Have you ever adjusted a patient numerous times only to realize you aren’t making the kind of progress you would like?
Maybe they are improving only a little or not at all, even though you know you are providing good treatment. It may be that you need to think about working on more than their structural issues alone.
“If you are only getting so far, they may be struggling through a divorce or their kids have gone off to college and they aren’t handling it well,” says Stephanie Zgraggen, DC. “You can provide adjustments but it is not going to change the way they process their situation. Sometimes bringing in other parts is important for effective care.”
Providing your patients more treatment options—offering wellness services—may be the key to keeping them healthier, retaining them over time, and increasing your overall income. Luckily, wellness is a relatively short jump for many chiropractors who already lean toward holistic care, and there is no shortage of options you can incorporate into your office.
“It really starts with looking at what you are passionate about,” Zgraggen says. “Figuring out what are other modalities or techniques that complement what you are doing that you can offer to patients.”
First steps, first
Delving into the wellness landscape can be daunting because the options are expansive. You could look to rarer offerings like practicing Reiki or Ayurveda, or selling air purifiers. Or you can choose practices that may be more familiar to most patients, such as nutrition, yoga, and meditation.
“Universally, mind, body, and spirituality are the three big buckets of wellness,” says Sam Wang, DC. “It’s fairly broad in terms of scope and often depends upon the providers’ education and their own personal beliefs on wellness.”
The first tack you can take when determining what to offer is to provide treatment or services that you are educated about or personally practice. This is relatively common, according to Dane Donohue, DC, who began discussing meditation with patients after he began meditating.
“I didn’t see the value before so I didn’t promote it to patients,” he says.
If you like to exercise, you may consider offering yoga, tai chi, or CrossFit classes. If you have found supplements are beneficial to your diet and improve your health, you’ll be more convincing when you offer them to your patients. Zgraggen, for instance, says she wouldn’t offer anything she hasn’t researched and used herself.
“Your patients respect you and if you live your life that way … they will see that,” she says.
The second path to take is to provide what you know your patients need. You can do this by giving them a health questionnaire during a visit or just by being an inquisitive caregiver.
Donohue says he sometimes asks his patients, “If I could turn my pen into a magic wand and could wave it and change something that would improve your life or extend your life, what comes to mind for you?”
DelRae Messer, DC, recommends talking with patients during an adjustment visit to see if they are already incorporating wellness into their lives—or if they even have an interest in doing so. If so, try to understand the results they are looking for and work backward from there to determine how you can help them. For example, if a large number of patients say they want to lose weight, you might want to create a six-week program that includes supplements and a cross promotion with a local fitness center.
Reach out with referrals
Once you decide what you want to offer, you’ll need to dive into the details. The easiest way to get your feet wet is by creating strategic alliances in your community and offering cross-referrals with other practitioners.
Whether you think yoga, nutritional services or spirituality is important, you need to find good people to whom you feel safe referring patients. This creates a sense of quid pro quo, making it likely they will return the favor and refer their clients seeking chiropractic to you.
Zgraggen recommends meeting personally with anyone you are considering for referrals and seeing why they do what they do. Make sure you know they are good at what they do and that your philosophies of care are in alignment.
“You need to make sure it helps complement what you are doing in your practice,” she says.
Working well with others
A step further into wellness would be bringing people into your office to offer their services or hiring employees. If you go this route, you’ll need a business model to ensure the viability of your efforts.
“A proper business thesis would be crucial,” Wang says. “They have to have a financial projection statement to see if there is a good ROI. A lot of chiropractors come with all heart and no head and say they just want to have something available to their patients, but they don’t recognize the amount of labor and expense. This can end up negatively impacting their practice.”
You’ll need to look at what the fee structures are for the services you would be providing to determine the potential costs and revenue. Do you truly have the space to have someone else in your office? And when could classes or other offerings be held?
For instance, Donohue said yoga is a great loss-leader, but not a money- maker: it brings people in but won’t make you rich. Personal training and rehab, on the other hand, will generate more income. Supplements, too, can pad your bottom line.
Donohue said his group makes about $10,000 a month from their sales. If someone is coming into your office to offer services, there are a couple of ways to accomplish this.
You can rent your space by the hour or take a percentage of the profits. For example, if a yoga instructor makes $12 per student per class, the office can take 30 percent of those earnings.
