Alternative revenue strategies: Wheels up by Southwest

Revenue growth in chiropractic doesn’t always require adding new services. However, when you consider alternative revenue strategies, you are likely looking to add nutrition, decompression, massage, aesthetics or weight-management programs.

While new services can succeed, they can also carry hidden costs, training requirements and increased operational complexity. Often, the most powerful growth strategy is not adding something new but refining what already works, like revenue strategies.

Consider Southwest Airlines’ approach, under the leadership of Herb Kelleher, with its “wheels up” philosophy maximizing time in the air, not on the ground. By simplifying operations and focusing on efficiency, Southwest turned discipline into sustained profitability. DCs can learn from this model: growing stronger not by expanding offerings, but by eliminating waste and maximizing what’s already working.

Wheels up: The Southwest advantage

For most airlines, airplanes spend far too much time sitting on the ground. Planes only generate revenue when their wheels are off the runway, flying paying passengers from one city to another. Every minute parked cuts into profit.

Southwest built its empire by minimizing that ground time. Under Kelleher’s direction:

One plane type: The Boeing 737. One set of parts, one maintenance model, one pilot certification.
No frills: No meals, no assigned seats, no first class; just fast boarding and quick turnarounds.
25-minute turnarounds: While competitors averaged 45–60 minutes, Southwest crews could unload, clean and reload passengers in less than half an hour.

This “wheels up” discipline of keeping planes in the air as much as possible created a cost and efficiency advantage so large that at one point, Southwest made more profit than all its competitors combined.

However, when they drifted from that model by adding fees, experimenting with hub routes and slowing turnaround times, efficiency and profitability declined. Recently, as they added checked-bag fees and explored seat assignments, their margins have tightened. The lesson: Focus, not expansion, was the engine of their peak performance.

The chiropractic parallel: Your wheels up

DCs face the same challenge. Our “wheels up” time is when we are delivering care efficiently. We don’t earn revenue when staff handle avoidable busywork, when patients no-show or when uncollected balances sit idle.

Instead of chasing every new program in search of alternative revenue strategies, here are four ways to apply the “wheels up” principle to your practice:

1. See more visits

Just as Southwest maximized flight hours, optimize your schedule. Reduce gaps, implement block scheduling and keep adjusting.

Block scheduling means pre-booking several weeks or months of appointments at once. Practices that do this achieve better treatment compliance. A recent analysis of 750 chiropractic offices found that clinics scheduling one visit at a time experienced patient dropout rates two to four times higher than those scheduling multiple visits ahead.

Imagine doubling your patient visits without doubling your marketing costs. Servicing existing patients is far more efficient than acquiring new ones. Block scheduling saves your team time and supports patients in completing their care plans; because they’re not making a “stay or go” decision after every appointment.

A simple metric to track here is your Future 30; the total number of visits scheduled over the next 30 days. A higher Future 30 means greater predictability, stability and revenue efficiency.

2. Collect more per visit

Like Southwest, which charged for value while keeping operations simple, you can increase revenue by modestly enhancing visit value.

At 125 visits per week × 50 weeks (6,250 visits per year):

A $5 increase per visit = $31,250 in additional annual revenue
A $10 increase per visit = $62,500 in additional annual revenue

If insurance companies reduced your reimbursement by $5, it would dramatically affect your bottom line. Don’t wait for them to fix that; find ways to add legitimate value for your patients that support faster recovery or better outcomes.

3. Collect faster

Revenue “sitting on the ground” in accounts receivable is as costly as a plane waiting at the gate. Speeding up collections strengthens cash flow and practice stability.

Implement systems to:

Keep credit cards securely on file.
Collect balances proactively; ideally before or immediately after care.
Segment accounts receivable (AR) into 31–60, 61–90 and 91–120+ day categories, by payer type (commercial, Medicare, personal injury, workers’ compensation).
Use e-statements or digital payment systems that can integrate with many chiropractic EHRs for seamless collections.

4. Reduce overhead

Eliminate services or tasks that consume time without improving profit. Efficiency drops when your team manages too many low-value operations.

Audit your workflows and identify repetitive, low-impact tasks that could be automated or outsourced. For instance, missed appointments can trigger an automated text or email to reschedule, removing the need for manual calls. Establish accountability metrics such as a “reschedule rate” for admin staff to ensure follow-through.

If you’re not embracing automation and efficiency tools as part of your revenue strategies, your competitors likely are.

The discipline of market leaders

In The Discipline of Market Leaders,¹ authors Treacy and Wiersema outline three dominant business strategies:

Operational excellence (efficiency)
Product leadership (innovation)
Customer intimacy (personalized service)

Southwest Airlines mastered operational excellence. They weren’t the most luxurious or innovative; but they were simple, fast and consistent.

Chiropractic practices face the same strategic choice. You cannot excel equally in all three areas. Some practices thrive on customer intimacy (boutique wellness centers), others on product leadership (cutting-edge technology), but for most, operational excellence, delivering care efficiently and consistently, offers the clearest path to profitability.

Lessons learned

Early in my career, I experimented with offering aesthetic and non-chiropractic services, and these can be great income generators for some practices. However, for my practice, what worked was refocusing on core chiropractic and musculoskeletal services. By doing so, I was able to simplify operations, reduce overhead costs and increase profits.

The lesson mirrors Southwest’s journey: Focus on your “wheels up.” Complexity erodes efficiency. Simplicity creates strength.

Final thoughts on revenue strategies

Alternative revenue doesn’t always mean adding new services. Often, it means optimizing what you already do. Herb Kelleher and Southwest Airlines proved that efficiency and discipline could outperform an entire industry. You can achieve the same by identifying your own version of “wheels up.”

Keep patients moving efficiently through care, raise your per-visit value, collect faster and eliminate waste. Profitability isn’t about chasing every opportunity; it’s about mastering the fundamentals that already drive success.

Naota Hashimoto, DC, is the co-founder of TrackStat, an AI automation software that plugs into your EHR to help practices see more patients with fewer staff members, reducing your overhead while simplifying your practice. He writes and speaks on chiropractic business growth, patient retention strategies and practice systems. For more information, visit trackstat.org.