Doctors of chiropractic should know what key performance indicators (KPIs) and metrics to track in their practice. The list is limitless, but one common thing I encounter with DCs who track their stats is they attempt to focus on too many things.
My mentor told me the execution and focus are big keys to success. Execution is difficult for some, and I believe one of the reasons is focus. When a rocket launches into space, all thrusters point in the same direction, and if you change the direction of one thruster, the rocket will not break through the atmosphere.
The same thing happens in your practice. If you, the owner, who should be heavily invested in your business, have trouble with focus, how do you expect someone in their 20s or 30s to stay focused on your practice? In most cases, they probably won’t, which is why I like to keep things simple and set some North Star metrics1 for team members. I like the team to have control over those metrics and rally around the same metric with the same milestone goals.
Practice goals for the entire team
We’ve all seen this work, and we’ve all seen this not work. Think about a sports team that plays cohesively, concerned about the score of the game over individual stats. We’ve seen teams look OK on paper but dominate other teams; we’ve seen teams look great on paper, but can’t win the big games. Your business is no different; if you get team members rallying toward the same goals, you’ll win more games. In your practice, that equates to helping more patients.
Know what to measure
Knowing all that, what do we measure? It depends on your goal, but for a practice with associate doctors or even your own office, increasing office visits may be the metric. However, I have seen offices obsess over office visits with a very low $/visit. Many are shocked at the number when they calculate it, and most think it’s higher than it is. When you collect $0 for a visit or take less on certain visits, that will decrease this number.
Review multiple metrics
That’s why I like to look at multiple metrics to ensure you have a healthy practice. Collections are great, and for some practices, it works. In health care, I feel people with a servant heart, which is a high level of empathy, who work well on a team, are the best fit. For a case manager or health care salesperson, I also look for a high factor of grit. This will provide that person with the caring attitude to help that patient, but with enough grit to continue when a patient does not want to pursue your recommendations. They move on to the next person and do not let the previous one drag them down.
Team members who love to serve others are typically motivated by outcomes and helping more people. I like rewarding the team for helping others, which is why our North Star metric is office visits, and everyone is on the same tier system. That does not mean their monetary bonus is the same, but everyone is rooting for the same visit numbers.
However, since most of us are in the healthcare business, profit is paramount. Profit isn’t a bad thing; it allows us to weather hard times, pay our team well, have team lunches, enjoy perks, invest in better equipment and more. This is why you should set a minimum $/visit metric. Increasing your collection visit average is important, because it allows you to spend more to acquire a patient. Offices that collect a small amount per visit become busy, and they have no time to work on the business because they are too busy with patients. They may think they are successful, but at the end of the month, there is very little cash in the bank account. There are expenses associated with processing patients, wear on equipment, staffing costs and although we all chose to become DCs to help others, without profit, you will never get out of debt and get ahead in life.
If you look at your visits tomorrow and estimate what you need to collect prior to each visit, your $/visit amount will dramatically improve. If a patient leaves the office with a balance, it takes several attempts to collect that money. Estimating what should be collected per visit for insurance patients is also important. I’ve seen offices zero out patient charges once, and the staff continue to zero it out without asking why it was zeroed out the first time. Those patients continued to receive care another 50 times, without paying anything out of pocket or through their insurance. If you don’t have enough profit in your business, you will not be able to afford enough help.
Recommend additional services
I never recommend what isn’t needed. However, many of us are underserving our patients by recommending too little care. If your goal is long-term improvement, it will often take 8-12 weeks to restore functional improvement. If a patient would benefit from another service, such as weight loss, extremity adjustments or other modalities, you could offer those. Additional services that are congruent with your model, that make sense, are great. I am a big fan of focus and like to keep the main thing the main thing, but things such as spinal decompression for a typical practice require a small amount of space in your office, and your practice is full of patients who need it.
Some of us do not like charging for our services because it’s easy to deliver, but we had to sacrifice time and money to go to school and rent a space to supply those services. My brother-in-law is an electrical lineman, and he went to work immediately after graduation, earning a six-figure income. Think of the opportunity cost; we had to spend money for school and not work. How much would you have if you made $40,000 per year for several years instead of racking up debt? Now imagine that was $75,000 per year.
I wrote an entire article on this concept of price elasticity. The article discusses selling your services for more while reducing your expenses. I am a fan of automating repetitive, low-value tasks to free your team up for important tasks, such as serving patients, sending a personalized get-well-soon card if a patient went to the hospital, or sympathy cards for the loss of a loved one. Those things should never be automated, because technology will never be as good as a human-to-human connection.
Future schedule rate
The next thing metric I recommend is the future schedule rate. This is the percentage of patients who came to your office with a future appointment. I think 75% is a great number to set for your floor. If you ensure this number stays above that, your practice will be in growth mode. Some think it should be 100%, but not everyone who comes through our doors is a good fit. Some could be vacationing in the area and had treatment, and some could have been discharged. If you are advertising on social media, it will be a numbers game, much like a spinal screening, and you’ll have to kiss a number of frogs before you find your prince/princess (perfect patient).
Patient drop-off
Many consultants like patient visit average (PVA), which is great, but it’s not a leading indicator of how your practice is doing. I honestly prefer patient drop-off analysis, because that will show you what specific visits you need to improve to fix your retention issue. This will show you where patients are dropping out of your practice, and if you perform an analysis quarterly, you could find the holes in the bucket. Read more at chiroeco.com/healthcare-kpis.
Final thoughts
A combination of leading and lagging indicators of practice are great. Lagging indicators are things like $/visit average, collections and PVA; those will provide retrospective feedback about your practice. Leading indicators are early signs that flow into those lagging indicators.
Scheduling patients for a future visit will increase your PVA, collections and profit. It’s simple, but that number will change long before collections change. Office visits increase when this occurs. If you schedule new patients when they leave, and if you transition your active care patients into long-term wellness care, you will also increase your future schedule rate.
Other metrics we track are new patients, conversions into active care, new online reviews and total patient visits from wellness care patients. All of those are automated, but giving your staff a handful of North Star key metrics with secondary metrics that support the main ones will keep your team playing together like a cohesive unit.
With better patient tracking and accountability, you will have a better team.
NAOTA HASHIMOTO, DC, is the co-founder of TrackStat, patient tracking software that makes it easy for admin people to attract and convert new patients while ensuring existing patients stay in the practice. It offers new ways to retain patients and ways for staff to communicate and schedule patients while providing you all the metrics of success.
Reference
- Simborg M. What is a North Star metric? The Signal. Dec. 10, 2018. https://mixpanel.com/blog/north-star-metric/. Accessed Jan. 28, 2024.
