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Chiropractic News

May 2004

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Automate your front-desk function

One way to increase your practice’s bottom line is to increase your patient flow. Another is to increase productivity by having staff work on value-added activities.

When my practice relied on insurance reimbursements, we were underpaid, overworked, highly stressed and under-appreciated. And worse — our patients were not receiving all of the benefits chiropractic care had to offer. They based their care on how many visits were covered by their insurance plans, not on what they really needed. Essentially, they received pain-relief care, but did not remain in care long enough to correct their subluxation problems or transition to wellness.

The co-pay, treatment plan, third-party model of chiropractic did not allow me to practice the way I felt empassioned to practice. So I opted to move toward a mostly cash, family-oriented wellness model of practice, a change that has paid off in high quality service, a substantial increase in return patients and a pleasant environment for both the staff and the families we care for.

As we transitioned to this type of practice, we streamlined many of our patient processes and cut paperwork and stress everywhere possible. We wanted to have more fun and impact many more lives. This required that we become creative with fee plans for individuals and for their families so that people of all ages and all walks of life could receive the benefits of wellness chiropractic care.

Our practice quadrupled in less than two years. But to accommodate the greater volume of patients and ease the patient flow, we had to change office procedures. Any analysis of our work processes showed that one of our major “pinch points” was the check-out desk. People waited five and six deep to pay for their visits and schedule their next appointments. The front desk became chronically chaotic. The phone was ringing, children were crying, salesmen were calling and patients were not being lovingly served.

We needed to find a better way. That’s how we developed the “no check-out” front desk. This dream-like invention was born of necessity. As a result of implementing this new procedure, in a few short weeks, the office was less stressful, fewer staff were needed and peace was the rule, not the exception. Now every time our patients leave after an adjustment, they have a smile on their faces now. It’s not just the adjustment — it’s the serenity and pleasantness that greet them every time they enter our door and warm thank you as they leave.

The core elements of the no check-out front desk are pre-scheduling and automatic payments.

We determined that if we could pre-schedule everyone in advance, we could eliminate much of the chaos caused by the front desk CA’s “fighting” over the appointment book. We also surmised that arranging for automatic credit card and debit card payments would eliminate nearly all money transactions during our prime adjusting times. We even implemented an automatic checking account withdrawal option. We figured if car washes, grocery stores, car dealers and mortgage companies can arrange for regular automatic payments, why couldn’t we?

1. Intake and education.
When a new patient enters our office we do the customary consultation, examination and spinal x-rays. After their findings are evaluated, I

determine my recommendations for the patient’s care. My goal is to educate the patient to first regain and then to maintain the healthiest spine that is still possible for them. I communicate through patient video education (our own) and verbally. Our banner of communication to everyone we meet inside and outside of our office is that “A healthier spine means a healthier you.”

Inside the office we teach primarily through patient-education videos. Patients learn why their spine is so important to optimal health and what a healthy spine looks like on an x-ray. We start on day one with a five-minute “introduction to chiropractic” video.

The patient returns for their second visit a day or two later with the spouse (a key to developing a family-oriented practice) for a group report of findings. But prior to the report, the patients view a second video that explains the report of findings. I then explain the importance of maintaining a healthy, well-aligned spine for life, why subluxations are so serious and how long it takes to correct the average spine.

Finally I review their individual x-rays and give them my recommendations. Then they receive their first chiropractic adjustment in our office.

2. Private financial consultation. After the orientation and report of findings, patients have a private financial consultation with one of my cross-trained staff, who reviews proposed care, discusses costs and payment options.

3. Prearranged scheduling and payments. All appointments are pre-scheduled using a multiple appointment calendar for the pre-determined length of corrective care. The patient’s financial payment is also pre-arranged to occur automatically every month. This eliminates the need to make a financial transaction for each visit.

4. Routine visits. On routine office visits patients sign in, pick up their records and route themselves to the adjustment room. Once at the adjusting table they relax face down until I arrive tableside to deliver their spinal adjustment. Afterward the adjustment, they route themselves back to the check-out desk where they hand in their record card. The staff thanks them warmly and sincerely for coming in.

In today’s fast-paced, high-stress lifestyles, people greatly appreciate not having to wait in line and enjoy being treated kindly and efficiently. Other ideas we have added or streamlined include more patient-friendly office hours, initiating a family checkup policy, wellness-care plans and non-symptom patient-education videos. We even created a “no appointment book” scheduling system and a “no recall” recall system.

All of these and other changes have dramatically improved our practice satisfaction and our results because patients now know why it is important to get a healthy spine and keep it. The patients get what they need; we enjoy our work much more; and many more lives are being transformed every day.

John Madeira, DC, runs a solo chiropractic clinic in Hershey, Pa. He is also founder of Madeira Success Strategies, a seminar and coaching program called “Chiropractic ... Pure and Simple” that teaches chiropractors how to run successful, high-volume, high-cash, high-touch practices. He can be contacted by at, 877-MADEIRA or through his Web site,

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