Learn how to retain your current patients while increasing your new patient base

As members of the health care community, we feel our primary goal is to maintain a clinic sufficiently to meet the needs of our community. Just as important, but escaping many new and established doctors, is sustaining a successful business. It is also as important as maintaining our technical and clinical skills, which is frequently the downfall of many doctors. Business or practice management classes are often paid little attention by students—a mistake that is devastating to many exceptionally gifted doctors. We must make a living to keep the practice running and to support our professional and personal life.

Therefore, accepting that we are both business professionals as well as health care providers will help us sustain a stable practice while providing for our staff and family. There is one overridingly important aspect of business and practice management: repeat business, or patients returning for necessary care. Notwithstanding what is commonly heard at practice management seminars—Where can I get new ones?—the question should be, “How can I keep those I already have and have them refer?”

The Law of Increasing Returns
Maintaining a stable practice base of patients, determining ways to have existing patients refer, and having a practice that is fun, with patients who assist in the growth of your present practice base, are key factors in the health of your business.

Remember, patient retention is not built on frivolous treatment plans or requesting that patients return unnecessarily. Instead, it is built on solid clinical opinions and treatment protocols that get patients well and induce their periodic return for support or maintenance care. There are many schools of thought concerning maintenance care, and it is not my intention to debate the issue here, except to say that I have utilized chiropractic care for my entire family the past 30 years and have helped them maintain a semblance of health that anyone would be proud of. Whether the adjustments assisted is not debatable for me.

In a business situation, understanding the nuances that drive your practice is crucial. Determining its strengths and weaknesses allows you to tend to the immediate and long-term needs of the clinic. Some doctors are great statisticians and maintain records and data that keep the practice on an even keel. They are able to determine which areas of the practice need an overhaul or mild tweaking. They also can determine whether promotions are working or a waste of time.

Using statistics well is a prime reason for success as little is left to chance. Begin gathering statistical data for each day and week and compare them from month to month. Every area of the practice can be focused on, including patient acquisition, compliance, and finances; insurance payments; missed appointments and recalls; and promotional successes, to name of few.

Statistics can be used for bonuses and as an incentive to increase business. Some doctors are gifted with the ability to project the big picture of chiropractic to patients and the community and have no problem with acquiring new patients and retaining them for supportive care.

These doctors have overcome the fear and possibility of rejection to speak before the public. They have regularly scheduled health care talks in their office and set up community workshops concerning wellness, ergonomics, safety, nutrition, and exercise. They have surveyed the neighborhood and met the needs of citizens with Medicare coverage, youth sport facilities, and allied health providers.

They have also gone beyond their comfort zones and taken professionals to lunch or met them one-on-one, including attorneys, medical physicians, and corporate leaders, to discuss professional alliances and assisting their clients or employees with conservative chiropractic care. But the majority of doctors are poor statisticians and have limited ability to acquire or retain patients as they wish. Therefore, a few ideas should be implemented.

Analyze your practice. Determine if patients are complying with your advice and following your schedule of care. Question your procedures and staff compliance when patients prematurely drop out of care or decide they will determine their own schedule. There are logical reasons why patients discontinue their care during the first five visits: 1) they often have not been provided with the educational tools necessary to determine why they should continue, and 2) their understanding of health care is based on the medical model, which is relief. Once the pain subsides, they feel satisfied and are gone. Is this the practice you desire? Chiropractic care is so much more, and patients deserve to know more and base their agreement with your advice on knowledge, not feelings.

Question how you express the value of chiropractic care. After a visit or two, are patients still unclear why they chose chiropractic care and why your approach to care is vastly different from that of the medical community. It is time to fine-tune your consultations. Be sure your concern is genuine and that new patients realize you understand their problems.

In your report of findings, outline your office menu of services and the programs tailored specifically for them. Clearly state why they need the care, what you intend to do, and how much it will cost in time and money. Patients aware of their responsibility will follow the schedule, comply with your recommendations, and, most important, refer.

Tweak your reports of findings and recommended schedule of care so they feel comfortable with your knowledge and approach. If you emphasize specific areas of chiropractic, such as subluxation correction, postural biomechanics, relief, or wellness care, let patients know the big picture. Allow them to be partners in their care, and provide the tools to define their role in assisting you and, one hopes, their family and friends.

Consider rehabilitation as an added service. Patients look forward to participating with their health care. If your office has a rehabilitation station, it may provide them with the necessary incentive to follow through with their care and refer.

Also, display illustrative posters and charts, CD programs, neuropatholators, waiting room videos, and pamphlets and brochures. Knowledge is golden and a key to your success.

Question your technical procedures and the tools you use to diagnose and treat these patients. A picture is worth a thousand words with diagnostic and illustrative programs outlining problems and progress. Use x-rays, sEMGs, and other thermal units to illustrate your concerns and approach. Use them to discuss the short- and long-term consequences of structural instability and early or late subluxations. Keep up to date with new technological developments.

Create a safety net. Are missed appointments the rule rather than the exception? If this is the case, your patients never received the knowledge to make an informed decision. Missed appointments are a symptom of poor communication between you and your patients. The staff is at the mercy of both. Maintaining a healthy patient base is a key to success.

Educate your staff. Have new-patient discussions in every staff meeting. Each week, outline every new patient’s problem so your staff has a clear understanding of why they need care. Discuss specific areas that concern you, such as preexisting complications and the rationale for their schedule, rehabilitation, therapy, and eventual supportive care. Your staff should not share this with patients, but their awareness helps increase their desire to see patients comply with your recommendations.

Review, recall, and reactivation programs. When calling about missed appointments, do not leave a message requesting that they call you to reschedule. Instead, leave the message that you have placed their name in the appointment book the following day, which prompts them to cancel rather than leaving the next appointment date vague.

If patients miss their initial appointments, you should make the call and ask them if there has been any misunderstanding or concerns. Patients who have discontinued care prematurely or without your recommendation should be sent a completion letter to be kept in the files. This letter will advise the patient that they have discontinued without your advice, and their file will be kept open for 6 weeks, after which it will be closed. You can also advise that you are available to refer them to a chiropractor closer to their home or work to encourage their necessary care. Be sure to maintain a record of missed appointments and attempts to call. This is for risk management to record that you have never abandoned your patients.

Spend some time and money gathering the tools necessary to attract new patients. Practice management seminars are necessary to reintroduce you to various methods of acquiring and retaining new patients. In business, we must maintain a steady base of patients and have access to potential new ones. The equation is quite simple: no new patients, no revenue. But it is easier to maintain and cultivate the practice we have rather than spending time and resources acquiring new patients whom we are unable to keep. CP

Joel E. Margolies, DC, has been in practice for 25 years in Atlanta and is the author of four books: Smart Start, Workshop Workbook, Chiropractic Marketing and Public Relations, and Personal Injury Workbook. He sends a free weekly chiropractic email newsletter concerning practice management, public relations, and philosophy to more than 10,000 DCs in 31 countries. Margolies can be reached via email: joel3639@aol.com,  or website: www.chirosmart.net.