In a state with DCs a-plenty, brand marketing is the magnet drawing in patients

Jeff Donatello, DC, knew he was getting a terrific deal when he bought a southern Maine chiropractic practice, a 200-year-old, 5,000-square-foot colonial farmhouse set on four picturesque, river-front acres. The seller of the practice used the historic, 20-room manor as his office, and had hoped to convert the place into a chiropractic-based health center, but decided to move to the Midwest. So, when Donatello took over 6 years ago, his goal was to fulfill the former owner’s dream.

Today, the farmhouse—now known as York Chiropractic Health Center in the coastal town of York—is a place where health care- and fitness-minded consumers can access services provided not only by Donatello, but also by a licensed acupuncturist, a registered dietitian, two massage therapists, a yoga specialist, a personal trainer, and an aesthetician.

In renting space to other practitioners, Donatello has created a synergy to the advantage of both provider and patient alike. "The quality of care and service is higher because we’ve made it so convenient for people to utilize the providers they need," says Donatello. "And, as necessary, we all refer patients and clients to each other. In this way we’re helping the patients and each other."

Making Less Into More

Maine is a relatively sparsely populated state—in upscale York, census-takers recently counted approximately 12,000 people. Nevertheless, it turns out to be a terrific place to practice chiropractic, thanks to a state law requiring health insurance companies to provide policyholders with generous coverage benefits. "The law specifies that anyone who belongs to an HMO is entitled to receive 36 visits per year to a chiropractor without requiring a physician referral," says Donatello.

Because of that coverage mandate, the state is a magnet that attracts chiropractors from other parts of the country.

"Some say Maine is becoming flooded with chiropractors, and they’re worried about how that is going to create an income hardship for the profession here," Donatello conveys. "I disagree with that concern. I think what you most have to worry about is not an influx of competition, but rather yourself. You do well no matter how crowded the market is as long as you have confidence in your abilities as a chiropractor and can communicate to people that yours is a practice where they will receive hight-quality care."

Donatello participates in a multitude of insurance plans, including a number chartered in neighboring New Hampshire where roughly half his patients live. That poses a problem, though, because New Hampshire-based insurance plans offer chiropractic benefits far less liberal than those in Maine.

"The typical New Hampshire HMO gives its members about a third as many chiropractic visits a year, and a medical doctor’s referral is required," Donatello observes. "Worse, the insurers from New Hampshire have been erratic in their dictates concerning coverage. First, they try to put limitations on visits, then they later drop those. Next, they put caps on insurance, then they change them. It’s unpredictable, and that makes it harder to do business. This has forced me to hire a person to be a full-time insurance specialist whose job it is in part to stay abreast of all the changes. Recently, I’ve had to support that position by adding a second person in that role on a part-time basis.

"One of my strategies for dealing with the problems created by New Hampshire insurance is simply to do a better job preparing patients up-front for the financial realities. Let’s say the patient has a chronic condition that’s going to require maintenance care, but his New Hampshire insurance is only going to pay for six visits. The next step is to educate the patient to be prepared to cover the costs for the additional needed visits out of pocket.

"In essence, I try with this process to empower the patient to not let his insurance company’s coverage limits be what determines the care he ultimately receives."

Talk of the Town

Donatello discusses a patient’s file with insurance specialist Elizabeth Lane.

About 60% of the cases Donatello handles today are referred by other patients. Another 25% are referred by physicians and other health care providers. The remainder—15%—are self-referred or sent by insurance companies.

Donatello attracts many of his new-patient referrals through public speaking. "I consider doing talks to be one of the best, most inexpensive ways to become known to people," he says.

Donatello appears at meetings of civic groups and private membership organizations once or twice per month to discuss health issues, always making sure chiropractic (and his practice in particular) figure prominently in those presentations. Typically, he picks a topic—stress reduction, for instance—then develops a talk on that subject and delivers it to as many different groups as possible over the span of the next several months. When the topic shows signs of becoming shopworn or he runs out of groups to which it can be presented, Donatello comes up with a fresh subject and begins the process anew. His current topic deals with children and backpacks, which he targets to teachers, school administrators, and parents.

"To get bookings, I don’t cold call any groups or organizations," he says. "I prefer to let my patients provide entre to groups in which they themselves are active. This is a much more effective and less stressful way to go about it." Because Donatello has garnered a reputation as an articulate, engaging, and informative presenter, he is now beginning to receive unsolicited invitations from groups who want to feature him.

When he gives a talk, Donatello usually opens by handing out a questionnaire to the audience. This functions as an ice-breaker and establishes a connection between speaker and listeners. Also, since the questions relate to the topic of discussion, it affords those in attendance a preview of points that Donatello plans to make, which, in turn, promotes audience alertness and stimulates thinking throughout the presentation. Importantly, the questionnaires double as a consultative tool for Donatello—at the end of his talk, he invites those in the audience who might like to receive care from him to put their name and phone number on the completed forms and turn them in as they leave the room.

