127: Is the skyfalling on Chiropractic?

127 Transcript Sky Is Falling MY23 Review

 
Is the sky falling on chiropractic?

Welcome to the KC CHIROpulse Podcast everybody. We're glad you're here today. This podcast is brought to you by Kats Consultants, and I'm Dr. Michael Perusich, one of your hosts. And this is my co-host, Dr. Troy Fox.

Troy is the sky falling on chiropractic practice?

Man, I don't think so at all.

I think I totally agree. The future is bright, but we do have to do some things to make sure it continues to be bright. Right. You know what, there's a lot of stuff happening right now, you know? Yeah. Politics are heating up. We've got all these people running for president already. It seems all for early.

It's not, but we, the economy's on fire. I'm not sure which kind of a fire, but it's on fire. And so anyway, we do this every middle of the year. And we talk about the mid-year review. So my question, is the sky falling on chiropractic? No, it's not. I'll be honest. Mm-hmm. I don't think there's ever been a better time to be in chiropractic and there's, I don't think there's ever been a better time that we've seen an opportunity for our practices to be just crazy successful.

Mm-hmm. There's so many opportunities for us right now. Now if you're sitting out there thinking, what are these guys talking about? These guys. My practice is down. You know what? Mm-hmm. Give us a call because I'm telling you, or you know, listen closely to this because there are some things you can do. And before I forget, go to our website and download one of our downloads is how to find $130,000 extra a year in your practice.

Boom. Mm-hmm. That's a mic drop right there. That'll save your practice. So anyway, some of the things I, I thought we'd talk about today are kind of the money. Talk a little bit with our practices. Mm-hmm. You know, see a lot of doctors just kind of running their practice by the seat of their pants, and they judge their success by how much money they have in their checking account.

But you know, sometimes we have to put our entrepreneur hat on and really actually run the budget or run the business. And it's funny that you say that because all this week that's literally, and, and I do some unique things. We back into things from, uh, we look at, uh, we take a glance at the year in review, and then we look at the year ahead, and then we break it down from there all the way down to hourly.

Yep. And that's where we start at. And that's, so we start with, with the year that we just had. We look at the year upcoming because sometimes people wonder, how do you set your goals in your practice? Or if the economy is faltering a little bit, what's gonna happen this next year? And. Regardless of what's happening with the economy, I'm not going to be the guy that says, well, let's, let's cut what we did this last year in half because the economy's not looking great.

I'm gonna look at where can I help my patients more? So we can either sustain or achieve more out of our practice. And then I, and then I again, break it down by the month, by the week, by the day, and then by the hour to see where we need to be. What kind of patient numbers do we need to look at? And is that achievable by me?

You know, because that's the other thing you have to look at. What are your capabilities? If you're straight outta school and you're used to seeing six patients a day in student clinic, is it reasonable that you're gonna go from 6 to 60? In the next week? Probably not, probably not. But if you are already seeing a specific number of patients and you know that there are gaps in your schedule, how do I maximize those gaps?

How do I, how, how do I make my practice more efficient? So those are some of the things that I look at when I start looking at my mid year review is how can we be better this next year? Yeah. Yeah. And you know, that, that brings up just a whole treasure trove of, of thoughts. Mm-hmm. Um, you know, I was talking to a doctor just actually yesterday and he says, wow, doc, my, my practice is really down.

I don't, I don't know what happened. So he started picking it apart just a little bit, and I said, oh, okay, so you're down. And he said, yeah, I'm gonna be like, I don't remember the number, like $200,000 off this year. I said, okay. Mm-hmm. Let's back up a little bit. Why are we looking at already at what we're gonna lose in the next 12 months?

Let's look at today. Mm-hmm. So we broke it down. We looked at his patient visits. We looked at his dollar visit or his collection visit average, and we broke it down and figured out that to. Not lose that 200,000 or, or to get back that 200,000 had to see four extra patient visits a daypart. Mm-hmm. Four extra.

Can you, can you not find four extra visits per daypart? I mean, how many people are coming into your practice saying, oh, I'm gonna, I really needed today's adjustment because I'm gonna go till up my five acre garden this weekend. Mm-hmm. And we're not listening, and we let that patient just walk out the door.

All right, well, we'll see you in a month. There's only, there's only two places that comes from, it either comes from the doctor's mindset or the staff mindset. Right. You gotta have both. Both of those. Yeah. So you've gotta have that mindset that's really paying attention, because you can find extra patient visits all day long.

