Managing a business is something chiropractors are not trained to do. Hiring a management consultant may be the best business decision you make

In medicine, there are specialists for every aspect of the human body. Brain injuries are not referred to a podiatrist, just as spine adjustments are not conducted by a dermatologist. Maximize your practice by calling in an authority in practice management. Chiropractic Products invited seven management specialists to offer advice on the best way to better your business.

Daniel H. Dahan, DC, is president of Practice Perfect, the largest multidiscipline health care management and consulting firm in the country.

Pete Fernandez, DC, is president of Fernandez Consulting in Seminole, Fla. He has practiced chiropractic for 20 years and has been a consultant for 23 years.

Dallas Humble, DC, is president of Dallas Humble Inc, a consulting company aimed at helping DCs grow in their practices and personal lives. He has owned and operated 23 chiropractic offices during his career.

Keith Maule is the CEO and co-owner of Kats Management, where, since 1988, he has spent 30 weekends per year conducting management seminars nationwide.

Dennis Perman, DC, is a cofounder of The Masters Circle—a personal and professional development company dedicated to helping chiropractors find success and fulfillment.

Mark Sanna, DC, is CEO Breakthrough Coaching LLC, which has been teaching a system of proven procedures and strategies for doctors in professional practice for the past 15 years.

David Singer, DC, is CEO of David Singer Enterprises Inc. The Singer system utilizes practice expansion seminars, one-on-one consulting, and a complete product line.

What are the most common business/management mistakes DCs make?

Dahan: Doctors, like all businesspeople, must have well laid out plans clearly outlining the clinic’s goals. Then, detailed implementation protocols must be set in place, such as due dates, a list of actions taken, records of resolved issues, and a follow-up procedure (every 30 days) to monitor progress.

Fernandez: The most common mistake is not having a consultant to guide them through the maze of HMOs, PPOs, IPAs, cash plans, PI, and WC. Today’s practice of chiropractic is far too complicated for DCs to figure out alone.

Humble: The most common business mistake doctors make is trying to do it all without the help and advice of a professional.

Perman: The most common business mistake is thinking that technical competence will prepare them for becoming effective businesspersons.

Sanna: I’ve found that while almost every doctor has regular hours for patient care, very few have established hours for practice building. Set aside an uninterrupted minimum of 1 to 2 hours each week in the office devoted entirely to practice building.

What marketing and/or management tool have you found to be the most effective to attract new patients and retain current ones?

Dahan: The most effective tool in attracting new patients is the diversified, integrated practice. Today, patients are constantly looking for better health care—all under one roof. To retain current patients, a well-trained staff must ensure every patient is given unadulterated attention at every visit.

Fernandez: Advertising is still the most effective way to attract new patients. The best patient retention tool is consistently providing quality care and using great office procedures, which results in happy patients.

Humble: Some markets require more external marketing and advertising, others require more face-to-face contact. Current patients are best retained through education, such as health classes, videos, and ROFs.

Maule: For new patient referrals, we work on three aspects: 1) the wow effect—after the office visit, we want them to say, “Wow!”; 2) communication—there must be effective education so patients will tell others; and 3) improving the abilities of the doctor and staff to ask for referrals. The second source is in the area of wellness, which includes chiropractic care, nutrition, and exercise. We must not limit ourselves to LBP patients, but move into preventative care.

Perman: The top marketing tool is word of mouth. Most chiropractors can attract new patients by learning to properly confront prospects and communicate. The best way to retain patients is to reinforce the benefits of regular care and the consequences of discontinuing the program.

Sanna: The best investment in new patient marketing is becoming Internet proficient. Frequency of contact, such as weekly or semiweekly e-newsletters, leads to a sense of community and trust among your existing patients. Also, chiropractors can provide e-health magazines with updates on health information and articles written by community-based health care providers, who can become excellent sources of referrals to your practice.

