223 Are you in a race to the bottom?
Jul 27, 2025Welcome to the KC CHIROpulse Podcast.
This week’s topic: Are you in a race to the bottom?
The KC CHIROpulse Podcast is designed for Chiropractic professionals ready to elevate their practice to new heights. This week, the show is hosted by Kats Consultants’ coaches Dr Michael Perusich and Marisa Mateja, seasoned experts in Chiropractic business management. This podcast provides invaluable insights and actionable strategies to help you create a flourishing and sustainable Chiropractic business.
In this episode, we discuss:
- Why setting your fees too low can can wreak havoc on your practice
- How low fees affect more than your bottom line
- Why your fees must be strategic or face eminent financial disaster
- How to build value in patient’s minds over cheap
- …and so much more…
In each episode of KC CHIROpulse, we delve into crucial aspects of building a successful Chiropractic practice, covering topics such as establishing a strong foundation, adopting a patient-centric approach, mastering marketing techniques, achieving financial fitness, fostering effective team building and leadership, integrating technology and innovation, and navigating common challenges in the field.
Whether you're a seasoned chiropractor or just starting your practice, the KC CHIROpulse Podcast offers a wealth of knowledge and personalized practical advice to help you navigate the intricate world of Chiropractic business. Join us on this journey as we explore proven strategies, share success stories, and connect with industry experts to empower you in your pursuit of building a thriving Chiropractic practice.
Don't miss out on the latest insights and expert guidance. Subscribe now and unlock the secrets to taking your Chiropractic practice to the next level. Your success is our priority at Kats Chiropractic Business Advisors.
DISCLAIMER: The information presented in this broadcast is for educational purposes only and is not intended to offer legal, investment, accounting, or medical advice, and represents the opinions of the speakers. Seek the consultation of a professional for advice in those areas. And remember…your results using this information may be different than described.
Dr. Michael Perusich:
Doctors, there's a high cost to cheap care. Hi everybody. Welcome to the KC Chiro Pulse Podcast, brought to you by Kats Consultants and Chiro Health USA. I'm your host, Dr. Michael Perusich, and I'm joined by my co-host, Dr. Marisa Mateja. Well
Marisa Mateja:
ha I call
Dr. Michael Perusich:
you a doctor. You should be a doctor. how are you today, Marisa?
Marisa Mateja:
I'm good. How are you?
Dr. Michael Perusich:
Always good.
Marisa Mateja:
Okay, good. Yeah, so for everybody
Dr. Michael Perusich:
out there we work together every day. So yeah, we I already knew how she was. Anyway. Um, Marisa, I, this topic is one of these pet peeves of mine.'cause I think. We've got this race to the bottom going on with everybody's pricing strategy and chiropractic. And I, I just feel like it's strangling the profession in so many ways. There's such a danger to competing on price as opposed to competing on value. Yeah. And when you separate value out and show the uniqueness of your practice, you really don't have any competition.
Marisa Mateja:
So why do we keep
Dr. Michael Perusich:
driving our pricing down?
Marisa Mateja:
We saw that in the community we were in, there was six or seven chiropractors with all within a couple miles of each other. Yep. And. There was a huge comradery between some of the others that always wanted to price themselves equally so that they felt like they took some of the competition out. And it was then people could just pick by doctor. You can still do that. It's on value. We came into the market and we're probably the highest priced. Not probably. We probably, we were the highest priced chiropractic office. We probably within 60 miles and we had no issue. We were the busiest clinic around. So I don't think, I think it's more on do people trust you? Do you have value? Are they getting what they need from you when they come into your practice? Yep. I think people will spend money and this is another area where I think docs have a hard time is because they're racing to the bottom. It's more about I don't wanna have the money comp conversation with people. Yeah. Yeah. I think that's what this all stems around is. I just don't wanna tell'em that, Hey. My value is this, you're going to have to pay this. I think that's really what this boils down to. So to combat that, you have to have really good communication.