And you can, mm-hmm. You can grow your practice without having to do some new patient promotion and, and giving your services away. You can grow your practice so easily from within. Mm-hmm. So that's nugget number one. Here's another nugget. When was the last time you looked at your budget? When was the last time you actually laid down a p and l?

Some of you're thinking what the heck's a p and l. That's your profit and loss statement. You can print it out of your accounting software or you can pick up the phone and call your accountant and say, can I look at my p and l? When was the last time you compared this year to last year? To the year before?

You'd be shocked where you're spending money. Sometimes, and with the, with the advent of QuickBooks, there's no reason that you shouldn't have those numbers at your fingertips. And if you're not looking at 'em, in a lot of cases what we see are doctors that think it's a dirty word to say they're running a business.

There isn't a doctor out there that isn't running a business. I don't care if you're a dentist, I don't care if you're a pediatric physician. I don't care if you're a chiropractor. We're all running a business. The end goal is, if you're gonna, if you're going to. Devote a majority of your waking hours to your practice, you should get paid for what you do.

You really should. Absolutely. Absolutely. And if your, if your expense ratio, in other words, if your expenses are 70% or more of your collections mm-hmm. Then look at areas that you can make some cuts with your expenses. You know, see if you can cut 15% out of your. Your expenditures. That's not hard to do.

Limit your equipment purchases. Maybe this year if you, if you're feeling the tightness of the economy or how many of us have equipment that we're not using? Mm-hmm. How many of us have equipment we're not using? Sell it. Sell it. There's always people looking for good used chiropractic equipment. Look at your suppliers, because sometimes your suppliers that you've used for the last 20 years may not be anywhere near what the low price is for the product that you're purchasing to bring into your practice as well.

Right. That's a great point. Yeah. Look at your supply chain, you know, and. How much of your collections are you actually saving? Mm-hmm. We always recommend that you should be saving at least 10 to 15% of your collections every single month. Slide it over into a business savings account and don't touch it.

It's there for a rainy day when you need it down the road. Mm-hmm. You know, doing those kind of things just make good financial sense. It makes your business healthy. You shouldn't spend every last time in your checking out. Your business checking account every month. It's an insurance policy. I mean, I look at it this way.

Let's say that this weekend I decide to go out water skiing because it's Memorial Day weekend and somehow in some freak accident I blow my knee out or break my leg. Well, if I didn't save money back and I don't have a business account that can withstand that. I'm in a lot of trouble. Right. And that would create a lot of heartache for me if I felt like that every time I left the house, that I didn't have some sort of cushion to rely on.

Do I want to use it? Absolutely not. I don't wanna break my leg. I don't wanna blow out my knee, right? I want to be able to practice. But I think you can probably very intimately identify with that because you had a problem that you had to be prepared for. Yeah, I blew out my elbow and had to have elbow reconstruction done, and I was outta practice for four months.

Thank goodness. We, we had, uh, been, we'd been saving a lot at that point, you know? Mm-hmm. Because my practice was pretty much down, let's just say it was, it was flattered in a pancake during that time. Yeah, absolutely. And see, you have to look at those things and that's why running as a business means looking at those different factors because you don't see businesses that don't have liquidity.

Ones that don't have liquidity or are bankrupt. Right. Or they're, or they're very close to it, you know, at that point. So why would we, as a chiropractic business operate without some sort of cushion set aside? Exactly. You have to have that cushion if you, if, if you're one of those people that doesn't think something will happen, I.

Good luck with that. Yeah. Take, take a look at your finances too. So what's happening in the economy right now? One of the things is that credit is tightening up. Mm-hmm. And you've seen this, you're, you're watching credit card interest rates, for example, go up. Mortgage interest rates are going up. The regional banks are, um, in financial distress, at least some of them are in financial distress because they're treasury bills that they have to buy.

They're treasury securities. Um, are, are down in value in a lot of cases because the feds have raised rates. As rates go up, the value of your treasury bills goes down. Mm-hmm. And so credit's getting tight. So go talk to your bank as soon as you possibly can and see if you can get a small line of credit set up if they're still lending.

Mm-hmm. You don't have to use it. You don't have to pay for it. If you don't use it, there's no charge to it. Right? There might be a documentation fee of 25 bucks or 30 bucks or something to get it set up, but that's no big deal. But then you've got an extra emergency fund and instead of using credit cards so much, you dive into your, you, you, you put something on a credit card, you get those airline miles.

