Part One of this article discussed why a stronger Report of Findings is needed. Part Two covers the sequence of the Report of Findings to obtain better patient retention and more cash. Following is an overview of the ten-step Report of Findings and then a detailed explanation of each of the ten steps.
Use “how” questions.
If needed, reschedule with spouse, significant
other and so forth.
5. REVIEW X-RAYS.
Use touchy-feely-showy technique.
6. FEAR OF THE FUTURE.
7. COMMITMENT LEVEL OF 10.
8. TREATMENT PROGRAM.
9. FINANCIAL ARRANGEMENTS.
The first steps are the standard consultation, exam and x-rays. I have found it doesn’t matter much what forms you use, as long as they provide the data you need and are not repetitive. However, it is very important to get the “how” questions answered. These questions can be phrased differently, but I like to use the word “how” as an easy way to remember. The questions are, but not limited to:
1. How long have you had the condition?
2. How often do you get it?
3. How bad does it get?
4. How have you tried to handle it-and has that not worked?
5. How does this condition affect your life-work, hobbies, family, etc?
In this area of the report, you are trying to establish the past condition of the patient and get them to really examine how it has bothered them. You may have to refer to this information later in step seven of the report, if needed. If you are offering a free consultation, then be sure to tell the patient the exam and x-rays are an additional cost. Make sure the person can pay that day for the cost of the exam and x-rays if they do not have insurance coverage. It is very expensive to bill someone and collect for such a small fee. Make sure the patient understands there is possibly a chiropractic problem, and the exam and x-rays are needed to determine what their problem is exactly.
Some doctors do not like to take x-rays or there may be patients who want to bring x-rays from another office and so forth. I strongly suggest you take your own. This way you get what you want and there is less delay in completing the report. You will achieve better results through patient education if you have x-rays. While there is no need to over-shoot, get the views necessary to substantiate your findings.
Many doctors ask if they should treat on the first visit. I tell them they are the best judge to answer that question. I prefer the patient receive some form of care, whether it’s ice packs, therapies and so forth. I don’t necessarily suggest manipulation.; however, it is up to the doctor. If you tell the patient you have to take x-rays to see if there are any broken bones or to determine what areas you will need to adjust, then it looks superfluous if you adjust. Use your judgment.
Step three is to schedule the patient for the next day you are open or as soon possible. Tell the patient when they come in again, you will review their x-rays and go over a treatment plan and financials. Inquire if there is anyone they will need to bring who will need to be involved in their health care decisions. If so, get that person scheduled to come along. If you don’t inquire, you can run into the problem of going all the way through the report to find out the patient can not make a health care decision. It could be a big waste of time that you can prevent up-front.
5. Review of x-rays
(use touchy-feely-showy technique).
On Day Two have the x-rays marked before you see the patient. It is much better not to do this in front of the patient because it appears that you worked on their case while they were goneyou did your homework. You don’t need to get complicated when drawing on the films. Just show the main areas of concern, such as hip level differences, curves they should have, bad disk spacings, etc. Remember they are not radiologists. Keep it simple!
Put the films on the view box and have the patient stand next to you. You will now start the touchy-feely-showy part of the report. I must stress a point first. I have heard doctors use technical jargon when talking to patients; unfortunately, the patient doesn’t know what you are talking about and it creates an even bigger problem.
For example, if you come across a word you do not understand, you will go blank immediately afterwards. Have you ever read a paragraph and then asked yourself what you just read? You went blank. You could not remember what you just read because you came across a word you did not understand. It is the only reason you did not comprehend the text. If you went back, found the word, looked it up in a dictionary, understood it and then reread the text, you would understand clearly. If you do not, you probably looked up the wrong word.
Do you want your patients to track with you and receive a full understanding of what you are about to teach? Absolutely; so don’t use technical terms. For example, don’t say subluxation-say “pinched nerve.” Don’t say cervical-say “the area of the neck.” Keep it simple. Your purpose is to effectively convey what you see-don’t cause your patients to “go blank.”
Use props to educate the patient. For example, demonstrate the patient’s condition with the skeleton and anatomical models sitting in the corner of the room. Use colorful posters and actual body parts to explain what is going on. You are trying to establish the patient’s present condition; what is going on right now in their body.
