Tom Klapp, DC, systemizes practice methods such as patient education, enabling a team approach to care

According to Tom Klapp, DC, many chiropractors run their businesses in one of two ways. The first is by chance; the second is by systems. “They hope that chance just works,” he says. “And it does up to a point.”

However, he says, the consequence is a practice that essentially enslaves the chiropractor. Klapp knows what he is talking about from firsthand experience. “The chiropractor who runs his practice by chance used to be me,” he says. “I was working under the mistaken belief that the office couldn’t function without me.”

That changed about 11 years ago when Klapp married his wife, Kim. “She broke down a lot of our office tasks and created systems for doing everything,” Klapp says.

The result of systemizing his Ann Arbor, Mich-headquartered practice, First Choice Chiropractic, is that he now has satisfied patients, a loyal staff, and most important, time for himself and his family. “We take 10 to 12 days off per month in the winter and go to our Florida home,” Klapp says. “Systems allow us to do this without any fluctuation in our practice statistics.”

Klapp’s 4,800-square-foot office includes five adjusting areas, two consultation rooms, an education suite, an examination room, and an x-ray room. The staff consists of five full-time employees and one who is part time. Kim Klapp leads the office team. There are two other chiropractors in the office. They render between 80% to 90% of patient care.

Every aspect of the practice is systemized, from the way the chiropractic assistants answer the phone to the way Klapp and his two associate chiropractors present their findings to patients.

Patient Education
Among Klapp’s practice focus is patient education. This begins in earnest following the patient’s initial visit. Patients receive their initial financial consultation on the second visit. The actual financial arrangements are made on the third visit after the patient has chosen his or her care program.

Klapp describes new-patient orientation as the “keystone” of chiropractic care. His approach is to educate the patient about what chiropractic is—many of the new patients have never received chiropractic treatment before—and to change their thinking about medicine in general, which they typically think of as a symptom-oriented, pharmacological approach. Even patients returning to Klapp’s care are required to attend the patient-education session, because he finds that they probably stopped their treatments because they didn’t get the message the first time.

The education session starts with a 7-minute video that gives basic information about chiropractic care. The video is part of the education system, but it is also designed as filler before Klapp gives his formal presentation. “Patients can be up to seven minutes late and still get the whole program,” he says. If a patient shows up once Klapp begins his talk, he or she is required to reschedule for another day. Patient orientation is given five times per week.

The session lasts an hour and includes a report of findings of the first visit. Klapp’s presentation tells the chiropractic story, covering why conventional medicine and surgery are not the best option. In his talk, Klapp uses metaphors to help the patients grasp his message better. He also uses a variety of visual aids, including a PowerPoint presentation and props.

Among the various props he uses are a plastic model of a spine, a light with a dimmer switch to illustrate how the nervous system is tied into the spine, a degeneration-phase model, x-rays, and a “subluxation stick.” The latter is a stack of beads with a spring running through them. The spring allows the beads to move. However, three beads do not move; this illustrates what happens to a spine when there is subluxation and dysfunction. “What I do is appeal to people’s learning style,” Klapp says. “About 80% learn visually. About 15% learn auditorily, and about 5% learn kinesthetically.”

Klapp’s view of chiropractic is as expansive as his teaching methods. “The big secret of chiropractic is that chiropractors are not back doctors; we’re nervous-system doctors,” he says. “Most problems are the result of problems with the nervous system.”

Correcting problems with the nervous system will allow for good health and proper functioning of the body, he says. This is the message that Klapp tries to impart during his presentation to new patients. “Chiropractic care is a process, not just taking a pill,” he says.

The third visit further determines the kind of care a patient will receive and how the patient will pay for it. This can include prepayment, a payment plan, or third-party-payor insurance. The fourth and fifth visits are designed to make sure the patient does not stop coming because of some issue with either their care or the financial arrangement.

If a patient continues through the initial five visits, Klapp says he or she will be a compliant patient and will stick with the recommendations for care.

