I don't have to make up questions for this column. I swear these questions came out of the mouth of a doctor during a recent discussion:
"I can't hold patients that don't have insurance or those whose benefits have been exhausted. Do you have any suggestions? I've thought about forgiving any balances they owe me for Christmas so that they could come back. What do you think?"
Retaining patients is an important issue of practice management. I'd like to give you something to think about. Insurance has only been paying for chiropractic services in any significant way since the late 1960s; Medicare inclusion arrived in the early 1970s. By the mid '70s, chiropractic was "covered" in most states.
But for nearly 70 years chiropractic was a patient paid proposition. Patients paid for chiropractic care! Were people smarter, more easily convinced, more compliant, or what?
I think that most chiropractors were smarter about selling the need for care. They understood that if they didn't convince the patient, no one else was going to do it. I believe that they did a far more compelling job of explaining the needs and benefits of chiropractic. Indeed, they believed that people needed chiropractic to improve their health and quality of life, for nearly all doctors referrals were their only source of new patients.
How did they do it without all the great videos, brochures, public acceptance, mall screenings and health fairs that we have today? I can dimly remember the early 1960s in practice. You saved your money so that you could go somewhere like Parker and learn how to do a three-day report of findings! You learned that unless you impressed, overwhelmed, and swamped your patient with compelling reasons and information they weren't going to "buy" your services.
You went to places like the dynamic essentials meetings where you became inspired with the wonder of what you had to offer the patients. You learned the importance of falling in love with what you were doing. Enthusiasm was the yeast that raised the dough.
I'm sure it was much the same in 1895. I've seen pictures from the 1910s and '20s of people standing on the sidewalks waiting to get in to chiropractic offices. Not everyone had people waiting. Some doctors went out of practice. The difference was commitment, conviction and the willingness to "tell the story." Not every successful DC was a great salesman, but they believed and lived what they espoused. Our history is filled with people who were willing to go to jail so that their patients could have chiropractic care.
It's right about this point in the conversation that I can usually hear the whining start. "I don't think I should have to sell my services. I'm a professional." Wrong! Every professional has to sell. There are lots of people out there who want to have that person as a patient. There is a lot of demand for the patient's dollar. My dentist is no longer satisfied with fixing my teeth. He can make them whiter, brighter, straighter and more attractive. I can remember a patient telling me that she and her husband actually had a discussion about whether to go out for dinner with friends or bring the family to the chiropractor. Few doctors see it so clearly. Lots of people want the patient's dollar. What reasons have you given them to spend it with you?
"Not being a good speaker" is not a valid excuse. Learn to be a convincing speaker. If it doesn't come naturally, it is a skill that can be learned. If you want people to want your services, you have to convince them over and over again. It's not enough to have a great report of findings. The education process needs to continue, preferably with a soft sell or educational focus. Too many practices are heavily focused on getting new patients and have no plan for anything after the first few visits.
Put yourself in the patient's place. A few weeks pass and the patient feels better. "No one talks to me about anything except this weekend's game. My wife sees that I feel better and wonders why I keep coming. I really would like to take the family up north this weekend. Maybe I'll just skip next week." It's the beginning of the end, especially if you haven't spoken to the patient about his care since early on in the care.
Insurance has made many of us lazy and complacent. We kept patients without a lot of effort because the insurance paid. Well, we can kiss that goodbye. Things are changing. It's a new day. Get over it. We need to go back to what worked in the "old days." Talk with your patients about their health problems. Cut down on the "schmoozing" and discuss what matters to the patient. Give them reasons to continue their care. Educate and inform them visit after visit, not just when you think they might leave your care. The "oldtimers" did it, and you can too. I have confidence it you!
Now, hang on while I pull my grinch hat firmly over my ears. The question includes, for reasons I don't understand, a suggestion about forgiving debts at Christmas. If you have generally good money policies and you carefully choose which debts to forgive, I guess I have no violent objections. If you're thinking that forgiving bad debts will convert financially irresponsible patients into "good patients," think again.
It could send a terrible message to the financially irresponsible in your practice and community. "Hey Martha, the old lower back is acting up again. Now seems like a good time to go back to Doc So-and-so. I don't have to worry about the cost. He'll wipe off whatever I can't pay for Christmas! That way, we can afford to rent that condo and go skiing!"
My regular readers know that I believe people need to pay their bills. There may be rare exceptions: those "worst story you heard this year" kinds of cases. We owe it to others to help those in need. We owe it to ourselves and those who depend on us to be able to differentiate "genuine need" from "I need the money for something I want more." So, forgive those rare "worst story" cases and make the rest of the people pay so that you can pay your debts! My best wishes for your holidays and a successful New Year.
Dear Readers:
I am always interested in hearing your thoughts and questions. I want my column to reflect your real life. You can talk to me or write me.
For those of you who would like to contact me by e-mail, I will need your full name, city, state, age, time in practice and normal weekly patient load. Also include your hours, number of staff and other pertinent information that you think I'll need to answer your question. I don't answer nonspecific questions like, "How can I improve my practice?" I may ask you to call me if your question is long or complex.
Kiki Herfert
15852 Jefferson Avenue
Grosse Pointe Park, Michigan
48230-1445
Tel/fax: (313) 822-9199
Kikiherfer@aol.com
