Tools for developing high enrollment and retention rates to support a chiropractic cash business plan
AFTER EXPERIENCING CHALLENGES WITH INSURANCE as early as the mid-’90s, the writing was on the wall. If I was going to thrive in practice in spite of insurance reimbursements getting lower while co-pays and deductibles were steadily on the rise, I had to master the chiropractic cash business plan.
Prepays seemed like a good approach until one week where three military families suddenly had to leave town due to being transferred. That resulted in writing more than $10,000 in refunds that week — not fun. I realized I could not continue running my practice by borrowing money from my patients. That’s what prepays are — borrowed money.
True cash practice
Let’s define what cash-based practices and insurance practices are, and more importantly, what they are not. Many people think that simply not accepting insurance means they are an all-cash practice and have a chiropractic cash business plan. This may not necessarily be accurate.
Do you accept personal injury or worker’s compensation cases? That’s insurance. Do you provide patients with a superbill for them to submit to their insurance for reimbursement? That’s insurance. Even without an assignment of benefits, these scenarios mean a person is not necessarily 100% cash. And that’s OK — it is even more of a reason to be compliant in coding, documentation, collections and discounting.
There are a ton of benefits to being cash-based — it’s more fun, more profitable, better for retention, and the list goes on. But make no mistake: Being “cash-based” requires expertise and knowledge.
A successful chiropractic cash business plan depends on having a high retention rate, a large enrollment rate and healthy collections. To do this we have identified the four pillars of running a cash-based practice (or in other words, the four pillars of increasing patient retention). Each of the four pillars addresses a key component of patient retention.
Pillar #1 — Track and report clinical results
Some patients who come to chiropractors have been to another doctor. If you ask them, “Why are you coming to me and not going back to your prior doctors?” the patient may say something like, “I just don’t know how I was doing over there.”
The prior doctor likely failed to let the patient know how they were progressing with care in an easy-to-understand format. People stick with things much better if they know they are making progress.
Why do you think Fitbits and Apple Watches have become so popular? People love to know they are making progress and the smart watches do a great job of giving people feedback. We like to use a letter-graded report showing the need for care, which increases enrollment. It also allows us to compare side-by-side the progress being made, which helps with retention.
Pillar #2 — Offer affordable payment plans
One of the biggest mistakes is “Let’s adjust you and see how you do” or “Let’s use your insurance visits first and then discuss a plan after that.” What happens? The patient magically gets “better” and you never see them again, or you see them when their insurance kicks back in. This kills your patient retention and prevents the patient from ever actually getting better.
Practices that offer their patients comprehensive care plans that cover all the care required (cash and insured visits) into one financial plan routinely have much higher patient follow-through and retention.
We include visits covered by insurance and non-covered visits in one care plan and offer three options to pay:
- Option 1 is recurring monthly payments split evenly over the course of care;
- Option 2 is an initial payment followed by smaller monthly payments (our favorite — the best of both worlds!);
- Option 3 is pre-paying for the entire course of care.
Most people pay for larger purchases using monthly payments. It is for this reason that we offer monthly payments or an initial down payment with smaller monthly payments. Not only do we see higher patient retention this way, we see a much higher number of patients transition to maintenance or wellness care programs.
Imagine having dozens (or even hundreds) of patients paying you monthly for their care plans. How reassuring would it be for you if you knew you had $15,000, $20,000 or more in recurring payments coming into your practice each and every month?
Pillar #3 — Automate all payment processing
Every time your patient has to make a payment, it opens the door to them choosing not to continue purchasing care. The more they “think” about the money they’re spending, the less likely they will continue to spend it.
You likely pay your cell phone bill automatically each month.
You don’t even think about it because it’s all automated. Why do cell phone companies do that? They do it because it simply reduces the likelihood of you questioning the money you’re spending and shopping around for better prices. In essence, it increases their client retention.
The more the patient has to touch their wallet, the more it reminds them of the money when they should be focusing on care.
Pillar #4 — Automate patient education
Patient education has been a pillar of chiropractic from the very beginning of history. Nothing new here. Much of it can be enhanced with automation, whether that be TVs in your office with educational content, weekly educational handouts for your patients, or email campaigns pre-programmed to go to your patients each week.
The overall concept is “drip-education” where we “drip” our message to our patients consistently and automatically. Think of it like a drip-irrigation system. Instead of flooding the patient with information, we are slowly educating them, bit by bit. Educated patients are more likely to stay under care, especially when combined with the prior pillars discussed above.
The structure needs all 4 pillars
Patients who are very well-educated on chiropractic will still drop out of care if pillars 1-3 are not addressed.
You may already be doing a great job of educating your patients — most chiropractors are. But if you are struggling, review to see if you are instituting all the pillars above. You may find you are missing one, or all.
Keep in mind that the end game is to ultimately be free from insurance dependency. I did not say get rid of insurance — I said be free from dependence on it. By focusing on these four pillars, you can have a stress-free, fun practice, increasing the quality of life for as many patients as possible.
MILES BODZIN, DC, is founder and CEO of Cash Practice® Systems, and became known as “the king of patient retention.” He has appeared in the Wall Street Journal and on The Brian Tracy TV Show; contributed to the best-selling book SuccessOnomics with Steve Forbes; and speaks internationally on the topic of client retention. Learn more at CashPractice.com or call 877-343-8950.
AMBER SHEPHERD has served in chiropractic since 2007 as a chiropractic assistant and for the past nine years as coordinating manager for Cash Practice® Systems.