Mm-hmm. Then, Use your line of credit to pay it off, and then you replenish your line of credit from your collections. And if you do it rapidly enough, you won't have any expense against it and you're not using your own money. That's a positive way to use leverage. Get off the credit cards, get onto a small, inexpensive line of credit, and save yourself a bunch of money.

And if you do have to make a decent size purchase in this economy, which I just did not too long ago. Mm-hmm. And my interest rate wasn't where I wanted it to be, it was higher than I really wanted to pay for an interest rate, but it was as good as I was gonna get. Right. Here's how you offset that. You offset that by making sure that you're not spending everything you make, again, setting money aside, but I'm setting additional money aside to pay down the principle of the loan faster so I can offset that higher interest rate.

Now I've basically got the loan at a lower, yeah, it says it's at maybe at 7.2% or whatever. Mm-hmm. Whatever the loan was. But now all of a sudden I'm offsetting that by paying my principle down faster and it's just a simple principle to where, you know, it hurts a little right up front because yeah, it'd be nice to have that extra four or $500 a month and instead you put it towards the principle and now I'm not paying the bank more than I should, and I hate paying people's stuff more than I should, you know, paying more than I should for absolutely.

Stuff. Absolutely. Absolutely. Absolutely. You know, the other thing that we need to do as business owners is we need to dive into the profitability side of the practice. And where's the profitability? Well, it really lies in just a couple of places. One, it lies in how good you are at collections. Mm-hmm. And of course, collections are also driven by how good you are at layering in services in your treatment plans Now, I would never tell you to do services that the patient doesn't need.

That's not what I mean. If the patient only needs an adjustment, great. Only do the adjustment. But how profitable are your treatment plans? How profitable is your fee structure? When was the last time you even looked at it? Some of you're sitting out there thinking, I don't even know what my fees are, which is fine.

I don't know that I really always knew what mine were. Well, I did, but um, You did when you figured them out. And that's another layer that I wanna add into this as well. You have to look at and, and you have to look at it from a minute by minute. Remember how I just said I broke everything down to the day to the hour?

So when I look at my services, I look at the amount of time that it requires to provide a certain service, and then I look back at what my hourly rate should be. And I always base that off of, okay, if I were just adjusting patients, what, what would my hourly rate be? Mm-hmm. Now I wanna back that in and I wanna look at exams.

I wanna look at needling. I wanna look, if I, you're doing counseling for nutrition services, what should the cost be on that now? You can, you can look at it and you realize that we've talked a lot about this. When you do first day services like exams, you're probably gonna lose a little money on the exam.

You're not gonna be able to charge for the exam. Hourly rate. Yeah. What? Yeah. And, and so that's not gonna happen. But you want to approach that you want to get close is you don't just want to throw a nominal number out there and go. Well, you know, this looks really good. And I think people, that's going back to that poverty complex where you're trying to play, let's make a deal.

When you lower that exam price, you're not doing a special, you just every day have the exam price lower than it should be. So you're actually losing more money than you should. So, analyze the services you're doing, how long they take to, uh, provide that service, and does that fit into the hourly rate model that you've got so far as your adjustments go?

It's a good way to back into it. Exactly, and if you haven't raised your fees in a while, there's still, I think a small window of opportunity to raise them a little bit. But here's one thing happening right now. The C P I number, which is consumer price Index, has started to bend just a little bit here as we come into the middle of the year.

And what that means is that the consumer appears to be hitting their tolerance on prices. And so we all know this, gas prices are up, eggs are up. And, and we're starting to see some things actually settle back down, but that's because of the CPI. So as that CPI starts to bend that window of opportunity to raise your fees kind of starts to close up just a little bit, because that means people are really paying attention.

So, but if you haven't, again, you may still have a little bit of an opportunity, and here's one way that you can raise them and still offer patients a good deal. Use a TPA. What am I talking about? CHIRO HEALTH USA is a great example of a TPA. It allows you to create a legal discount program for your patients, and there's a real nice way to set these up.

It creates a membership program in your practice. It allows patients to have a good deal and some of you're out there going, I'm not doing that. I'm not that. That just doesn't sound right in my practice. You know what? Patients are used to it. Every doctor they go to, whether it's the dentist, the eye doctor, even hospitals have these now.

