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144: The Chiropractic Agreement Part 1

chiropractic business managment Oct 08, 2023
Kats Consultants
144: The Chiropractic Agreement Part 1

144 The Chiropractic Agreement Part 1

The Chiropractic leaking phone call. Wow. Doesn't that sound interesting?

Hi everybody. Welcome to the KC CHIROpulse Podcast brought to you by Kats Consultants, helping doctors keep their pulse on success. I'm Dr. Michael Perusich joined with my cohost, Dr. Troy Fox.

All right, Troy. We've talked about this before.

You've talked about this a lot. Who is the agreement between, and everybody's going, What's the chiropractic leaking phone call? But I want to start with this. Who's the agreement between? Is it between the doctor and the patient, the patient and the clinic, or the patient and the staff? Where's the agreement in that clinic?

It's always between the doctor and the patient. We're the ones that are talking with the patient about their condition. We're the ones talking about talking with the patient about what needs to be done to impact that condition. And so as a result, We're the one that makes the agreement with the patient about treatment, how often they're being treated, when they're going to be treated, and what services are to be provided at that point.

That's all handled by the doctor. So by the time they get to the front desk, it's a matter of scheduling. It's not a matter of coming to agreement. And I want to pick that part. Just a second. We're going to go step by step through this. Okay. So doctors, you do a great exam. You start building a great relationship on day one, day two, you do the report of findings and some of you may do the report of findings on day one, that's, that's fine, whatever works just so you're doing it well, but you do it well enough that the patient looks you in the eye and says, yes, doctor, I want care from you, I'm committed to the process that you just explained to me that has a verbal agreement.

In, in law school, they teach would-be attorneys that that is a legal contract. Basically. No, we're not talking about contracts here. We're just talking about agreements that have been set. So if that's the case, if the doctors established an agreement with the patient, what's next? Yeah. So next is that the patient arrives at the front desk and they got a schedule and the staff facilitates the process that's already been agreed upon.

Exactly. They support what you just told the patients already agreed to care. That's why they're at the front desk. They're getting ready to schedule. Great. They schedule. And that seems to be the easy part. In a lot of cases, most doctors get through this part of it. Pretty good. Then we have a couple other things going on.

Number one, staff training that staff needs. To be an extension of you, so staff training is important, but even with good staff training, we sometimes end up in the leaking phone call situation. Do you want to describe what that is? And then I can, I can talk a little bit more about, about that. Hi Fox chiropractic.

This is Michael. I need to cancel my appointment for this afternoon to which the staff says one of a couple of things. Now, if they abide by the agreement, what does the staff say, Troy? They say, Oh no, what's, what's going on today? Oh, uh, my son broke his thumb. Oh, okay, well, no problem. What day works better for you this week?

We've got some time on Wednesday afternoon. Would that work better for you at this point? And if they say, well, I'm going to, you know, I've got something going on all week or whatever, you know, I'm not the best at staff verbiage, but then Bridget usually will say at that point. Okay. Well, let's go ahead and get you on the schedule first thing next week and get you back on track with your appointments.

And we would add one more thing to that. We would add if it's going to be that far out five days was the line in the sand. It's going to be more than five days. We'll let the doctor know that you're going to be slightly off your treatment plan. And he may talk to you about a catch up schedule. Okay. Mm hmm.

Yeah. Absolutely. Okay. So that helps support the agreement that the doctor and the patient have. Okay. But if I'm Michael and I call up and I say, I need to cancel my appointment this afternoon and the staff says, Oh, Oh, do you like, would you like to reschedule? Yeah. Okay. I'm sorry. That's nails on a chalkboard for me.

And I literally just got the, the goosebumps or whatever. Yeah. My arm from that. What? What? Why? Why? Why? Why does, why does staff do that? Okay. Had they been trained to do that? No. Well, we hope not. Yeah. And I, I want to talk about what good training is here in a minute, but we hope not. And hopefully you've worked with your staff to develop them, to have the communication strategies and tactics down so they know how to handle those calls.

But why would a staff person come back with, would you like to reschedule that? That puts all the control into the patient's lab and, and the natural. Answer to that is no, I don't want to reschedule. So it's, it's, it's simple psychology because when you put it back to the patient at that point, they're busy, they got a lot going on in their life.