Dr. Michael Perusich:
Really good. And you bring up a great point. We were the most expensive clinic probably within several counties. Around us. And yet we were the busiest. Yeah. And so we know that you don't have to compete on price. And yet we keep seeing doctors finding it easier to just say I'll just charge$5. And we're reverting back to the early years of chiropractic. And I wanna dive into that just a little bit. We need to take a quick break, but, we're going backwards. When we do that. So we're talking about the danger of competing on price and that there's a high cost to cheap care. So we're gonna take a quick break. We'll be right back.
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Dr. Michael Perusich:
Welcome back to the KC Chiro Pulse podcast. We're talking about the high cost of cheap care. And before we took the break, Marisa, you brought up some great points about you have to communicate value and a hundred years ago or more when chiropractic was new, and most of us, I think. Our education. We've heard the stories about the doctors who had the box on the wall and it was, just put, put some money in the box, whatever you feel like today's value was, what it was, what was it worth to you? And you'd get a couple of bucks or five bucks or maybe on a good day you'd get 10 back then. And I feel like we're reverting back to that just a little bit. I saw on Facebook the other day, I saw somebody advertising an$11 deal. And I've seen these before and I've talked about these before, but it's always a reminder of, oh my gosh, what are we doing? Yeah. When we're offering an$11 first day, and lemme tell you what was involved in the$11 first day, it was a consultation. It was an evaluation and an exam. It was a one region X-ray. So like cervical or lumbar, I guess it was your first adjustment. It was one therapy and a 15 minute chair massage. Wow. Wow. The value, and I'm using air quotes for those of you just listening, the value of that's probably a couple hundred dollars or more. And so you're given away
Marisa Mateja:
time.
Dr. Michael Perusich:
Yeah. You're giving away all this time and all these services. To a patient who now believes that your price is gonna be very low, so how are you ever gonna bring this patient back in and deliver a report of findings and talk about the financial side of care when it's gonna be a thousand dollars or more? It's just not going to compute to the patient. And I think this is why so many doctors doing these low priced deals. These cheap and expensive first days. I think that's why they're having such an issue with dropouts and patients not returning.
Marisa Mateja:
Okay, so think about this for just a second. If I went to a surgeon. To have a consultation. They're not gonna discount their rate. They're not going, oh,
Dr. Michael Perusich:
there's no$11 surgeon.
Marisa Mateja:
They're not going to say, I'm getting you in the door because, or whatever. No it's definitely going to be, here's what the cost is. You may be outta pocket this much. We expect this much. I have, I had a couple procedures done just routine stuff or whatever, and I had to pay$600 upfront. Before I could even do anything. Yeah. And that was the expectation. And did I think anything of it? No. I paid it. And that's the mentality that I think we have to adopt. Is that. Patients know they have to pay when they come to your clinics. Yeah. Don't cheapen yourself. Like you know that there's going to be services that A, either aren't going to be covered by insurance. Yep. Or B, you're gonna have to pay out of pocket for all of it. There, there's a huge line there because insurance has gotten so crazy. Number one in costs and things that, and deductibles are so high that most of the time we're all paying out of our pocket anyway.
Dr. Michael Perusich:
Of course we are. Especially for chiropractic care.
Marisa Mateja:
Yeah.
Dr. Michael Perusich:
Chiropractic care almost doesn't make sense in the insurance model anymore, but I think we have confused affordability with cheap. Yeah. And we think to be affordable, we have to be cheap and. The two are dissimilar concepts from each other. You can still have premium pricing. Yes. If you have the right positioning and communication strategies with your patients and get paid what you're worth, because I'm telling you guys, you're worth more than$11.
Marisa Mateja:
And when was the last time you raised your fees? Are you keeping up with your salary being. Inflationary. Are you keeping up with the times right now and being able to raise what you're getting paid? That means you have to go back to your fees and you have to really look at those. And I see far too many docs not. Thinking in those terms, and thinking about how do I make more money? How do I stay up with the three to 6% of inflation every single year, so I think that's something that, I think that's something that this. Industry then forgets about because, oh, the guy across the street still charging this, so I'm gonna stay where I'm at. Versus it goes back to value and it goes back to what are you worth that you've gotta pay yourself what you're worth.
