Chiropractic S.O.S.

By Laura Newsome

If the reality shows that animate our TV screens offer a window into the American psyche, one thing is clear—we are a country obsessed with makeovers. In recent years we have watched people reinvent their living rooms, their physiques, their worn-out cars and even their sense of fashion. The high end of the reality rehabbing industry revolves around experts who refashion failing businesses into the eye-catching, customer-grabbing, money-making machines the owners always envisioned. These slice-of-life portraits of businesses in peril are so dramatic that it’s easy to forget about the actual experts who help businesses reinvent their images and reach new levels of success every day.

Though not as dramatic as a dysfunctional hair salon or a kitchen serving up bland food, real-life chiropractic consultants help struggling chiropractors reshape their practices, regardless of the stage of the chiropractor or the state of the practice. Offering a range of services from free website materials and informative seminars to tele-coaching and even personal in-practice visits, the job of a chiropratic consultant ranges from answering simple questions posed by chiropractors just starting out to offering much-needed life support for practices mired in low revenue and anemic patient rosters.

“Right now the basic problem of most practices is finding new patients and getting cash-based reimbursements during this challenging time when insurance payments are decreasing,” says Mark Sanna, D.C., CEO of Breakthrough Coaching and a member of the Chiropractic Summit and the board of the Foundation for Chiropractic Progress. “Another big challenge is maintaining a positive attitude during these challenging times and not being brought down by doom and gloom.”

A negative feedback cycle can kill any business, particularly one as focused on vision and wellbeing as Chiropractic. Sometimes a chiropratic consultant’s main job is to reassess where a practice is headed and shake a chiropractor out of negative, defeatist thought patterns. CJ Mertz, D.C., founder of Full Potential Leadership and the 14th president of the International Chiropractors Association, recalls one of his most dire makeover cases: “One chiropractor in the Northeast had been practicing for six years and had never had more than 100 adjustments in a week. He was going through tremendous financial strain, insurance wasn’t paying for his services and he didn’t feel like he could ask his patients for the difference. He was losing money and had lost all confidence in Chiropractic. He called me up and said, ‘I believe in Chiropractic, but I don’t know if I can be a chiropractor anymore.’”

After months of working with Mertz, the struggling chiropractor became one of his coach’s best students. Now one of the top chiropractors in the region, in just 18 months, the once-struggling DC went from seeing 60 patients to 600 patients a week. He now sees about 1,300 patients a week, is financially set and enjoys one of the highest patient retention rates in the profession.

Like many professionals who enter a career based on their love of helping people and perfecting their craft, chiropractors often approach their offices through the eyes of a practitioner first and as a businessperson a distant second. While chiropractic colleges are working quickly to fill this knowledge gap with business and marketing classes, many DCs still struggle with building the patient networks and strong financials necessary to succeed. 

In today’s economy, robust networking is seen as a pillar to a chiropractor’s success. “New patients should come from referrals by other professionals—massage therapists, medical doctors and personal trainers,” says Sanna, a Fellow of the International College of Chiropractors and the author of “Breakthrough Coaching: The Book.” “Going out in the community and meeting as many people as you can, hosting new patient orientations and health and wellness lectures about stress relief, weight loss and nutrition are great ways to find new patients.”

This new model of the proactive chiropractor, who feels at home at a networking mixer as well as an adjustment table, reflects the changing realities of the business. “Back in the 80s, a time when insurance was paying well for chiropractic care, there were fewer problems with revenue and patient drop-outs,” says Mertz. “But by the mid-90s, there was a stark decrease in the amount of services paid by insurance companies, which really changed the canopy.”

In addition to chiropractors being inadequately trained in marketing and never taught how to create robust referral programs, Mertz cites a lack of patient education as the second biggest problem plaguing chiropractors today. With insurance less readily available than in decades past, DCs must educate their patients about the value of chiropractic care so they are willing to pay for their services through specially tailored, cash-based patient care plans. 

Today, Mertz has coached more than 15,000 chiropractic teams using his formula for success—
a subluxation-based, cash-driven, lifetime family wellness model. “The most successful chiropractic practices in the world are 75 percent cash, 25 percent insurance-based,” says Mertz. “If you are 80 percent insurance and 20 percent cash it’s a nightmare—that paradigm is dead. You’re struggling and worried and stressed out all the time.”

