In 2003, I opened my sports injury, or as I describe it, an "active lifestyle" practice. Things were going well and I certainly did not have many complaints. But in 2007, when I reviewed the business plan I had originally written and the goals I'd hoped to attain by my fifth year, I realized I was going to fall short in one very important category: annual gross collections.
I realized that the ultimate answer to meeting my goals was not the number of patients I was able to see but rather in the amount of revenue I was able to generate per visit.
One option would have been to perform additional services during each patient visit. The problem was that I could not justify the medical necessity for more services. I concluded that I needed to focus on ancillary services and retail sales in order to increase my collections per patient visit.
Consider Your Patients' Needs (Not Your Own)
I considered what else I could provide to my patients that would:
The last was crucial in maintaining long-term relationships with my patients as opposed to being viewed as just a "triage" center for acute injury. Like most docs out there, I have a very high standard with regards to what I am going to bring into my practice and recommend to my patients. It could not be viewed as "gimmicky" or merely a "moneymaker". I did not want the desire to increase revenue to tarnish my reputation. I also knew that whatever I decided on had to meet some very specific criteria. So, I took a good look at my patients, their needs, and the treatments I performed.
Who was I treating? My "typical patients" are active individuals.
What was I treating? Musculoskeletal conditions (exclusively).
What were patients asking me about vs. not asking me about? Mainly pain relief, joint health and osteoporosis.
How could I address their needs and provide better care? By providing high-quality, research-backed supports, exercise equipment and supplements that would enhance my treatments, speed recovery and prevent future occurrences while promoting overall well-being.
Since I was already dispensing exercise balls and bands, I decided my new initiative would be to enchance sales of nutritional supplements. I was selling a few supplements at the time: protein powders, protein bars and multivitamins but was never overly serious about it. This time had to be different.
Research and Decisions
I began by doing research on various nutritional supplements in order to figure out which would fit best into my practice and which had the best research to support their use and demonstrate efficacy.
I was pleased to find that many of the supplements that were best supported by quality research were those that addressed musculoskeletal health.
I then began to research nutritional supplements focused on the treatment of acute conditions, nutrients that would help with inflammation and pain control.
After my research, I decided on a product loaded with information right out of top notch, peer-reviewed journals.
I found that the product maker's approach to nutrition fit perfectly into my approach to treating patients.
That was crucial as I had decided earlier that I would not introduce something into my current practice that was "extra" or different than everything else.
Integration Tactics
The next step was to smoothly integrate nutritional supplements into my existing "office flow". There were very specific questions that needed to be answered. How would I make patients aware of these products? When/how would I discuss the specifics with patients? How would the supplements be dispensed? How would we keep track of who bought what and when. How would I and my staff be involved in the process?
I decided the smart thing to do was to make as much of this process "automated" as possible so as to limit the amount of time and effort it would require during each patient visit.
I created a questionnaire to figure out who was interested in learning more about certain supplements and had patients fill it out along with their initial intake paperwork. It included basic questions on their interest in utilizing supplements and whether they were already doing so. It broke it down very simply by asking if they were interested in pain control, joint health, or overall well-being and gave me a topic to start a conversation.
Rather than bringing up nutritional supplements "out of the blue", I would merely follow up with information they had already expressed interest in.
[pb]I prepared patient-friendly information cards with pictures of individual supplements, an explanation of how it worked and why it would be beneficial. These cards cited specific sources to assure patients knew this was not merely my opinion but peer-reviewed research. Rather than spending 5 minutes during each patient visit reciting the same information over and over again, I would give the patient an information card and ask them to read it before their next appointment. (The nutritional company I use eventually developed an entire line of these cards for doctor's use.) I would follow up with the patient during their next visit knowing they already had a base of knowledge.
Often times, I would find that the patients had already decided to make the purchase just based on the information they read.
I created other sheets geared more towards my staff and me in an effort to streamline the process of making recommendations, giving actual dosage instructions and documenting the purchases. These included laminated 8x11 cards with "Nutritional Supplementation Protocols" that were kept in each treatment room on the counter where patients could see it. Each protocol had a specific goal; pain and inflammation control, long-term joint health, etc. It was something the patient could actually hold in their hand and read while I briefly discussed it. It was a great visual aid.
I also created a sheet that listed each supplement as well as the various dosage recommendations. Because the dosages vary based on each individual patient, I listed the different dosages and merely checked the box next to the appropriate one rather than having to write it out each time. This sheet was copied for the patient's file and the original was given to the patient to take home. It also included any contraindications Again, this limited the amount of explaining I had to do.
Marketing within my office included pieces that the nutritional company provided such as a poster board on an easel near the entrance of my office, individual "flyers" on bulletin boards in each treatment room and brochures and leaflets in my waiting room. I also created a Power Point presentation that looped continuously on a TV in my waiting room. Patients could actually see a supplement being described on the TV and then reach over and pick up a leaflet that described it in more detail.
I also installed small corner shelves in each treatment room and placed (empty) bottles of the supplements on the shelves grouped in typical protocols so that I could point to them, pick them up and hand them to the patient to look at. There is something about actually holding something in your hand that helps in the decision of whether to purchase it or not.
One of the barriers I thought I might run into was the fact that many patients were purchasing "the same" supplements from big box stores for much less money. How would I compete with them? I decided that I would focus on the fact that my supplements were of a much higher quality than the majority of those found in retail stores and that the patients were going to get valuable advice from me, a doctor rather than from a retail sales clerk working off commission. I also put a "discount program" in place. The program required a membership with a cost of $20 per year and offered a 10 percent discount on any purchases over $20. For the average patient who purchased 2-3 supplements per month, it was a no-brainer as they made back their $20 in savings in about 2-3 purchases. It also created loyalty. Why would they buy from the big box stores when they paid for this membership and were getting my high-quality supplements along with professional advice for about the same price as the others? Sure enough, I found that patients were coming into my office to buy supplements even though they had been released from active care months and even years earlier.
As time passed, I found that the majority of patients were open to utilizing the anti-inflammatory and pain relief supplements I was recommending. These consisted of omega-3, a bromelain-based supplement and a white willow bark-based supplement. Interest was also strong in long-term joint health, which typically included omega-3, glucosamine / chondroitin and proteolytic enzymes. Multivitamins did well as did a bone support formula (calcium, magnesium and vitamin D).
Increased Gross Revenue
I did it. As I looked back on my yearly statistics, I was pleasantly pleased to see the numbers had grown significantly.
Annual Gross Collections from Nutritional Supplements (Rounded to nearest thousandth):
2003: $2,000
2004: $2,000
2005: $2,500
2006: $17,000
2007: $19,000
2008: $36,000 (This is when it became a formal part of my business plan.)
2009: $36,000
2010: $34,000
Like anything, implementing the sales of nutritional supplements into my practice took some time, a lot of thought and a ton of effort. In my experience, these are the initiatives that typically have the best results. Making quick decisions without adequate consideration is never a good idea especially when the care of your patients and your reputation is at stake.
In retrospect all of the work was certainly worth it. These products have had a tremendously positive impact on the way I treat my patients and their response to my care. It has also resulted in a nice bump in my annual revenue, and that was the goal!
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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A central challenge in creating our identity is that chiropractic is a method of care, not a technique or procedure. This is an important concept for us to promote. Our patients are treated with lifestyle modification, exercise, nutritional supplements, diet and a whole-body approach to accelerate the natural healing process. We are not simply CMT providers.
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