Singer: There are four main tools vital to a practice’s success: 1) know how to ask for and get referrals; 2) host in-office workshops for patients and their families and guests; 3) do outside lectures; and 4) coordinate health fairs, screenings, and wellness days. The most effective way to retain patients is to educate them on how chiropractic works.

Who or what are the direct competitors? How can DCs compete?

Dahan: There are three types of competition: 1) The doctor’s own imagination limits his growth by not trusting his own intuition and foresight; 2) The advanced center; and 3) The medical community, which is hiring DCs to increase revenue and reduce the chance for DCs to compete aggressively.

Fernandez: The DCs’ main competitors are back pain centers and pain clinics owned by MDs, DOs, and hospitals. To compete, chiropractors should “out-market” them.

Humble: The main way competition affects a practice is when doctors become preoccupied with what others are doing.

Maule: There are about 60,000 chiropractors and 270 million potential patients. The problem is lack of exposure and knowledge. As a profession, we must become committed to education and exposure.

Sanna: The mind-set that there are not enough new patients to go around limits growth and stifles opportunity. Chiropractors should seek to become proficient in the techniques of their choice and to deliver the highest quality care possible.

Singer: The most direct competition today is other chiropractors, as well as hospitals and the medical profession. To beat the competition, you must have a unique marketing approach, such as specializing in one area.

How important is choosing a consultant company that is consistent with the DC’s belief system? Why?

Dahan: DCs must discuss all issues pertaining to their clinic and contact multiple references to confirm these views. DCs have the right to demand that a consulting firm be ethical, passionate, knowledgeable, patient-driven, have a vision, and be a friend.

Fernandez: Our belief systems determine which path we will take to reach our practice goals. Each practice philosophy has unique practice-building needs.

Humble: It is one of the most important factors DCs can make. The consulting company has to know what the doctors want in order to deliver the goods.

Perman: Pick a consulting company you resonate with, one that stands for values and ideals you can relate to. Most consulting companies have something good to offer—just not for everyone.

Sanna: Choose a management consultant who is familiar with the practice of chiropractic today. It is extremely important that there is a fit between your practice philosophy and your management company.

Singer: It is absolutely important that a chiropractor understand the services and philosophy of the consultant. For example, our program is customized for the individual doctor to help them achieve their goals. Every practice does not face the same obstacles; therefore, our program isn’t the same for everyone.

What services should DCs expect from their management consultants?

Dahan: Daily unlimited access to consultants to answer all questions and concerns, weekly faxes to share national information gathered, weekly live classes to train staff via the Internet or a toll-free number, monthly newsletters to solidify all protocols, a monthly calendar with daily tasks to help manage duties and goals, a monthly marketing theme, marketing kits for PI/WC and general health care, quarterly analysis with graphic reports to show progress and set new goals, free seminars , an affordable fee with reasonable contract clauses, access to extensive material, and all necessary forms as well as staff training videos at no charge.

Fernandez: DCs should expect their management consultants to be able to advise them in all areas of their practice. Also, DCs should choose consultants who provide one-on-one consultations on a weekly basis.

Humble: Some are best at helping you set up a practice whereas others are best at other things. Look for someone who meets your criteria based on what you want to accomplish.

Maule: We seek to offer a system that provides key elements of success: faith, hope, and love. Also included are the cutting-edge technological tools and seminars at eight different locations per year.

Perman: The best consultants bring a genuine desire to create a relationship based on accountability, shared responsibility, mutual respect, and love.

Sanna: Choose a consultant who offers a flat rate and run in the other direction from percentage agreements. Look for a company that will provide personal consulting and a long-term relationship. Ask to attend a program free of charge to meet its current members to see whether the fit is right.

Singer: Doctors should expect their consultant to provide useful, ethical, and legal methods that work. Consultants should offer a diversity of ideas so each doctor can select the methods that fit the flavor of their individual practice. Should something not work for a doctor, the consultant should be able to provide another solution.

What should DCs watch out for when choosing a consultant?