And right now they've had some sort of event that upset the apple cart, right? Whether it's a death in the family, their son broke his thumb, or maybe their work schedule just got in the way today. So that's, you know, no big deal. We, we work around those situations all the time. But if you say, would you like to reschedule my instant responses at that point, when I've had an upset of the apple cart moment is no, and with that handout, right, no, I'll just get ahold of you later.

And the problem is. That may that, that one, at least I know what's going on. If they come back to me and say, so and so had a business meeting and their son broke their thumb, but if they don't reschedule at that point, the next thing that has to happen. And sometimes we struggle with this one as well, is a complete note in the patient's file explaining why there's a disruption in care.

So the doctor understands it and the staff understands it when they call back, Hey, how is your son doing with his thumb? Um, let's get you back on the schedule or let's look at what we can do to schedule you. So we're going to do a follow up call with them if they don't call us back in the next couple of days.

Yeah. So there's some simple things that have to happen, but what are those all have tied together? They go back to the agreement that I made with my patient. And they agreed upon and said, yes, I want to get care. I want to get better, or yes, I want to start a wellness maintenance program with your, with your office.

They've agreed to that. And so I've got an agreement. I've got a verbal agreement with them. The staff's job is to support that. And so when we drop the ball, that creates some other problems. And you may want to add a couple more things to this before we go to the next step of what it actually creates.

Yeah. So there's a couple other triggers in there that I just want to point out cause there's some missed opportunities. So we'll use your broken thumb example. If I call in and my son's had a broken thumb and you asked me if I want to reschedule tomorrow, you're talking about rescheduling to tomorrow and I don't know yet my schedule.

I might say, you know what, let me see how all this plays out. I got to figure out what I got to make up at work and so on and so forth. I'll call you back. To which you can either say, you can either put that in the patient's lap to call you back or you can take back control by saying, you know what, totally understand emergencies are crazy.

We'll call you at the end of the week just to see how you're doing. Okay. I just took that whole thing and instead of letting the patient walk away from the clinic for a minimum of three months, if not a lifetime, I just took the opportunity to build a relationship and an even stronger relation because of that.

Patient's going to walk away from that phone call going, wow, how nice are they? They're going to call and check on us. So don't let those missed opportunities happen. There's some great opportunities when patients call you like that in those scenarios that we can either let them go or we can take the opportunity to build the relationship even stronger to where they want to come back more.

Yes. And it's all about loving up on our patients. Right? So if I truly care about my patient and I'm concerned about their health and I'm concerned about their wellbeing, those are the natural steps that you should take, right? To make sure that that patient gets care. If this were your brother, your sister, or your mother or father, and you were in the same situation with them, man, let's say you're treating your father.

And you know that he needs to be seen at this point, three times a week. You're like, man, you got something going on right now that we really need to work on and I need to be consistent with you. My dad calls you and goes, Hey, mom had a fall. We got to go to the hospital. I'm not going to be there for my appointment today with you.

We're going to immediately make sure we reschedule that. We're not going to ask, do you want to reschedule? We're going to say, Hey, go ahead and get mom taken care of. Or we're going to holler at you here in a day or so, we're going to check in on you. And the first thing I'm going to ask is with, with true, with true concern, how's mom doing?

Right. You know, obviously I probably would know that, but you know what I'm saying? Yeah. If it's, if you're checking on somebody, you want to find out one, the apple cart upset moment. What's going on with that are things better because here's the thing, my patient is also under emotional stress as a result of that, which is going to do what it's going to compound their condition.

Yep. So there's a lot going on with that. It's, it's a, it's a real complex moment, but our patients really appreciate, yeah. And our patients appreciate when we, when we check up on them and we follow up with them, because in a lot of cases, what happens we get busy and we forget. Yep. You know, it's like follow up texting when we follow up with a patient and a patient does not respond to the text message.

Let's say I've got somebody that's, uh, really doesn't know their schedule and they're a traveling salesperson. I've got a couple of guys like this that it's like, Hey, we're going to set up a monthly appointment. We have no idea what day we're going to be able to set it up. So we have them on. Maybe a monthly text message.

Sure. They don't respond the first time. So my, my deal with them is here. I'm not here to push you, but I am here to support you. And my job is to make sure that we keep consistent care with you. So I'm going to, I'm going to message you. And if you don't respond, I'm going to wait a day or so. I'm going to message you again.

If you don't respond that second time, at that point, from a psychological standpoint, I know you got my messages and I know that you're aware. I'm going to leave it alone and I'm gonna let you go at that point. Now, some offices, depending upon where you're at, if it, you know, we're in a small rural community.