Dr. Michael Perusich:
So you just made me think of something. What we're really competing against is poverty complex. Oh, for sure. We're competing against poverty complex.'cause I'm here to tell you, you can't set your fees to what the chiropractor across the street has their fees set because you don't have the same overhead.
Marisa Mateja:
I was just gonna say, you don't know what their expenses are.
Dr. Michael Perusich:
And you don't know that at their fee that they're making any money either.
Marisa Mateja:
Exactly. And far too often we see that happening when we look at statistics from offices that are not priced accordingly. They're not covering their overhead and they're really in the negative every month because they haven't stopped to look at what are they bringing in compared to their expenses.
Dr. Michael Perusich:
I think we talked about this in a podcast a few weeks ago, or maybe it was a seminar. I can't remember. Just they all remember. I know, I just remember talking about it. There's this thought process of. There's really two different ways to run your business model and one is to run it transactionally and the other is to run it tally. And so are you a transaction based clinic? Is it, is your clinic all about we gotta figure out a way to get, the patient to pay something and we gotta figure out a way to try to get them to schedule. And the two are disassociated with each other neither one happens, or, we get paid a little bit and then they don't come back or. Are you transforming lives? If you're positioning yourself as a clinic that's transforming lives over the long term and helping people maintain optimal health and wellness. That's invaluable to people. Yeah. And we know that since the pandemic, people value their long-term health so much more, which raised us higher on the totem pole. And yet I still see us trying to do the transactional methodology and lowering the price. And it's like we think everybody out there has to just dip their toe in the water with chiropractic. Like they don't know what chiropractic's about. So yeah, for five bucks I'll, I'll give it a try.
Marisa Mateja:
Yeah.
Dr. Michael Perusich:
People know what you're all about. Get out in the community and get people to know you and see your personality and you'll drive high value patients into your practice.
Marisa Mateja:
Yeah. And give exceptional service period. Like Exactly.
Dr. Michael Perusich:
What kind of an experience are you creating? Yeah.
Marisa Mateja:
If you're creating an experience that people are craving, we'll say. Then they're gonna stay with you, yep. If you're creating relationships that people need and want in the medical community, they're not a number, they're not just a last name walking in, they're more than that. You know about their lives, you know what they're doing on their weekends, things about them that you can then connect back to their care. The value's very high for people.
Dr. Michael Perusich:
It's very high. Yeah. And everything for me is, as and most of out there, everything for me comes back to the math. It comes back to the numbers. And if you have yourself priced below your profitability point. Yeah. I mean that, that's just insanity. And you may be super busy, and we know of some clinics like this, they're super busy. But their profits like a dollar per patient visit. Yeah. How do you live on that? Yeah. And think about that. Think about the danger behind that. If you don't have a good profitability zone or buffer in your practice, what if you have an injury and you have to be outta the clinic for a couple of months? Yeah. How do you survive if your clinic was only making a dollar profit? Yeah. And you can't survive'cause the, you've not been able to create any kind of buffer and you may have money in your checkbook, but Yeah. I gonna say really quick, your
Marisa Mateja:
savings that you do have may be gone very fast. It'll
Dr. Michael Perusich:
go quick.
Marisa Mateja:
Yeah.
Dr. Michael Perusich:
So that lowering of your price, because you think you are attracting people based on price. Puts a tremendous amount of pressure on your practice and you.
Marisa Mateja:
Absolutely. Yeah. And I think there's no need for that. I think it all starts with good communication and excellent service, and finding the patient's true need of why they're there and connecting with that. Once you have some of those key components in place the pricing shouldn't matter that much.
Dr. Michael Perusich:
It shouldn't matter. And we're not saying that you can't be a, I'm gonna call it a discount clinic, a low cost clinic, whatever, but you have to figure out how to make up the profitability somewhere. So you can't be, you can't be low cost and then give
Marisa Mateja:
it all away and
Dr. Michael Perusich:
give it all away. Us. And you can't be low cost And, not see very many patients.
Marisa Mateja:
Yeah.
Dr. Michael Perusich:
You've gotta make it up on volume so you can't be low cost and low volume. You can be high cost and low volume and make good profitability.
Marisa Mateja:
Yeah.