"It’s not at all unusual to have as many as 40% of the audience give me a completed, signed questionnaire," he says. "So, a day or two later when my office manager calls each person who submitted one, we’ve already got some useful information on them in front of us. This allows the follow-up conversation to proceed much more productively than might otherwise be the case. From any one public talk, I can normally expect to gain one to four new patients when all is said and done."

Hot Off the Press

Another favorite marketing tool for Donatello is the bi-monthly column he writes for the local newspaper titled "Fit For Life." However, its content has less to do with exercise and health than with Donatello’s often humorous recounting of his personal experiences as an outdoor enthusiast and family man.

"I write about my helicopter skiing adventures, surfing trips, mountain climbing experiences, travel, and other things of interest, even the funny things that happen with my dog and kids," he tells. "I’m looking to make people chuckle. But, I also find ways to weave in serious information pertaining to achieving fitness and good health."

Beth A. Cole receives a toggle recoil adjustment on C1 from Donatello.

Pounding out a draft of each 600- to 800-word installment of "Fit For Life" takes Donatello about an hour. "Since I write about the things I do and enjoy, there’s almost no research involved," he reveals. "Compare that to what a physical therapist friend of mine has to go through for his column. Because it is focused on clinical issues, he has to conduct extensive research each time. I’ve known him to spend an entire day doing nothing but looking up facts and figures."

The reward for writing the "Fit For Life" column is difficult to quantify, Donatello admits. He estimates no more than a dozen people have decided to become patients of his as a direct result of reading "Fit For Life" in the time he has been authoring it, which is about 18 months. Even so, he believes that thousands of others who before would never have even considered going to a chiropractor, are now at least open to the possibility of doing so. That, he insists, makes it wholly worthwhile.

Those who decide to give Donatello a try—whether as a result of exposure to him through the column, at a speaking engagement, or via one of the York Chiropractic Health Center providers—quickly come to appreciate his somewhat unconventional approaches to chiropractic. "I have an undergraduate degree in medical rehabilitation, so I’ve never been one to close my eyes to adjunctive therapies," he shares.

Donatello decided to become a chiropractor before completing the undergraduate medical rehabilitation program at Springfield College in Springfield, Mass. As it turned out, Springfield College required its rehab students to complete 600 hours of various internships in order to receive a diploma. One of the places Donatello interned was the office of a chiropractor who made use of physical therapists. In the course of this internship, Donatello spent afternoons beside a physical therapist and mornings in the company of the chiropractor. "I was able to compare and contrast the two professions," he says. "I found chiropractic much more appealing and satisfying because it offered a greater challenge, as well as real freedom for the practitioner to decide how best to care for each patient."

After graduating from Springfield College, Donatello immediately went on to Palmer Chiropractic College. He received a DC credential in 1995, then headed back home to his native New Hampshire, where he began searching for an established chiropractic practice to acquire. The search eventually took him across the state line to Maine, and the town of York.

Survival of the Fittest

The chiropractor from whom Donatello acquired the practice had implemented a variety of management systems to ensure a smooth business operation. As a result, Donatello was able to step right in and concentrate on providing patient care. That’s not to suggest he has never had to give thought to the running of the practice. To the contrary, Donatello finds it necessary to work at improving cash flow.

Donatello takes an X-ray of patient Kimberly H. Robinson to determine a treatment plan.

"Because so much of my practice is insurance-based, I have to be constantly taking steps to make sure the money comes in through the doors when it’s supposed to," he says. "I mean, you can see a million patients and it won’t do you a bit of good if you’re left hanging out to dry for 6 months until the insurance companies decide to get around to paying you. You’ve got to have a stable, positive inflow of cash in order to keep your practice operational—meeting the payroll, paying your phone bill, keeping the lights on."

To promote positive cash flow, Donatello makes it a rule to collect from each new patient all the information his or her insurance company will require. "Before care is provided, we call the insurance company to confirm benefits," he says. "We also make sure we’ve crossed all our t’s and dotted all our i’s when submitting claims so as to minimize the possibility of delays in processing or, worse, outright denial."

At present, Donatello sees patients 3 days per week only. He could extend his availability but prefers not to because he doesn’t wish to cheat himself of time with his young family.

"I intend to be around for my two daughters as they’re growing up," he says. "I also want to be able to have time for other interests, such as bicycling and kayaking. I’m not going to let myself become so chained to my practice that I lose sight of what’s important in life." CP

Rich Smith is a contributing writer for Chiropractic Products.

Jeff Donatello, DC, can be reached via email: yorkchiro@hotmail.com.