Most people are going to follow up. They are going to get back with you. But if you're in a, you know, a busy metropolitan area, you may be putting another message. You may say, Hey, I'm going to get ahold of you twice. And if I don't hear from you, we'll wait a couple of weeks and then touch base with you.

So you have to figure out what your policy is going to be, but there should be some sort of followup if you actually care about the patient. So if you think about it that way, it's really important for you to follow up. Not only from a standpoint of your practice, but for the welfare of the patient.

Absolutely. Hold that thought because I want to just let that soak in for everybody. We need to squeeze in a word from our sponsor here, but we're talking about the chiropractic agreement and that agreement is between the doctor and the patient. and how our staff should be supporting that. And sometimes we get in these situations where we have what we call the chiropractic leaking phone call where patients leak away from the practice because we just didn't handle it right.

So we're going to come back and we're going to talk about that some more. And I want to talk a little bit about what good training is all about. Get your staff. working with you towards that agreement. So we'll be right back.


Hi everybody. Welcome back to the KC CHIROpulse Podcast. We are talking about the chiropractic leaking phone call, which really is about the agreement that the doctor develops with the patient, where the patient becomes engaged in the process of, uh, accepting care and how the staff can support that process.

And Troy, we've, we've talked a lot about. How these scenarios come up and how, you know, when a patient calls and needs to cancel an appointment or something, how there really are some great opportunities there to really build and strengthen the relationship. Now there, there are times when a patient's not, you're not going to find that opportunity.

There are going to be a small percentage of patients who call and say, Nope, I will call you back or I won't be back or something, but let's, let's train our staff. To, to be able to handle even those calls a little bit better, at least find out why they're not coming back. You know, that's only fair. It is.

And I think it's important for the doctor to know, because if, if there's something, maybe it's a personality conflict, maybe it's a technique conflict, maybe it's just simply that the patient wasn't going to get better no matter what you were going to do. And it's time for a referral and maybe you missed an opportunity to refer that patient out.

So. You need to know when those situations happen. So you can self evaluate and look at it instead of beating yourself up. What can I do better next time? What did it, would it have been appropriate for me to refer that patient back to maybe some further imaging? Maybe they need some physical therapy.

Maybe they need to go back to, uh, you know, and really, we don't do much of this anymore. Back to your medical doctor for pain management. Cause we're not seeing much of that anymore. Now it's literally what I'm seeing a lot of is. Take some ibuprofen and yes, you should be seeing your chiropractor, which I think is wonderful news for us as chiropractors that we're dealing with those situations, but we have to be appropriate with it.

And sometimes, and I've, I saw this just a week ago or so, when I referred a patient back to their medical doctor to ask a couple of questions and gain some support, they came back from their medical doctor and their medical doctor said, we're doing exactly the right thing. You need to go back to your chiropractic and continue care.

And so there was an opportunity that, that could have turned out if I hadn't have referred them back, it might've been a situation where the patient dropped out of care and just said, I'm not coming back. Well, at that point, all you can really ask because we work for them, right? They're our employer. So if they say I'm not coming back and I'm Adam adamant about it, what I'd like to know in the notes is why, why, you know, Why that way I can get better at what I do.

My trade, my craft has to become better. It's not an affront to me, right? I may feel like it is at the time. Cause a lot of us wear our hearts on our sleeves. We want our patients to care, care about us as much as we care about them. But that's, you know, that's, that's the end situation, but the staff has to be able to handle that with empathy.

They, they have to be able to talk to that patient and say, you know what? I get it. Can you, can you at least tell me why if you don't mind sharing that? And we say that a lot. If you don't mind sharing that, if they do not want to tell you, then they are not bound to tell you. But if they're willing to share in a lot of cases, they will because either a, they have a grievance B, maybe, maybe they're just one of those patients that you didn't get through to and they feel great.

Well, I want to kind of. know that, that they feel great. They feel great. They just didn't understand why they were still getting care. So you've got those situations. Um, and, and those, you know, those do get frustrating, but at the same time, we can avoid a lot of that with staff training, staff training.

Yeah. And you know, I had a patient one time that called and canceled right after her first adjustment visit, she called that night and canceled the next appointment or, or probably a couple of weeks worth of appointments. And my, my staff was trained to say, Oh my gosh, what can we do to change that? Why did you change your mind?