Mm-hmm. They have these discount programs to help with services that insurance doesn't cover. And what's one primary thing that insurance doesn't cover? The maintenance adjustment. So the TPA also allows you to quit playing the insurance game with your patients and your care plans. And move patients really simply over to a cash base, cash base fee schedule.

And that really helps your profitability in the long run. And when you look at the CPI and we're all looking at that right now because we're going, okay, are people maxed out? Do people have expendable income? I. Chiropractic has become an integral part of people's healthcare. Absolutely. So they're gonna utilize it.

But here's two things you look at. Number one, what are the, what are the other doctors in your area? What are the other chiropractors in your area charging for similar services? Mm-hmm. That's always a good place to look. The other one is how much demand. Do you have in your practice? If you're a practice that's you know, maybe you're flailing in the water a little bit right now and you're trying to figure out a way out of it, maybe now is not a time to raise your prices.

Maybe now is the time to figure out how to get the word out there. But if you have a large demand in your practice, sometimes, and I'm not gonna say every time, but sometimes that indicates that maybe your pricing is too low. Right. You know what I mean? It's like if you go into the store and you see bubblegum for a scent.

You're gonna buy 99 of them. Whereas if it's, you know, 25 cents, you're gonna buy four. So, in other words, if you have a huge demand of patients coming into your practice, it may be an indicator that, hey, my pricing is so low that everybody's being driven into that funnel. And I could raise my prices a little bit.

I could maybe do one or two things, either see more patients, or if you're already fairly full, you, and you know, like in my case approaching 60, I might wanna back off a little bit. If I can make the same dollar amount and see one less patient an hour, it's easier on my body. So there are a lot of ways to look at it when you, when you do, uh, when you do look at your pricing.

But that consumer price index is something that you have to keep in your peripheral vision because you do, it may be something we're dealing with over the next year to 18 months. Yep. Uh, probably at least. Yeah. And so the other thing that drives profitability is how you put your treatment plans together.

So I touched on this a minute ago, but I wanna dive into it just a little bit more. I know a lot of doctors, especially when the economy starts to tighten up just a little bit, we wanna run to poverty complex. This is not a time that you have to run to poverty complex. Give the patients what they need. If they need the care, show 'em what they need.

Teach them why they need it and help. Help them understand why they need it and give them the care. Patients will pay for it if they find value in it. So we have to value promote. Mm-hmm. We have to help. Mm-hmm. Our patients really understand why they need care and why it has good value to it. So look at the value built into your plans and how are you presenting those plans and docs.

One of the things that knocks practices down is having the PRN mindset. Now. Mm-hmm. We have an article about this coming out in one of the chiropractic rags here, I think in a few weeks. So I'm not gonna, I'm not gonna knock the cover off the ball here because you can read about it. But, um, having the pr mi, pr r n mindset does nothing more than tell the patient you're good to go.

You don't need chiropractic again unless something happens. So I'm quitting you. Mm-hmm. And patients will not come back. And if they do that a couple of times, they come in, they see you three times, and you say, well come back when you need to. And then six weeks later, something happens and they come back in, they got the same pain, they come see you three times, and then you tell 'em, well come back when you need to.

You do that about three times. They're gonna quit coming to you, period. Because they're gonna finally say, you know what, I keep going back to that doctor for the same dang thing and he, and it keeps coming back, so I'm gonna try somebody new. That is an incredibly damaging mindset for your practice. I think it's probably worse than poverty complex, but the two are kind of coupled together sometimes.

To me it looks like when, when we approach patients from that standpoint, I. It, it does a couple different things. Number one, it, it looks like that from, from my viewpoint when I'm looking at you, it looks like that you're, you're either unwilling or unable to educate that patient as to what the true dangers of subluxation are, right?

Because we all, we've all seen it. We've seen patients that are an absolute abject train wreck, and. The only thing they're worried about is their pain response, because that's what somebody else has told them is only worry about the pain side of this. Uh, you know, a kind of a tough example is, is one where I, I use with patients at times when they talk about that, and I say, just think about this for a second.

If you go to your cancer doctor and you tell 'em, I feel pretty good today, and they just go, okay, just call me when it hurts again. You would think that was just nuts. But because we've perpetuated some of this in chiropractic, unfortunately the patient relies on that pain response because they don't know what else to rely on.

