Chiropractic Products sits down with four management consultants to identify the necessary tools for a successful practice in the current health care environment

Health care is continually evolving. What was applicable a few years ago may be completely inappropriate in today’s climate. This is a time of great schism in chiropractic practices. According to four management consultants interviewed by Chiropractic Products, there are more booming practices then ever, but at the same time, a greater number of practices are failing or stagnant.

If your current practice management and patient attraction and retention methods have not been successful, take the advice of these four experienced coaches: Pete Fernandez, DC, of Fernandez Consulting, Seminole, Fla, has consulted for 21 years; Larry Markson, DC, has been the CEO of The Masters’ Circle, Lake Success, NY, for 4 years; C.J. Mertz, DC, of Waiting List Practice, Dripping Springs, Tex, has worked with chiropractors for 14 years; and David Singer, DC, of David Singer Enterprises, Tampa, Fla , has 20 years of coaching experience.

CP: Why are some DC practices declining, and what do you recommend to counter this trend?

Fernandez: There are a couple of reasons practices are declining. First, there are old doctors who are not going to change their ways even though the entire health care marketplace has changed. Second, there are doctors who compete with managed care organizations by reducing their fees. To succeed, I recommend that doctors join managed care plans that pay fair fees and then add services that are not covered, such as scoliosis, returning spinal curves after a car accident, and athletic injuries.

Markson: During the past 3 years, the average chiropractic practice has been decreasing by 7% to 9% per year. Doctors blame it on marketplace conditions and on low self-esteem. They do not feel they are worthy of success, and therefore have concepts and use procedures that display their low self-esteem. To succeed, doctors need a healthy self-image, clinical competence, and sound practice management procedures. In addition, the doctor needs to stay current and be honest and ethical. Most important is the self-image the chiropractor projects to the public. People will not accept the message without first accepting the messenger.

Mertz: There are more booming practices and also more failing practices now than in the history of chiropractic. The reason some DCs’ practices are declining is because they are using obsolete technology from the 1970s and 1980s. Another major problem is that doctors’ teams continually change. As a result, the doctors are burdened with having to manage everything themselves. Those doctors who are relying on HMOs for generating patients are having retention problems because the number of visits is limited. Chiropractors must seek and deliver modern strategies that succeed in practice. They must build stable, championship teams and develop core internal and external marketing skills that can produce new patients for their practice. Finally, they must strengthen their philosophy to put patients on a year-long program and automatic resigns for lifetime wellness programs.

Singer: One reason is because the environment around them has changed, but they have not changed. The systems they are using may have worked at one time or maybe never worked—they need to change. Another reason is that some doctors are not mentally in their practices. Their attention is focused on things outside their practices. A doctor who is successful is one who is mentally focused and willing to change and implement new approaches.

CP: What is the best way to attract new patients today?

Fernandez: Personal contact is always the best. Advertising and screenings are also effective. Once the practice is established, referrals will bring in new patients.

Markson: Internally, everything sells your service—the way the phone is answered, the office decor, the attitude of your staff, and your technical skills. The best way I know to sell services externally is by public speaking. The second best way, if constructed correctly, is spinal screenings.

Mertz: Chiropractors need to be constantly focused on attracting new patients as they go about their daily clinical and business activities. They also need to engage their patients to join them as members of a movement to transform the health beliefs of the entire community. This motivates patients to refer others. Spinal screenings, lectures, telemarketing, infomercials, and well-placed newspaper advertisements are effective and should be implemented. However, a change in the chiropractor’s mindset is ultimately what I have seen yield the greatest number of new patients.

Singer: The best way is to determine which of the following three methodologies you are most comfortable with: meeting people one-on-one, public screenings (stress, carpal tunnel, etc), or lectures. Getting new patients is simply a numbers game. Of the three options, public speaking allows you to communicate with the greatest number of people in the shortest amount of time.

Fernandez: The best way to compete is not to compete. Rather, provide services HMOs will not cover, such as scoliosis correction, returning the curves to the neck, and rehabilitation.

Markson: Doctors choose whether to be insurance-dependent or to position chiropractic as a distinct healing art. Confident doctors are moving away from managed care panels, which typically underpay and limit visits, and they are now moving toward cash-based practices. In my experience, those with cash-based practices are doing better than those that are insurance-dependent. People are willing to pay for superior service at a fair and equitable fee.

Mertz: I recommend staying as far away from HMOs as possible. When HMO patients come to your practice, explain to them the scope of services you can provide that are not covered by their HMO plans. We provide a script to our clients so they can convert an HMO patient into one who pays cash for a year-long program.

Singer: If the patient’s HMO excludes chiropractic care, it is important to explain that the HMO system focuses on medication. If the problem were chemical, the patient would probably be feeling better. But if the problem is physical in nature, all the drugs in the world will not resolve it. Ask patients whether they would be willing to go outside the HMO to get back their health. If the HMO does cover chiropractic, but you are not on the panel, explain that you have a special program for people with that particular HMO plan. The special program could include added services and/or a reduction of the standard fee.