You know, whatever they said, and it was all because that particular patient had only been to a chiropractor who did one technique. She had moved to our town. She thought all chiropractors did that technique, but hadn't said anything to me about it. And I adjusted her using a different technique apparently, and she didn't like it.

So my staff said, look, come in, Dr. Perusich does all kinds of different techniques. Maybe he can do something different. She came in, tells me, it's funny, she told me that she'd only ever had activator. She thought that's what chiropractors did. I'm like, Oh my gosh, if I'd have known that I do activator.

Yeah. So she's like, Oh, well, great. I didn't really want to leave the practice. I just didn't like the treatment. I'm like, so we changed it. Right. We saved the patient, but had my staff just said, okay, well we'll just cancel all your appointments. We'd have lost a patient who wound up being a great patient, was a patient for years.

Mm hmm. And you learn something from that. And, and it's the same thing I've learned over time to ask patients, have you received chiropractic care before? How long has it, how long has it been and what type of treatment did you get when you were going to the chiropractor before? Was it Hands on adjusting treatment.

Did they put their hands on you? Was it a tool that they adjusted you with? I always ask that question because they may or may not have a preference. And then I ask, once they tell me how they were adjusted, did you like the technique that was used and was it effective for you? It's a really great question to ask.

But I, I learned, I learned that from a bad situation from a patient quitting care because I did a different technique. Yeah. This is, this is why y'all out there need us as your coaches, because we've made the mistakes. We can tell you which ones on your own, or if you do make the same mistake, we can help you overcome it.

But anyway, um, so let's talk a little bit about staff. Okay. And what we're talking about. Asking staff to do. I don't think it's very intuitive or innate. Maybe it's just not innate. I think it's innate in our nature to when somebody sounds like they're negative on the phone and they want to cancel, which is negative terminology.

I think our instant reaction is I got to get off this call as quickly as possible. And so the natural reaction is okay. No problem. You're all canceled by. Yeah. And so we need to create The A different thought process for our staff. And so we need to train them. And I want to talk about what training means.

But more importantly, more importantly, we need to develop them. So here's what I hear doctors do a lot of times. We have a procedure manual. Here's our procedure manual. New staff person. Read it. And by the end of the week, I expect you to be proficient with everything in there. That's teaching. That's not training.

That's what we did in school. We're given a book. It's supported by maybe a little bit of a lecture. We try to take some notes. We study the notes. We go take a test to prove that we have the knowledge, but it's knowledge that goes away. immediately unless there's reinforcement to it. So that's the same thing that happens in our practices.

If all we're doing is teaching because we walked them through it once and we gave them a book to read, it's never going to stick. So training is that process of actually talking about it, letting them see it, letting them read it, and then doing it together over and over until they get to the point.

Where they can do it on their own and teach somebody else how to do it. That's the development part. And I would throw in there that reinforcement is important, ongoing during your staff meetings. You should revisit this topic on a regular basis because your staff is not static. Maybe yours is. Maybe you're a way better manager than I am and you've kept your staff around for 30 years.

We do have people that stay and love to be in our practices. Sure. We also have staff turnover and we're going to have new people coming in that are excited about chiropractic excited about what our practice is doing and can't wait to get there. I've got one right now. That's getting ready to start. But you know what?

I don't know what she would say on the phone, but I have to train and we have to train and then we have to talk in staff meetings as well. And the reason part of this topic came up today yeah. Was because even with a well trained staff missteps occur. So reinforcement is so important for our staff members.

So that way they can be successful at their jobs because they truly do want to support you. Sure. And they want to do it sometimes. Sometimes they make a misstep and as a result of that misstep, you may feel like that you've got a leaky bucket. Basically, it's like, wow, you know, the patient, I talked about all this stuff.

We agreed upon it. The patient seemed to be happy with what they're doing. And the next thing, you know, you are like, wow. And three months and the patient calls and goes, you know, I haven't been in there and I know you guys tried to call me, blah, blah, blah, you know, and I need to get back on the schedule and it's a really good opportunity to educate again at that point.

So sometimes it's not all is lost, but same time, I feel like we lose ground with that patient's care and something that was supposed to be very supportive for them. Had a huge disruption in it. I hate to see that for our patients and our staff should see it that way as well. It's a disruption to their care.