To aid in retention, each patient is assigned a patient advocate—one of the chiropractic assistants—who acts as a liaison between the patient and the office, and makes sure that appointments are kept and that any questions about billing or issues about treatment are resolved immediately. Klapp sees the advocate system as a smaller part of the communication and education system that he has put into place. However, they do play an important role in retaining the patient. “[The patient advocate is there] anytime there is a miscommunication or misunderstanding that would otherwise lead to a new patient unnecessarily dropping out of care if we didn’t track them through the ‘hand-holding’ period of their first five visits,” Klapp says.

“For example, if the patient didn’t understand their report of findings, if they experienced more symptoms after their first adjustment, if they didn't understand that we will work with them to make care affordable, or if their symptoms are relieved after just a few adjustments,” Klapp says. “Basically, we provide so much information on the patient's second visit, that there’s always a chance that something important could be misconstrued by the new patient.” The patient advocate’s job, like any customer-service representative, is to help the patient solve these problems and retain the patient for the practice.

The patient advocate may also help the patient beyond his or her formal chiropractic care. “The advocate may help the patient find an attorney if their case warrants such a referral,” Klapp says. “Or, they might help a patient find some kind of nutritional supplement or some other health-related product not sold in our office [with the doctor’s guidance, of course]. Usually, the patient advocate also helps the patient with insurance-related questions or issues.”

The patient advocate may also function as the “voice” of the patient, discussing sensitive topics with the chiropractor for the patient. “Perhaps the patient finds the adjustments uncomfortable but doesn’t want to raise the issue with the doctor, fearing the doctor’s feelings may be hurt. When the patient lets the advocate know this, the advocate can let the doctor know what's happening and the doctor can make the appropriate change in that patient’s adjustment or other care,” Klapp says.

Other systems behind the scenes are keys to Klapp’s success.

Hiring System
Klapp has a system for hiring employees—another innovation designed by his wife. The process begins by placing a specific advertisement with proven verbiage in a particular part of the local newspaper. Those who respond are brought into a group interview that begins with an alphabetizing test. Applicants who fail the basic test are dismissed from the interview. Applicants then go through the new-patient orientation. This process determines whether or not the applicant is hostile to chiropractic.

“We require them to be under chiropractic care—at our expense, of course—so they can know what the patient is experiencing and benefit from chiropractic care themselves,” Klapp says. “If a job candidate will not even agree to be under chiropractic care, then how could we expect that person to be an advocate for chiropractic care to our patients?”

Once a final candidate is identified, he or she meets the rest of the staff. Klapp then polls his employees, and unless 100% of them vote to hire the applicant, he or she will not be hired. “Now the team is invested in this person. It cuts down on personality conflicts, potential turf battles, petty jealousies, and all the other ‘stuff’ that keeps staffs from being the best,” he says. After an employee is hired, he or she goes through a rigorous training program.

Training System
Training is also systemized and covers every aspect of patient interaction, from answering the phone to presenting findings. Training is handled by one person. This guarantees that it will be consistent and thorough. All employees are trained from the same manual—CAs from an office-systems reference guide that Kim Klapp created; and chiropractors from a chiropractor training manual.

As with all of the systems in the office, the goal is to create a repeatable, successful result. “Most of our systems are all about the exchange of information,” Klapp says. “The doctor has to understand why the patient is there and must be able to communicate with the staff, patient, and vendors.”

The systems all hinge on procedures that are designed to yield a predictable result. For example, the training system typically yields a better-trained staff, Klapp says.

The chiropractic assistants have procedures that allow them, for example, to answer questions in a predictable way using what Klapp describes as “pat responses” or by diverting it to the staff member who is an expert in that particular area, such as insurance.

The chiropractors must follow their own systems as well. As with the chiropractic assistants, the chiropractors’ training focuses on communication. “We train them how to communicate with patients because the real world operates very differently from [the chiropractic-school setting],” Klapp says. For instance, Klapp requires findings to be presented in a particular order.

Each patient is presented with a bound booklet that outlines their entire case with the chiropractor’s recommendations, a printout of the patient’s x-rays, and examination results. It also includes printed results of the patient’s electromyograph, thermal scan, and posture analysis. The chiropractor gives a verbal report of the contents to the patient. The booklet is kept by the patient as a record of his or her condition. It is also intended that the patient will refer to the booklet as he or she goes through treatment—to compare future exams and x-rays. CP

C.A. Wolski is a contributing writer for Chiropractic Products.