staff knows they can turn to a written document such as an SOP for instruction or to answer a quick question about a process, they won’t need to interrupt you, your patient care, or put a chore on the back burner.

“The best use of chiropractors’ time is utilizing their best skill set — being a doctor,” says Paul Maguire, DC, a chiropractic coach. “If you want to grow, you have to have help,” Maguire says. “No doctor can do it without help.” He also suggests that if the office is a mess, hire someone to get it organized. Need marketing materials? Leave the designing and writing to the pros.

Lisa Goldberg, MD, of All Care Consultants takes the SOP one step further. “The whole office has to have a mission statement,” she asserts. When everyone understands and buys into the purpose and goal of the practice, they’re more likely to follow a process that works toward that end goal.

Stick to a schedule

Sheilagh Weymouth, DC, knows what she’s supposed to do every moment of every working day thanks to a carefully planned schedule that includes time for phone calls and catching up on administrative duties.

“I’m kind of a free spirit,” she admits. “The way I’ve been able to maintain my creativity and free spirit is by creating structure.”

Her dogged devotion to her calendar also allows her to offer something missing in many doctors’ offices: “I am always on time.” In fact, even her late patients know they may not get their full time with her.

Weymouth also lets her patients know when she’s available to talk on the phone. She doesn’t return calls at that time; instead, she expects patients to call her. “It’s not a time for a 20-minute phone conference, but for a quick question,” she says.

“A big mistake a lot of doctors make is that they try to have office hours all week, and they have no administrative time,” Mills Chang says. She suggests DCs set aside 10 percent of their face-to-face patient time for admin duties, and give staff scheduled and uninterrupted time, as well.

Carrie Oleston, DC, and Cindy Perkins, DC, are also devoted to their carefully managed schedule. In business together at Back in Health Wellness in Lutz, Fla., the two chiropractors have one another to lean on.

“Most of our patients see either one of us,” Perkins says. “That allows us to break the work up.” Along with regular business hours, they offer early morning and evening appointments. The two also alternate office hours on Saturdays.

“It’s been very important to allow patients the opportunities to come in,” Perkins says. “Making it convenient makes it easier for patients to follow their care plan.”

“Watch the hours that people are coming in to the office,” Marsala suggests. “You may find that it’s more cost effective to offer early morning hours one day a week than to stay open until 8:00 p.m. every day.”

Marsala also strongly advocates protecting down time. “You’ve got to get away from your office,” she says. “You need that down time to rejuvenate.”

For Noel Plasker, DC, of Family Wellness Center in Ho-Ho-Kus, N.J., that down time is every Thursday. “I can do something for me and recharge my own battery,” he says. “I want my mind clear when I’m with my patients.”

Hire the right people — the first time

When it comes to getting the best employees for the job, Dr. Donald Palmer, regional development director of HealthSource, has one piece of advice: “Hire slow and fire fast.”

When a business is growing quickly, it’s easy to fall into inefficient hiring strategies — such as rushing to fill a position or keeping staff that is not working out. But these approaches end up causing more problems.

“It hurts everybody on every level,” Palmer says. “It hurts business, it hurts the rest of the staff, and it hurts patient care.”

Having a hiring process can help. “Know what you’re looking for,” advises Marsala. “It is a pain in the neck, and it does take more time to create a process. You may get fewer applicants, but they better fit your needs, and you also have a process to use for next time.”

It’s also a good idea to have a file of potential hires, even when you’re not looking. “If you’ve got an important position in your company, you need to have a reserve,” Marsala says. “You should have one or two people in mind so that you’ve got backups to call.”

To cut down on the time invested, check out standardized employment forms available on CDs from large office supply stores. “Don’t reinvent the wheel,” Marsala says.

Plasker has a unique approach to hiring — after placing an advertisement, he sets up a group job orientation for the applicants. Those who are still interested at the end of the presentation can complete an application and meet with him one-on-one.

“The advantage for the employee is that they

No matter how careful you are in the hiring process, sometimes an employee is just not a good match. “Once you know it’s not working out, it’s best just to move on,” Palmer advises. “But it’s hard. We’re doctors for a reason — we want to help people.”

Go with the flow

There are as many different approaches to office design as there are chiropractors. Choosing the right one for your office can take time and energy. Pay attention to the focus of your practice, your budget, and your space.

Jennifer Walker, DC, of Balance Chiropractic and Wellness in Roanoke, Va., chose a therapy bay where she can treat many patients at once. Three treatment rooms are spots of soft tissue treatments, stretching, and active release. She and two massage therapists rotate the use of those rooms.

“Between the three of us, we manage the flow of treatment,” she says, and the layout of her space helps.

Although she has a relatively small practice, Weymouth’s office has four treatment rooms — two for seeing patients, one that houses her detoxification equipment, and another designated as an apothecary and her office. If patients arrive early, they can settle into one of the two treatment rooms.

Whatever the layout, keeping the office tidy and clean is an absolute must, says Palmer. “Walk in your front door every once and a while and see what it looks like to patients.” Files and projects should be put away when they’re not in use and outdated magazines and promotional materials should be discarded regularly.

“Probably the No. 1 thing is having order,” Palmer says.

Simplify payment plans

Whether yours is an all-cash practice or you accept insurance, receiving payments can clog the system. This is a two-pronged problem: offering easy-to-understand payment systems and making the payment process run smoothly.

“You have to have a model that’s affordable and manageable for patients,” Maguire says. Simplicity is key. “You have to explain things in a way people understand.”

“I recommend only three options,” Mills Chang says. First is a prompt-pay scale that offers a discount (or other incentives) for quick payment. A monthly plan controlled by the office can also save time, especially if the office staff can run credit cards at a set time each month. Finally, Mills Chang recommends checking out a debit system with external financing, which she calls “super effective.”

Whatever the payment options, reducing the time it takes for your patients to check in and check out frees your staff for other duties. Plasker prefers patients to book their appointments and make payments in advance.

“It saves time for the patient, and it saves staff time,” he says. Patients don’t have to check in with the front desk before leaving, keeping their appointments quick and simple.

Watch the purse strings

There are countless new gadgets and technologies out there designed to save time and increase efficiency. But not all of them deliver, says Goldberg. “Don’t put in products and services just because someone else is doing it,” she says.

Some chiropractors are penny pinchers, but not “dollar pinchers,” she says. Any purchase or additional staff hire must make sense in the larger picture. Otherwise, money is wasted and efficiency is lost.

“Doctors do things out of desperation,” she says. “But an ounce of prevention is worth a pound of cure. Don’t buy something just because it’s good. Buy for need, not for want.”

The same is true for marketing efforts and staff expansion, Mills Chang says. She suggests having a set number of marketing initiatives each month and measuring their effectiveness regularly.

“Keep track of everything as you’re planning and doing,” she says. This monitors efficiency and creates a template for next time.

Calculating the return on investment also ups efficiency, Mills Chang says. Return on investment — whether on staff, equipment, or services — should be two to three times the cost.

“I think a lot of times doctors focus on new things and things that sound complicated, instead of focusing on the little things,” Palmer says. “You really have to put yourself in the mind of the patient and ask yourself, what do they care about?”

In the end, efficiency is about making calculated changes. Sometimes these work out, and sometimes they don’t. The key is flexibility — something Walker is comfortable with.

“I’m not resistant to change,” she says. “If something isn’t working, I’m not afraid to change it.”

Laura Laing is a Baltimore-based freelance writer and editor. Although not a chiropractor, she contributes regularly to Chiropractic Economics. She can be reached through www.lauralaing.com.

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