It is. And we all know, especially in an acute care, uh, treatment plan. If you get your visits too far apart, not going to make any headway. The body's just going to fall back into its natural positions. And then Wolf's law is going to jump in and take over. So we always like to bring up Wolf's law, but training and development has to be something that we implement into our practice as a regular ongoing, uh, ongoing program, and we need to be listening to our staff or somebody needs to be listening to our staff and.

We need to be creating the culture where it's okay to make mistakes. We learn best from mistakes. So when you make a mistake, let's talk about it. Let's, let's make sure that we're overcoming the mistake and not making it a habit. And that's, that's truly why at Katz Consultants, we work with not only the doctors, but we work with staff as well.

You have to develop, because we don't expect you to do all the training. It'd be great if you had time to do it, but docs, you're busy. We get it. So we help you with the training portion of this. We do it in a way where other staff members, other, other folks that have been chiropractic assistants over the years and have become very adept at it.

Very good at it. Understand the psychology. of the patient, understand the relationship between the patient and the doctor, step in and say, here's how we do things. You know, we hear this a lot from doctors that they think coaching business consulting, they think it's a burdensome amount of time on them and doctors.

We know you don't have a lot of time. We're doctors. We get that. We have practices. You know, we understand the time commitments and that's why we developed cats chiropractic business consultants into something that's. team engaged and staff driven. So consulting works best when your team and your staff are driving the process, when they're engaged in the process, when they're managing it for you and all you have to do is have them.

Tell you, Oh doc, you've got a webinar. You need to be on. It's, it's only going to be 15 minutes long. So go jump on it. Or your coaching call is in 30 minutes. Here's what you're talking about today. And at your staff meeting, your staff's telling you here's, here's the webinars that we've watched this month.

We're working on our CA certifications. We've had our coaching call and blah, blah, blah, blah, blah. And here's the marketing we're doing. And so forth, that should be an engaged team, but you don't get to that point. Your practice doesn't become staff driven until you've done development and you've built everybody together in that process.

And that's what we do at Kats. We bring the entire team together. So it takes the burden off of the doctor. So the doctor can do what we do best. And that's deliver great patient outcomes and build patient relationships and engage with the community. So people want to come for lifetime, but we can only do that when we've got that team behind us really helping to support us.

Like we first started talking about with the doctor patient agreement, your staff is there to support that. The reason we get involved is because that, that, that development is a process. It's no different than when a patient comes to you to get care. It takes time. It takes some repetition. So you gotta get reps in and you have to work on different aspects of it.

So it is a process rather than an event. We don't just dump a book in your lap and go here, read the first 300 pages and you'll be good to go. No, it's a process that we walk through and that's why there's coaching calls. That's why we have events where we talk about here are the steps. You know, to this aspect, to that aspect, you know, and every time that we do, uh, one of our virtual seminars, we're talking about a very new area.

In other words, we're going to break it down and we're going to pick one area typically that we need. For that, for that actual workshop or seminar, whatever you want to call it at that point, we're going to train you in one area, your staff's going to be involved. You're going to be involved that way.

You guys are all on the same page. That's the wonderful thing about what we do is we involve staff and everything you do. It's not just you doctors sitting in front of a computer screen, listening to us. And you have to go back to the staff and somehow train all that. No, we take care of all that for you.

So this is a great topic. And I know a lot of doctors out there are suffering from the, the impact of staff not being developed well enough that they're losing these opportunities with patient phone calls and scheduling changes and patients wanting to cancel schedules and, and so forth. And We just want you to know there's a, there's an easy way to handle this.

And part of that's in training and development. Part of it is being armed with the right verbiage and communication strategies and so forth. And those are the kind of things that we help you with at cats consultants. So if you haven't done so go to KatsConsultants.com that's cats with a K - K A T S Go to KatsConsultants.com

Check us out You can see a lot of the the information on there that we have you can go to our blog. We've got some free downloads on there. Check out what we do. We've got different membership options and so forth. And if you're ready, if you're ready to take the next step, if you're ready to go the path to prosper or the path to mastery, um, jump on our calendar.

Let's do a quick call. Let's talk about your practice. We don't accept everybody into our program. So let's find out if you're the right kind of doctor, we're the right kind of fit for you. And if you're, if you've got the right kind of drive, To be a Kat's Mastery client. So, all right, Troy, anything else to add?

Nope. I think we covered it today. Okay. Awesome. Everybody. Well, thanks for listening to the KC brought to you by Kats Consultants. We'll see you next time. See ya.

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