Dahan: The following outlines should be followed when choosing a consultant: Has the consultant owned and operated a clinic prior to being a consultant and if so for how long? How many clients does the consultant have? How many states does the consultant operate in? Is the consultant personally qualified to answer questions? Is the consultant a qualified biller/collector for national offices? Has consultant ever been expert witness? If so, how many times (And from a defending and or prosecuting side)? Does the consultant teach most classes at seminars? Is consultant a “power house” of information or just a great salesman?

Perman: Know the details of the financial arrangement before you commit. Be absolutely certain about their financial policies and track record for providing what they advertise. Also, there should be some provision for dissolving the relationship, should the situation call for it, the rules of which should be clearly defined.

Sanna: Neither chiropractors nor consultants are deserving of a bad reputation, and it’s important for both parties to work diligently to combat any misperceptions. The right consultant functions with ethics and integrity, and is committed to your success and the success of the chiropractic profession.

What do you predict for chiropractic practices?
Dahan: There is no question that the future of health care lies in the integrated practices DC/MD/PT or any combination thereof.

Fernandez: The successful practice of the future is one that will specialize in a niche, especially chiropractic rehabilitation. The general and PI practices of chiropractic will be gobbled up by the MDs, DOs, and hospital-owned back pain centers.

Humble: The age of antiaging and wellness is here. There will be more multiple DC partners, and the MD/DC practice will change according to its present status. Hiring an MD for the purpose of billing more is not working and is causing more headaches and overhead.

Maule: The future of chiropractic will include all these directions. Our profession is much too large to be unidirectional. All of these directions can and should succeed.

Perman: The direction of chiropractic is away from insurance-dependent emergency crisis intervention and toward individual responsibility and family health and wellness. Patients are realizing the fallacies and failures of the allopathic model and the simple elegance of the chiropractic wellness lifestyle.

Sanna: Approximately 30% of medical physicians remain in private practice, and the day of the solo chiropractic practice is gone as well. Also, the multidisciplinary practice is on the cutting-edge integrating chiropractic into mainstream health care. The paradigm of multidisciplinary practice is one fraught with many pitfalls, and those contemplating it should do so only at the advice of a consultant and legal counsel who are well versed in the model.

Singer: Doctors will have to diversify the way they market to build their practice, payment options for patients, the programs of care offered, and the type and number of people they see.

Any last words of advice?

Dahan: A doctor can be successful only if he or she treats every single patient as if this patient is a loved family member. Only with this kind of compassion, care, love, and admiration can our profession succeed.

Fernandez: DCs should not waste precious time and money trying to recreate the wheel—trying to figure out something that has already been figured out by the experts. It is much faster and much less expensive to learn from the success of others than by your own failures or mistakes.

Humble: The future for the chiropractic profession is better than ever. We have to tweak our way of thinking and marketing a little bit. See what the public wants and deliver the service to them better than anyone else.

Perman: An identity-based approach is consistent with the basic premise of chiropractic—health comes from within and so does success. It starts with a decision to pursue excellence in every aspect of your practice and life. Success comes from you, not to you; so grow yourself, and you’ll naturally gravitate toward the beliefs, behaviors and habits that will help build the practice you really want.

Sanna: The language of reimbursement today is the language of function. To fully participate in the mainstream of health care, DCs must become proficient in assessing and documenting the functional outcomes of their care. Remember that the CPT codes with the highest value are active care codes: therapeutic exercises, kinetic activities, and neuromuscular rehabilitation. The reason for the high levels of reimbursement is that they produce a higher quality outcome. Patients who participate in rehabilitative exercise programs have a lower rate of recurrence of their original conditions, and this is recognized by third-party payors.

Singer: Every person does better with a coach and with new ideas to expand their practice. Every dollar spent to expand your motivation, purpose, ideas, procedures, and knowledge will be a dollar well spent. CP

Julie Z. Lee is a contributing writer for Chiropractic Products.