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During the past several years I have seen striking changes occur in the field of financing chiropractic care for patients. Before the 1970’s, doctors had to be able to take cash for treatment (fee-for-service). In the 70’s, insurance companies welcomed chiropractors and paid quickly and well. In the 80’s, billings were scrutinized and co-pays were the flavor of the day. Now in the 90’s, HMOs and PPOs have arrived on the scene; cutting treatment fees and delaying delivery of the money. How many times have you had your bills cut, slashed, delayed and then denied? Too often, I’ll bet.
I have seen chiropractors near tears over having treated their patients with such wonderful care and then are denied the benefit of being paid. Their only solutions are to turn to the patient for payment or to write-off the money as non-collectable. Now the once-faithful patient blames the doctor because the insurance company failed to pay. Unfortunately, this is a common problem.
And what about the now common types of insurances where treatments are restricted because they do not fall under the proper amount stated in the clause “reasonable and customary?” Insurance costs have gone upplans have been restricted. Fewer and fewer patients are obtaining chiropractic care as part of their insurance plans. Patients are getting less care and don’t want to let go of their hard-earned cash.
My solution? A better Report of Findings! This is the number one problem I have witnessed repeatedly in almost every clinic I have assisted and with every doctor to whom I have spoken. How do you execute a stronger Report of Findings? One that gets patients to “stay and pay” for fees after insurance has run out?
How does your practice compare?
How do you determine if you have a strong Report of Findings and thus good patient retention? Through statistical analysis. You must figure your patient visit average (PVA), which is very simple. For example, consider your number of active patients over a period of time, say two months (the longer the better), and divide that number by the number of patient visits you had in the same time frame. An active patient is someone who came into your office to see you for the purpose of getting help for a condition and you did a consultation, exam and/or x-rays. Let’s say you had 40 active patients during the past two months and 800 patient visits during the same period. Your PVA is 800 divided by 40, which equals 20. Twenty is your overall PVA.
Your overall PVA accounts for the average visits per active patient. Note that you may go further and calculate your PVA per category of patient. For example, some personal injury (PI) patients may take 90 visits. Teenagers may take 10 visits on average. Another statistic to calculate is your average percentage of patients who complete the programs they start. For illustrative purposes, I refer to the overall PVA in this article.
On average, most doctors I have surveyed require 30 to 35 visits to take a patient through pain relief and correction before they are ready for maintenance. A good maintenance practice has a PVA of over 35. I have also heard other chiropractic consultants provide this figure as an average for the first two levels of treatment. This average need of care appears to be a rather stable figure across the country. Although there is no God-given formula to determine exactly how many visits a patient will need, most chiropractors to whom I have spoken use a treatment schedule of four treatments the first week (or every day the first week or two), 12 during the next month, eight the following month, then four, two, and one in subsequent months, and then the patient is released from care. Now add in a few re-exams, and so forth and you are in the range of treatments mentioned above.
I have also found the average Doctor of Chiropractic usually has a PVA of around 15. I have seen it as low as 5 and as high as 50 or more. This figure should be 30 plus if you are keeping patients long enough to get the results you wish. Remember, this is an average. Some doctors tell me they get patients better faster. While they could be excellent adjusters, I believe human bodies get better only so quickly.
Are your patients dropping out too soon?
Next, ask yourself if you feel your patients are dropping out of care too soon. Do you want to get your average patient through pain relief and correction? Are you giving your patients that level of care? Do you want a pain-symptom-oriented clinic or do you want a long-term heath care facility? Many doctors have told me that fellow chiropractors have been ripping the system off by over-treating their patients. Excuse me, but how do you over-treat according to the above if the patient needs it. Yes, there are some chiropractors who need to re-evaluate their intentions in the field of chiropractic, but are you being honest with your patients by not “selling” them enough care?
Sorry, I mentioned a four letter wordsell. If a patient came to you for help, and a full treatment plan is what he or she needs, then why lead your patient astray by not telling him what he needs? This is what the Report of Findings is all about. It is your time to pitch your waresto sell your goods. If you don’t do it, then you will not achieve results such as higher patient retention and your patients will not get the care they possibly need. The Report of Findings is your primary sales tool. The report involves all the steps from the initial consultation to the financial arrangements for care. Your Report of Findings should be done at the beginning and preferably before care begins.
I am not telling you to sell every patient on receiving 30 to 35 treatments. You must use your judgment. You are the doctorthe expert on this subject. You’ve invested years of your life to learn how to adjust and treat patients. You invested thousands of dollars to get to where you are now. Use your knowledge. Estimates of care are done by using your judgment based on the condition of the patient, patient’s age, health, similar cases, and so forth. As I mentioned, there is no God-given formula to plug in x, y and z factors and get 27 and 2/3 visits. This is an estimate of care; however, it is not a UCAFF (unlimited care at a fixed fee). It is not a guarantee and it is not an exactitude. It is your best shot on how many visits the patient will need to get the proper care she needs.
What if it takes more visits? Offer the same fee rate as if you did a package of visits (no discountsyou can not say that). What if it takes fewer visits? If the patient paid in full for treatment, then either refund the money or better yet, use it for the patient’s maintenance program. I will offer more later on treatment plans. Remember, financial plans come only after you have “sold” the patient on getting care.
Retention: key to more cash
Over the years I have developed a ten-step Report of Findings sequence that will result in better patient retention and more cash in the door. You will be able to convince patients to pay in full at the beginning of treatment for their entire treatment plans and it is not difficult if done in the proper sequence. However, it is challenging if they fall out of care too early. If your patients want your services-take the money! Remember to inquire with your local board to find out the specific requirements if you take payments in full at the beginning of care. Some states may require you to set up an escrow account and others don’t.
I have ob-served (from actual survey results) clients who use the ten-step Report of Findings go from an average PVA of 15 to 17 to more than 25and many over the 30 mark in a very short time. One doctor called and announced he was seeing a PVA of 33 during the past three months, and he was at 17 only four months ago. These doctors have been able to get patients to pay in full for services at the beginning of care. The doctors report that it is easier, the patients thank them for explaining what the services will cost and their patients are much better educated on chiropractic. The best part is they are sticking around longer to get the care they need.
Don’t sell the wrong person
You must understand that not all patients are going to pay up-front for full-care packages. In fact, out of ten new patients who come into your clinic, you should see two patients whom you do not want as patientsso don’t sell them, two who do not have the money to pay for their x-rays and six who should be good patients. Out of the six, there should be two to three who will be able to pay in full and will want to if you offer the right incentives. If you are not experiencing this, your marketing is off and you are attracting the wrong type of patients.
An example of attracting the wrong patients is by using telemarketing. Clients I have surveyed offered “free” consultations, exams and even x-rays. The phone solicitor calls people during the day. Who is at home during the day? Usually people without a job. I had one doctor in Utah who was attracting eight new patients per week from telemarketing, yet only two were staying around after the free part was over. I persuaded him to ask $25 for the service and the number dropped to three new patients per week, but he was still keeping two. If you are marketing in bad areas, then stop and start a good marketing program.
Another benefit? With a stronger Report of Findings, your practice’s current demand for attracting new patients will go down, yet you can still attain your goals. Instead of needing ten new patients per week, you may only need fivea big difference in your work load and staff time!
This concludes Part One. Please look for the conclusion, outlining the ten steps to a better Report of Findings, which will appear in the April edition of Chiropractic Economics.