Dr. Michael Perusich:
You can make high cost and high volume and make great profitability. Yeah. But you can't be low cost, low volume. And that's where the rubber, I think, meets the road because in a low. First day fee practice. You're creating so many dropouts and people that won't come back, or people that won't commit to and engage in any kind of a care plan, especially when you tell'em how much it's gonna be because their expectations were set by you differently. It makes it really hard to have a practice like that.
Marisa Mateja:
Yeah.
Dr. Michael Perusich:
Excuse me. Absolutely. We need to take another quick break. We're talking about the danger of low prices and the race to the bottom and how there's just a high cost to be paid for your practice and your success. So we'll be right back.
Kats Consultants:
Kats Chiropractic consultants, your partner in chiropractic success. We are dedicated with one-on-one guidance to bring you all your practice management needs. Let's supercharge your practice. Give us a call today.
Dr. Michael Perusich:
Okay, everybody. Welcome back to the KC ChiroPulse podcast. We're talking about the high cost of cheap. Care, and I think we've beat this to death a little bit, but you know, Marisa, let's, let's talk a little bit about how do you overcome this? And I think the first thing is you have to admit to yourself that you have. Poverty complex.
Marisa Mateja:
Yeah. I think that's number one for sure. And then how do you overcome that? You have to get better at being, I'm gonna say transparent with patients. And it's just black and white. Here are my fees, here are my recommendations. Here's what your insurance is gonna do. If you accept insurance. Yep. If not, here's what our cash plan looks like. And being able to do that black and white. And I would say the biggest advice I could give any doc. Is, get out of the money conversation. Keep yourself out of it. Don't be a part of it. Have your staff well trained and let them handle that. And if you don't have someone who can handle the money side and be black and white with your patients, find them.
Dr. Michael Perusich:
What did I tell every patient that asked me something about money?
Marisa Mateja:
Go see Marisa. Yeah, I have no idea. I wasn't always at the front desk, but yes. Go talk to the front desk. I don't know what things cost. Keep yourself out of it. I think that's such a huge benefit to docs. Let you have that good heart, that good caring nature, all of those things, and want to take care of people. On the care side. Yep. Don't get yourself mixed in. That's where everybody falls down, I think. Is when they get mixed in with, Ooh, I wanna be caring, and then I want to, oh, I'll give you a deal, and I'll do this for you. And it's don't play. Let's make a deal. Get out of the conversation and your practice will go up if you have somebody in that place that doesn't mind being honest and transparent with somebody and being able to tell them, here's what. Insurance is gonna do, here's what your costs are, here's a payment arrangement, let's move forward.
Dr. Michael Perusich:
So I think it comes down to three basic things. One, you have to have a good fee strategy that creates profitability. Yes. Number two, you have to understand. The communication strategy behind the money conversation. And Marisa, you're spot on. You've gotta have somebody in your practice other than you doctors that you can train that can have this conversation. And number three, you have to understand your, not only your overhead, but all of your KPIs, and understand your trends in your KPIs so that you know if you're. Driving the practice in any kind of a long-term profitability zone. And so if you need help with stuff like that. These are the things that we do at Kats Consultants, give us a call. We don't charge you anything to just have a conversation, so give us a call or jump on our calendar, Marisa, tell'em how they can get ahold of us.
Marisa Mateja:
If you go to our website, it's super easy. Right at the top of our website, on the right hand side it says, let's chat. You are welcome to click that and then you can pick myself, Dr. Perusich, Dr. Callo, um, and you can jump on any of our schedules and we're happy to chat with you. So there's absolutely. We're very low pressure. It's, we're here if you need us, type thing.
Dr. Michael Perusich:
Like we're chiropractors, we're, we wear the same shoes that you guys do, and we just want to help you have great success in your practice like we have had. So give us a call. And of course we appreciate you tuning in every week. So and subscribe, wherever that is on here, please. Yeah. We're growing like crazy with our podcast and it's all because of you listeners out there, so we appreciate you tuning in. So from all of us here at Kats Consultants. We thank ChiroHealth USA for being a sponsor as well. We'll see you next time.
Marisa Mateja:
See ya.