Ask questions to see if they are tracking with you. Don’t say, “Do you understand?” Instead say, “Do you feel that pressure when I touch you there?” or “What would happen if you bent over and…?” Consult the patient’s understanding. If you lose them, back up and find out where you lost them. Keep checking for comprehension. Make sure the patient has no more questions before going on to the next step.
6. Fear of the future.
The use of an organ/nerve chart is very useful when explaining the next step fear of the future. In this step you are educating the patient on the problems that could arise if their condition is not corrected. There are several organ charts available that work well, and some have nerves and organs that light up.
The main consideration regarding what chart to use is whether it easily traces the nerves coming out of the spine to the related organ(s). Show the patient where their area of concern is and have them trace the nerve to the organ. Ask them what organ it is and what would occur if the organ did not get the proper supply of nerve communication. Trace each area and give examples of what could happen to someone who had these problems if they were not corrected. Do not say it will happen to them; rather, what could happen. Check for any questions and answer them.
7. Commitment level of ten.
The next step is very critical. You must get a “ten” before going on to the treatment plan and finances. On a scale of one to ten, ask the patient for their commitment level on correcting this problem. If you do not get a ten, find out why and handle their consideration(s). If money or time-related issues come up, put these objections off by saying you will be addressing them next.
Ask their commitment level again considering the treatment will be affordable and the time can be arranged. Get the patient to say the word “ten.” Once they do, shake hands to show that what they did is a very good thing. Validate the decision. If you do not get a ten, know there is something stopping them. At this point you must handle the patient’s objections and barriers to receiving the proper care.
8. The treatment plan.
Now you are ready to talk about the treatment plan. Keep it simple. Talk about the three levels of carepain relief, correction and maintenance. Explain that at first the patient will need to see you more often and as they get better, the treatments will be less frequent. Clarify why the frequency decreases and that it is very important they not drop out of care before the plan is done. If they become free of pain and quit coming, the problem could come back, only worse because of degeneration, etc. Tell the patient you will be doing therapies as you go (if you do therapies) and re-exams. Let them know about any special braces, nutritional supplements, and so on. Keep it simple. You do not have to go into details.
Next let your patient know that their treatment plan will take several months and about __ number of visits. Give your estimate of care. Check to see if they have any questions.
9. Financial arrangements.
The last step of the report deals with money. If you are not comfortable talking about money, then get an assistant to do it. Just make sure your assistant doesn’t have a problem taking pre-payments in full. If you do this step properly and really care about getting your patients the best care, they will see you are sincere. Determine different incentives to offer your patients if they pay their co-pays up-front or pay the whole amount ahead. Another option is to offer savings plans.
For a cash patient, an incentive might be to not charge for therapies if the patient pays for manipulations up-front. This could result in tremendous savings for the patient. Say you estimate the plan to be 30 treatments with 15 therapies; the cost would be $45 times 30 or $1,350. If the patient pre-pays in full, it would cost $900.
Decide what incentives you want to offer; however, do not offer a discount. In most states it is illegal, especially with insurance commissioners. Remember, no one can tell you that you must charge for treatments. It is fully legal to see what you can do to help the patient financiallybut don’t give the farm away and don’t treat for free unless the patient does something to be rewarded for it. As I stated in Part One [Chiropractic Economics, March 1999], each week you should see two new patients whom you will not want as patients, two who will probably leave because of the money and out of the six left, two who will be able to take advantage of pre-paying in full. The other four should be strong candidates to work out financial arrangements to accomplish their treatment plan. Try to avoid extending payments for more than the treatment plan length. If you do, you will often find that you become a low priority when the electric bill gets too high.
If patients pre-pay for 30 visits, guess how many times you will see them? If your PVA is 15, it means even at full rates, you would have received $675. With a stronger Report of Findings, you’ve earned $900 and patients will get the services they need. Ask yourself, who wins here? You both do, and that’s the whole point.
Now you can indoctrinate your new patients. Treat them, walk them up to the front desk to be rescheduled and pay what they have agreed upon. Smile knowing that you have just helped someone get better.