“With this option, chiropractors themselves don’t have to have a ton of knowledge, they just have to vet whoever is coming in,” Zgraggen says. “Whoever owns the office should be making some income … you have liability as soon as someone walks in the door.”
She recommends making sure someone like an LMT or physical therapist has current certification and malpractice insurance if needed.
A more expensive—and more profitable—option is to hire employees to provide your wellness services.
“You get to make a lot more profit and there is a lot more quality control,” Donohue says. “The chiropractor needs to be the quarterback of the wellness team and the team will run their plays.”
Wang recommends starting this process by seeking legal counsel from a lawyer who specializes in co-ventures. You can also work with a consultant who performs practice integration. State associations often have resources that can help. And you can talk to colleagues who have successfully done this in their practices.
On your own
If you decide to offer wellness treatments yourself, you need to ensure that you have the knowledge required to offer these services. There are many educational opportunities available to help you become certified or well-educated in almost any area
You can become certified to teach yoga with about 200 hours of training. The International Chiropractors Association has a certification program to become a wellness provider. Associations offer webinars, conferences, and other training. Wang recommends working with credible, reputable groups.
“When you go to conferences there is always a vendor or two peddling the next shiny thing and a lot of it isn’t backed by published research or any significant data outside of their own,” he says. “Be skeptical if it sounds too good to be true.”
Services you provide should be evidence-based and anything you sell should come from a reputable organization.
He also notes to be cautious about claiming to be an “expert” at some- thing unless you truly are. A weekend class on eating well won’t make you a nutritionist.
Taking the plunge
Each time you adjust a patient, you have an opportunity to bring them into the wellness side of your practice. But if you want to introduce them to other services, you have to know your patients first. Get a complete health history and listen to them when you’re with them.
For example, if someone is in for a back adjustment, and you see in their records that they are taking medication for depression or gastrointestinal issues, ask them about it.
“Talk with them about that and why they are on it,” Donohue says. “You can say something like, ‘Maybe we can see if I can help you in a more natural way. Is that something you would be interested in?’”
He then uses a wellness prescription pad where he circles items the patient needs to manage their various health issues. After the visit, they take it directly to the front desk and get their “order” filled.
On top of offering à la carte services, his group uses a wellness program that encompasses chiropractic and other modalities including yoga, nutrition, massage, supplementation, and meditation. He also provides a 10-day detoxification plan that is particularly popular in the summer and after the holidays. Offering wellness as a package or part of a program makes it less confusing for patients, Donohue says.
It’s also more profitable to package things up: Donohue’s wellness plan costs $3,400. In order to make it more affordable, they offer a 10 percent prepay discount. Patients who want to pay over time can use a credit service to finance it interest-free for 12 months.
Most of these services won’t be covered by insurance, meaning you have some leeway on discounting them. Zgraggen says good options include allowing people to pay a flat fee per month—such as $100—and come in for unlimited classes, offering reduced prices for buying a package of classes instead of just one at a time, and offering family packs at a discount.
Keeping your patients
On average, you probably spend about 15 minutes with patients when they come in for an adjustment. One benefit of offering wellness services is that it gives you one more oppor- tunity for patient contact. The more time they spend in your office, the more likely they are to come back or refer friends and family your way.
Zgraggen said chiropractors she consults with don’t like the idea of “selling” to their patients. Instead, she recommends thinking of it as providing them with something they are already doing on their own; the supplement industry has been reported to take in $132 billion glob- ally each year.
“There are so many people out there spending money in the wellness industry and we have an incredible ability to influence positively what people are consuming and spending,” Messer says. “I would rather they get nutritional supplements from a chiropractor than go to a drugstore and get them there.”
Messer also recommends events like monthly healthy happy hours because of their versatility. You can talk with patients about nutrition or wellness or provide healthy recipes. These can be tailored to the seasons or for holidays.
“This lets people come in and see the energy and environment of the practice,” she says.
Sometimes wellness treatments can even bring in patients who aren’t believers of chiropractic, Donohue says. More people see their medical doctor than a chiropractor for back pain. If you can get them into your office for acupuncture or yoga classes, it may give you the opportunity to connect them with chiropractic as well.
“Chiropractic is always going to be what our backbone is, but you can’t push it down their throat,” Donohue says. “A lot of people come into our wellness program, but don’t want to do the chiropractic part; through the process we are often able to change their mind.”
Tammy Worth, a freelance writer based in Kansas City, Missouri, specializes in business and healthcare subjects. She can be contacted at firstname.lastname@example.org.