Learn the basics of building a high-volume cash-based practice

If you’d like to own a chiro­practic office where there’s no third party telling you what you can charge, cutting your payments and demanding stacks of documenta­tion, then you are in the right place.

Imagine this same office packed with people clamoring to get their spine checked because they understand the value of regular chiropractic care.

Not only does that sound exciting but it is also awesome to impact so many people’s lives in a positive way, while at the same time moving chiropractic toward a higher level of cultural authority. But before you commit to jumping the insurance ship, there are some basics you must nail down.

Contend with conflict

If you are running a successful cash-based wellness practice, you are no longer allowing a third-party payer to determine the necessity, frequency, type or efficacy of the care you are providing. That is now between you and the patient, and you have to develop the philosophy behind the care you provide so that there is no conflict.

A sound philosophy is vital for developing a successful practice, and it especially rings true for an all-cash, chiropractic wellness-care practice. You can’t explain and expect patients to buy into what you are selling them if it isn’t first clear to you. That idea may seem obvious, but many chiro­practors don’t grasp this point.

Your philosophy of how and why you deliver ongoing “maintenance and prevention” wellness chiro­practic care isn’t right or wrong when compared to anyone else’s—it should be unique to you.

If you believe patients will best benefit with chiropractic and exercise therapy in combination, that’s fine. You would develop your practice around this premise.

If you best identify with vitality-based chiropractic, and believe it is the only service required, that’s the niche you will target and over time serve it better than other chiropractors in your area.

Simplify your services

While focusing on and writing out your care philosophy, contemplate the services you want to provide that are most important for your community and that you are passionate about delivering. That combination will help you create the perfect practice.

You can provide virtually any service within your scope provided you can make a profit for your business and it fits well with patient flow. If you already offer hour-long massage sessions, you may choose to continue offering those.

If you provide a modality such as laser or ultrasound that has the desired effects for your office, then you might opt to continue offering those at a specific price per service or make them part of what a customer has access to as part of their fee structure for the day, week or month.

But every additional service you offer does complicate your business model to some degree. Sometimes simpler is better. Chiropractic is powerful and typically does not require much more to complement it other than a little healing time.

If you are starting a new office, start simple and add services (and staff) only as patient volume and income will support it.

Set up systems

Being known as the cash-based practice in town is a busi­ness model that sets you apart from the insurance-based chiropractors in town. You can take it a step further and offer more convenient open hours along with creative and affordable payment options.

You also want to be known for running an efficiently flowing office that provides a consistently excellent customer experience—one that blows people away, visit after visit. How do you make this happen? Systems are the answer.

Systems are critical for transforming a business run off goodwill and grit into an asset that anyone can run once they learn the procedures. They are the defined proto­cols and scripts that allow you to develop a practice that can run with or without you at the controls—one where you can easily replace administrative and professional personnel, yourself included.

If you are the business or you require administrative staff with specialized training, then you don’t have the correct systems in place. Systems are the reason a franchised business has a higher success rate over a mom-and-pop business. Once your systems are in oper­ation, then you can ramp up marketing to push new patients through the door.

Formulate your fees

The cash business model lives and grows by people spending their money for something of value. In most offices, the fees are set so that people in the community can get affordable access to long-term regular chiropractic care as part of their overall wellness or vitality plan.

Your overhead influences your fees. If you are in a high-rent space in an affluent neighborhood, your expected and accepted fees may be quite different from those of a doctor in a more modest community. Regardless, you want to provide a customer experience that is greater than the fee paid.

If you have an existing office and plan to simplify the services you offer, you may not need the same number of staff. You might even move to a smaller space. Look at every aspect of what comprises your fixed and variable overhead and reduce it as much as possible.

Once you’ve minimized your overhead, you can deter­mine if you are able to set cash fees reasonable enough for your community.

Whether you are starting a new cash office or transi­tioning to an existing one, set fees that would make sense to those who have insurance just as much as they will to those who don’t. If you are great at selling chiropractic, perhaps your fee structure can be higher.

While charging more per visit and seeing fewer patients seems like it makes sense, it overlooks many components of success when approaching a chiropractic business. A proven cash-based practice may not have the same level of annual gross revenue as an insurance-based one, but it can still turn a stellar net profit.

Clearly, every top-performing, high-volume practice has someone running it who is excellent at communicating the importance of regular chiropractic care for healthy aging. Nevertheless, no matter how good you are, you cannot overcome a fee schedule that doesn’t fit your socioeco­nomic market.

 

Daron Stegall, DC, is the founder of Express Chiropractic Franchising and COO of Pivotal Practice Solutions, specializing in developing cash-based chiropractic wellness care practice models with prepayment and membership payment options. He is also cofounder of successfulchiro.com, providing chiropractic business and marketing solutions since 2001. He can be contacted at team@practicepivot.com or through practicepivot.com.