Does that make sense? Because they have no way to gauge when they do or do not need care other than just pain response. Yeah. You hit the nail on the head and my question to you is, can a patient be subluxated without pain? Yes. Yes. And so there are many other factors involved in a subluxation. Even though the pain may have subsided, you may have lost a range of motion, you may still have spasm that when you palpate it, they're not palpating that air and going, does it hurt right there?

Oh, if I push right there, it really hurts. They're going, I don't really have any pain. And the second you touch 'em, they go, oh doc, that's really sore right there. Yeah. So do they still have some pain? Yeah, it's just kind of hidden. And so I, I struggle with that from a standpoint of I want patients to be not only pain free, but I want 'em to be functional.

Absolutely. Absolutely. Plus you, you want to limit the damage that the body does naturally over time. You know, think about Wolf's law. Plastic deformation happens when you put, uh, Pressure, abnormal pressure on normal tissue, even bone. Mm-hmm. It will remodel. Yeah. And if we just allow that to happen, have we done a disservice to the patient?

I think so, yeah. And then you can get into a hundred, we could go 80 different ways with this. We could get into arthritic damage due to aging and start talking about, you know, is that something that happens naturally? Is it more of an autoimmune problem? Should we also be teaching, teaching patients about gut health?

We're, I mean, there's so much involved in this that doesn't say, it doesn't scream prn to me. No, it, there's nothing PRN about chiropractic in my opinion at all. So I agree if, if you're having an issue with that, I mean, this is, these are everything we've talked about are reasons why you need a good, solid business advisor on your team right now.

Here's the funny thing. In times like now, times like where the economy's really tough, there is more money made in down economies than at other times. Mm-hmm. So, and as crazy successful as chiropractic is right now, this is the time to be in the game. But you gotta be in the game correctly. And so you need business advisors who understand.

How to play the game correctly and how to make the little shifts and changes along the way. because at some point, Troy, you said this, we're gonna slide back out of this, you're gonna have to change again. Depending on how tight it is, you're gonna have to make changes. So this is when you need somebody really watching over your shoulder and saying, Hey, let's do this, or let's change this.

We're like little mama bears. That's right. We help, we help guide you in the right direction. So, no, but truly sometimes it just takes that, you know, even with my own healthcare, I just had an appointment not too long ago and met with somebody, uh, about my own health and, and, and she said to me, why?

What is your main reason for being here? And I said, because I can't be trusted to. Take care of my own healthcare as well as I should. I need someone else to point their finger at me and say, you need to do this. Absolutely. So they're, and you know what? My patients need that as well, but when it comes to coaching and business, It's the same concept.

Sometimes we need somebody from the outside looking in to help push us in the right direction because paralysis by analysis is a real thing, folks, right? And you guys don't stock you guys out there. You have time to go be doctors and then you need to have a family life. Mm-hmm. Let us do the research and come up with the innovations and those kind of things.

And then help you layer it into your practice as it's needed. So do yourself a favor. Go check us [email protected] if you haven't already. There's all kinds of information on there. You can see the different programs we offer. We've got everything from deep dive one-on-one consulting to some great subscription programs.

If you're just looking for that, that business based information, whether it's patient communication or how to market correctly, or the artist setting fees or whatever it is, we talk about all aspects of your practice. And so go check all that out. Check out the downloads and make sure that you're subscribed to our weekly podcast.

Which if you're listening today, you probably are, but tell your friends about it too. Because we, we put these out every single week because we're chiropractors just like you, and we had great success and still do in practice, and we wanna share that with people. So, all right. That's my 2 cent plug. I think that's a great 2 cent plug.

And, and honestly, you know, sometimes we look at where we're at and we think it takes such a major change and it's amazing sometimes the tiny baby steps that we can give you. That make big changes in your practice. That's, and that's what I really, that's love. That is sometimes a little tiny change changes the whole barometer and brings the whole staff back together in excitement about what you're doing.

Because face it, we all have hills and valleys in our practices to where we're not as excited about going in that day as we were yesterday. So sometimes just small changes in your practice are helpful. Absolutely. Yeah, give us a holler. Great spot to end there, Troy. Thank you.

All right everybody. Thanks for listening to the KC CHIROpulse Podcast brought to you by Kats Consultants…helping doctors keep their pulses on success.

So go check us out at KATSCONSULTANTS.COM and we will see you next time.