To combat the changing pay structure sweeping the industry, many chiropractors need to call in experts to reshape their ailing practices. When Sanna receives an S.O.S. call, the first thing he looks for are a few key statistics that make or break a practice: the number of new patients, the number of office visits per week, the average time allotted for each patient visit, the services rendered and the percentage of revenue collection.

“The first thing many struggling chiropractors do is stop keeping statistics,” says Sanna. “Improvement begins with looking at the core stats, so a successful practice must stay in alignment and share a vision even under financial stress. When they get in trouble, a lot of DCs have a ‘me against the world,’ bunker-mentality, but if everyone works together, the business will become more profitable, even in stressful times.”

Despite the myriad problems that can plague a chiropractic practice, three factors alone are essential to success: strong patient referral numbers, strong patient retention rates and strong revenues. “Undergoing an extreme makeover is a matter of faith, and chiropractors often have a tremendous fear of change,” Mertz says. “If you gave most chiropractors the opportunity to move their practice down the road, they would change their office layout, their patient education and move to a cash position, but they often face tremendous resistance to change inside the four walls they’re currently in. They need a mental edge, and a coach can quickly transfer that fear into fuel by creating big changes within 90 to 180 days.”

Through his work at Full Potential Leadership, Mertz advocates a “two-practice mentality,” where all new patients are quickly inducted into a cash-based system, while old patients gradually make the transition from insurance to cash. “Once a chiropractor gets that first monthly cash investment from a new patient, the chiropractor has a revelation. And the confidence that comes from enrolling new cash patients rolls over into previous patients and suddenly, there are no longer two practices.”

While not as dire as problems that threaten the bottom line, a secondary symptom of an ailing practice is an office filled with employees, but low on morale. “Most chiropractors don’t know how to hire and train people, so they have employees who are just there to get paid,” says Mertz. “They are not spirited teammates who are part of the practice. Insurance used to cover these problems and the money flowed in very easily, but now everything matters.”

Since astute patients are likely to pick up on the energy of an office and less likely to stay with a chiropractor immersed in a negative environment, Sanna recommends monthly staff meetings and team huddles every morning to set the mood and the agenda for the day. “Regular meetings are extremely important because not one person in a room is as smart as everyone put together,” says Sanna. “You have to channel your passion and work together as a team.”

Another common problem in the business is creating a hodge-podge practice incorporating bits of advice from various seminars a chiropractor has attended. As a small business, a chiropractic office should reflect the aesthetics, personality and working habits of an individual chiropractor, otherwise it will ring false to potential new patients. “Sometimes the pieces of the puzzle don’t fit,” says Mertz. “The software doesn’t match the schedule book, the financial programs don’t match the care plans, and patients are dropping out and not referring others because there’s not a solid, congruent practice system in place.”

Whether a chiropractic practice is struggling with low patient visits, over-reliance on insurance, bad office morale or a disorganized workspace, many chiropractors can’t pinpoint the epicenter of their problems. They need the outside opinions and advice of a coach who can survey the entire office, diagnose the problem and find workable solutions. 

For Sanna, one of his most dire rescue missions involved a nearly retired, successful chiropractor who had put all his money in the stock market and lost everything during the crash of 2008. “The bank had foreclosed on his house, and he was living in a mobile home,” says Sanna. “It was a difficult situation because his peak earning years were over, and he and his wife had a goal to get back to the point where they’d have the money to retire again.” With Sanna’s help, the chiropractor was able to work for three more years before selling his practice to a young DC just starting out. In that short span of time, he went from being destitute to fully replenishing his retirement account.

While dramatic stories of bust and boom make up a large percentage of their workload, chiropractic consultants like Mertz and Sanna hold seminars across the country to educate chiropractors about how to prevent their practices from becoming the kind of “worst-case” anecdotes that animate seminars. “I tell young docs just starting out to meet as many people as they can,” says Sanna. “Build a base of contacts and collect as many cards as you can. Build up an e-mail list and send out weekly newsletters. Practice your speaking skills, volunteer in the community, join Toastmasters or your local Rotary Club. You will have success in direct proportion to the number of people you meet.”