Why is it that over the past decade many chiropractors have seen a steady decline in their patient visit average? Is it that their adjusting techniques have become so proficient that they can now accomplish in five visits what used to take 25 visits? Probably not. A more likely reason is that many chiropractors have allowed themselves to become victims of the cost-slashing (care-eliminating) efforts of the managed-care industry. They are letting insurance companies dictate what their patients’ care plans should be.
Allowing insurance companies to set your patients’ treatment plans would be acceptable if the insurance companies acted only in the best interest of your patients’ welfare. However, more and more insurance companies seem to be in the business of paying as few claims as possible.
Chiropractors who are struggling with declining patient retention have, over time, allowed the insurance carriers to dictate to them the amount of care their patients should receive to correct their conditions. In an effort to gain acceptance by their patients, some chiropractors have even devised treatment plans that look remarkably similar to the limits of the insurance coverage their patients have.
Your patients require and deserve more from you. You have a responsibility to communicate to them what they need, and not merely what their insurance carriers will allow. How can you empower your patients to receive more of the care they need in an environment of shrinking third-party reimbursement? Many of your patients are educated, savvy health-care consumers who will not simply submit to your treatment plan unquestioningly. For this reason, it is more important than ever for you to be able to provide a substantial rationale to motivate your patients to comply with their treatment plans.
One of the most effective methods to accomplish this goal is to shift the emphasis of your care away from pain management and toward a focus on the improvement of function. While highly effective in controlling and eliminating pain and discomfort, the greatest value your care provides is the improvement of your patients’ abilities to perform their activities of daily life.
Functional improvement affects every facet of your patients’ lives, from their ability to earn a living and enjoy recreational activities, to improving the quality of the relationships they share with their families and loved ones. When you effectively communicate the true value of the services you perform, your patients will be far more likely to accept and adhere to the plan of care you recommend – even when it is beyond the limits of coverage of their insurance policy.
The First Impression
In most cases, a patient’s decision to purchase (yes, they are purchasing) healthcare from you is made by the end of his or her first visit to your office. Implementing value-building procedures on a patient’s first visit is the first tool you must employ to improve patient retention. In a managed-care environment, if you do not create a powerful perception of value on the first visit, chances are the patient will not be back.
One of the simplest and most effective ways you can increase the perception of value of the first visit is to record the examination. After asking your patient’s permission to record the exam, place a microcassette recorder nearby and call out your findings to the recorder. An amazing transformation occurs – the perception of value of your examination rockets upward.
Performing an examination that has a high perceived value is a critical step toward improving retention. You should frequently hear from your patients comments such as, “Doctor, that was the best examination I’ve ever had!” and, “I’ve never had such a thorough examination in my life!” When you begin to hear comments such as these from your patients on a regular basis, you will know you are on the right track.
Communicating a level of service that goes beyond the ordinary will often surprise patients accustomed to being treated as no more than a number at many health-care providers’ offices. It will build the foundation for a rapport between you and your patients that will extend throughout their plan of care.
Timing is Everything
After you have prepared a foundation of value on your patient’s first visit, be prepared on the second visit to present your plan of care and a financial plan. Many chiropractors become squeamish when it comes to discussing finances with their patients. You must keep in mind that you are in business. By being direct with your patients in regard to their finances, they will take your commitment to them far more seriously than they would if you avoided discussing finances.
In a busy practice, it is often impossible for the doctor to take the time required to discuss finances with every patient. In that case, the responsibility may be delegated to a staff member. However, this essential, value-building procedure should not be delegated until you have a full mastery of the procedure yourself.
If you do not help your patients confront their financial responsibility in the beginning of care, you risk falling victim to the “Law of Diminishing Utility.” This principle states that the perceived value of a product or service will decrease or diminish with its usage or consumption over time. Think of your favorite meal at your favorite restaurant. You look forward to it each time you go. What if you ate two of those meals in a row? Would the second taste just as good as the first? What if you ate three? Four? You would not be as enthusiastic about that now not-so-favorite meal any longer.
Your patients are most motivated to correct the cause of their condition at the beginning their care – not on their 27th visit, when the symptoms that caused them to seek care have dissipated or resolved. That’s why it’s most effective to have patients make a financial commitment to their care early on. When patients commit in advance to a payment plan for their covered and non-covered care, the greatest obstacle to following through with care is removed.
The Phases of Care
Once you are beyond the patient’s second visit, you can sustain a high level of perceived value throughout care by implementing a program of care that is based on a treatment protocol with specifically identified phases of care, each with its unique goals and projected outcomes. To increase your patient retention, institute a program of patient education that enables your patients to understand the value of the acute, active and wellness phases of care.
The first phase of care, the acute phase, is directed toward decreasing your patients’ acute symptoms. The reduction of inflammation and pain are the goals of this phase of care. Your patients’ greatest motivation during this phase of care is the reduction of their symptoms. You need to take concrete steps to ensure the patient will continue beyond the symptomatic phase of care. Identify and educate your patients in the goals of the acute phase of care, including symptom relief, while simultaneously educating them in the goals of the next phase of care, the active phase.
The goal of the active phase of care is improvement of function. In this phase of care, it is important to start the patient as quickly as possible on an active treatment model that is geared toward restoring function to the injured part of the body. Educating your patients in the benefits of becoming actively involved in their own healing process is one of the greatest value-building procedures you can perform, and will dramatically increase your patient retention beyond the acute phase of care.
The active phase of care should consist of a program that combines chiropractic adjustments with therapeutic exercises, neuromuscular re-education, and kinetic activities designed to challenge, but not frustrate, your patients.
If a patient becomes bored because your rehabilitative exercise program appears too easy or is below his or her abilities, the result will be decreased compliance and a premature drop-out from care. Likewise, if you ask your patients to perform activities that are beyond their current abilities, they will also be more likely to drop out early from care. An effective active phase of care should be based on sound rehabilitation principles and should always show the patient “what’s next.” If there is no “what’s next,” the patient will have no perception of the value or reasons for following through with care.
Effective treatment protocols are based on a combination of your clinical experience, knowledge, and the nature and extent of the patient’s condition. Your protocols should provide a framework for care that offers not only a beginning and middle, but also an end, to care. By using outcomes assessment tools, and other objective measurements of improvement such as computerized range-of-motion and muscle-testing, you can effectively determine when your patient has achieved maximum improvement. At this point, your patients can choose to include regular chiropractic care as an integral part of their healthy lifestyle by following through with the final phase of care, the wellness phase.
Patients who complete a care plan that provides them with what they need – as opposed to what their insurance will pay for – are patients that stay long enough to get well and long enough to refer. Increasing your patient retention is not about giving your services away for less than your costs, nor is it about care plans that “coincidentally” match the meager benefits offered by many patients’ insurance policies. It is about providing excellent healthcare and creating sustained perceived value based on sound protocols and principles that motivate your patients to achieve the fullest expression of their function through chiropractic.