Improve patient retention by using the franchise model

Patient retention is an issue facing every chiropractor in practice today. All too often, patients will simply disappear from care with no explanation, leaving you to wonder if they moved out of the area, could no longer afford treatment, or were dissatisfied with your care. When patients do not complete the full course of care, they might not get the best results.

This can be damaging to your reputation as well as their health. Some patients will even complain to other people in the community that you did not help them without mentioning that they did not follow your advice.

Giving patients choices is the key to patient retention. Different patients have different needs, and chiropractic care does not have to be a one-size-fits-all proposition. For a patient-retention plan to succeed, it needs to meet your patients’ needs as well as your own. You will retain more patients if you give them a choice of the kind of care they receive. Of course, it is not a good idea to allow patients to completely dictate their course of care. And patients come to you because you are an expert, and they want your advice. They simply expect your recommendations to be logical. Chiropractors can learn a lot about patient retention by examining how other businesses approach the topic of customer satisfaction.

Many doctors believe that thinking of their practice as a business will compromise the quality of their patients’ care. They fear that this will mean treating patients like numbers and destroy something sacred in the doctor/patient relationship. But in this case, implementing business practices can lead to improved patient care and better results. Chiropractors can find a solution to their patient-retention problems in a familiar source—franchise businesses, such as McDonald’s and Starbucks. Franchises standardize everything about their business: the goods and services offered, the prices, even the decor. No matter whether a McDonald’s is in Beijing or across the street from your office, you can always order a Big Mac. At the same time, there is choice within the standardization of a franchise. Starbucks has more than one type of coffee; McDonald’s sells more than just hamburgers. Standardization and choice are both key to the incredible success of franchise businesses.

Chiropractors can reap the benefits of offering standardization and choice by creating packages of care. Begin by creating custom packages for the three types of patients that chiropractors see the most—acute, rehab, and wellness. Explain the packages of care offered, and help patients choose which package is the best for their conditions. Each package should have an estimated cost and program of care modified by the doctor for each patient.

Once patients have chosen a package, invite them to schedule the necessary number of visits that day. This will help with patient retention because they have already committed to those visits and adjusted their schedules.

Acute care package. This package is designed for patients who are injured and/or in pain. The primary goal is to get patients out of pain. Other goals are to reduce inflammation, minimize injury, and prevent injuries from getting worse. The acute care package involves a lot of passive care. You will be making adjustments and using therapies such as heat and ice, passive traction, and ultrasound. Acute care would probably be the most concentrated package of care lasting between 2 and 4 weeks. When patients have completed all the visits in the package, reevaluate them to see if they need to continue with acute care. Once patients have finished with acute care, then they have the option of moving on to rehabilitative care.

One of the major reasons that patients drop out of care is that they do not know how to evaluate their progress. When you start each visit by asking them “How do you feel today?” you teach them to evaluate their progress by how they feel. This means that you are in danger of losing patients as soon as they think they feel better. To keep your patients in care, make sure that they know you are evaluating their structural and functional improvement, not just how they feel, until the package of care is completed.

In many cases, insurance will pay for care that gets the patient out of pain or restores function (acute and rehab care), but insurance will rarely pay for preventive (wellness) care. Your patients should be made aware of this up front. Each doctor will have different circumstances; however, the acute care package generally costs more than the other packages of care because it is more labor intensive.

Rehab care package. Once patients have completed the acute care package, they could then commit to a rehab care package. The primary goal of rehab care is to restore life function as measured by activities of daily living (ADLs). Active patient involvement increases as you and your patient work together to bring the patient back to normal. During the rehab phase of care, use rehab equipment and instruct your patients to perform rehabilitative exercises at home.

Rehab care will focus on your patients’ abilities to perform ADLs, such as being able to perform their duties at work, dressing, driving a car, or carrying their children. Insurance companies are particularly concerned with seeing a patient’ s ADL scores improve because it gives quantifiable information about whether or not the patient’s condition has improved.

How long patients will need care is dependent on the their circumstances. On average, rehab care will last an additional 2 to 9 weeks after acute care. Once you have determined that your patients are finished with rehab care, they can then move on to wellness care. Unfortunately, the majority of insurance companies stop paying for care once patients have achieved maximum improvement.

Wellness care package. The wellness package is for patients who are interested in maintaining or improving other aspects of their health through chiropractic care. During wellness care, patients will primarily receive adjustments to align their spines for healthy movement with very little rehab.

The type of wellness care that patients receive will be based on their age, goals, and the amount of time they want to spend. Counsel patients on subjects such as diet, exercise, and ergonomics at work. Wellness care is a global, total-body approach to health care, and both acute and rehab care are more locally focused. Once patients have experienced the results of chiropractic care through the acute or rehab care package, they will be more likely to want to become a wellness patient.

Customized Packaging
Offering packages of care does not require you to change your methods of practice. If you use a certain adjusting method, offer massage, and recommend custom-made orthotics to your patients, you can continue doing all of this within the scope of your packages of care. You do not have to sacrifice anything to use packages of care. If you offer adjunctive therapies that reduce your patients’ pain and help return them to good health, suggest them to the acute, rehab, or wellness patients who would benefit.

When creating your packages of care, customize them to suit your preferences and to meet your patients’ needs. You can still practice exactly the same way, except now you are clearly defining your methods of care so that your patients understand why they are necessary. Both you and your patients can continue to have choices within the standardization of the packages of care.

Packages of care benefit the patient because they let the patient know up front how much time and money they will need to commit to getting well. These packages also take away some of the uncertainty for patients. It reassures them that your primary goal is to get them well, and that they will not have to accept care that they do not want.

Packages of care will be even more beneficial to you because they will help you standardize your care and leave you more time to give special attention to your patients. CP

Jeffrey D. Olsen, DC, has been in private practice in Roanoke, Va, with his two partners/brothers since 1997. Olsen has also instructed as an adjunct faculty member at the College of Health Sciences in Roanoke, teaching anatomy and physiology in the Physician Assistant Department. He can be reached at (800) 553-4860.