Fernandez: It will be very beneficial in the long run. Ten years ago, MDs and DCs did not talk to each other. Those who are not in managed care are being thrown together. The problem for these combined practices is there are no established protocols.

Markson: Chiropractic is a drugless healing art, while allopathic medicine is drug-based. Although they both have value, they are in opposition to each other in philosophy and approach. In my opinion, the MD/DC practice will have no impact on the chiropractic profession. While there are chiropractors who align with physicians and run service-oriented practices, many are in it for monetary gain.

Mertz: Currently, the MD/DC practice is very small. Chiropractic philosophy is that the power that made your body heals your body. If after seeing the DC, the patient then goes down the hall to the MD to get a flu shot, the patient will be totally confused. I believe the MD/DC model is a passing trend. There are now more models of successful traditional chiropractic practices than before.

Singer: I believe the MD/DC practice is a passing fad. The only possible negative effect this could have on the chiropractic profession is when chiropractors integrate with physicians for purely monetary reasons rather than to better serve their patients. These doctors may practice unethical methods, which, in the long run, will reap negative consequences, both for individual chiropractors and the profession.

Fernandez: The sharing of space is going to be very prevalent, whether it is five chiropractors in one office or chiropractors combined with other medical professionals, such as physicians, osteopaths, and psychologists. All this turmoil in health care is nothing but a prelude to national health insurance, which, I believe, will include coverage for chiropractic.

Markson: Chiropractors of the future will be subluxation-based, experience high volume, be noninsurance dependent, and have fair and equitable fees. Currently, there is a split in the philosophy of the chiropractic colleges. Some colleges are interested in the MD/DC model, while others are promoting the traditional chiropractic model. I am betting on the traditional model—wellness through spinal adjustments, good nutrition, a positive mental attitude, and a chiropractic lifestyle.

Mertz: I see chiropractors in each town uniting with a vision to have everyone in that town under care. I have large pockets of clients already doing this in the United States, Canada, Australia, and Europe. Instead of being competitive, chiropractors are forming teams to assist each other—and all are benefiting. I see the chiropractor of the future as high volume and cash-based—easily providing 300 adjustments in a 28-hour week.

Singer: Because the successful practice is moving toward cash-based, chiropractors will need to be more effective in educating patients. Only patients who are properly educated will be willing to pay cash for services. The practices of the future are going to be focused on better communication skills and patient management tools.

Fernandez: Consultants have experience and know which business practices and office procedures work and which do not. We can help chiropractors be more successful; we polish diamonds in the rough.

Markson: In all aspects of life, people need a coach to stop them from reinventing the wheel. An experienced consultant can guide doctors to the attitudes, procedures, and systems that are known to be successful. Chiropractors, when on their own, tend to use procedures they like rather than what works well. A good coach evaluates strengths and weaknesses, and then helps doctors to polish their strengths and overcome their weaknesses. Also, good coaching holds doctors accountable for what they do.

Mertz: Most chiropractors have trouble seeing the changes that need to be made in order to develop and maintain a more successful practice. They often need help in breaking through the fears that get in the way of making needed changes. Once the fears are addressed, a coach can assess what new or better skills are required. A skill development training program can then ensure that the changes that are made are permanent rather than temporary.

Singer: For the same reason a person would go to a doctor for health care. Doctors examine patients to see whether there are any problems. Likewise, consultants examine practices for malfunctions. We help chiropractors evaluate their practice, find out what is not working, and then advise doctors on running an efficient practice so that the desired results can be achieved.

Fernandez: The most damaging advice a consultant can give is an unethical or illegal method. Also, trying to change the way a DC practices is also damaging. For example, if a doctor is a mixer, but a consultant advises a straight practice, this goes against the doctor’s belief system.

Markson: A not-so-forthcoming consultant can be devestating to a practice. For example, if a consultant spends his or her time making clients feel better, rather than coaching them with success principles—this is damaging. Without constant individual attention that holds the client accountable, the client will fail to make the changes that will bring about and maintain success.

Mertz: Above all, I think it is unethical for a consultant to take a percentage of income. It is damaging to look for solutions that might create client satisfaction in the short- term, but end up causing long-term problems. For example, encouraging the doctor to sign up for all HMO panels may bring patients initially, but ultimately, it will not be a winning strategy. It is also damaging for consultants to provide guidance outside their area of expertise. It is important for a client to know the scope of a consultant’s knowledge base before engaging that consultant.

Singer: Failing to explain to the client the consultant’s purpose and intention and the program focus is damaging. The consultant-client relationship is similar to marriage. Both need to know what the other needs and wants so that expectations are realistic and can be fulfilled.

About the Author
Sherry Kahn, MPH, is a contributing writer for Chiropractic Products.