A New Look at Patient Retention

There are few careers that can challenge the wits of an individual more than that of a health care provider practicing outside the mainstream health care model. This includes most alternative medicine practitioners and certainly, to a large degree, chiropractors. By being outside the mainstream model, I am specifically referring to the fact that as chiropractors, we are outside of the medical system which directs patients in and through to various providers and services.

At the front end of the system, the major marketing campaigns are funded by big pharma. This fact obviously leaves us out. Once a patient is in the system, we are generally outside the traditional referral network of most physicians. Finally, and maybe most significantly, the insurance system does not make it easy for patients to choose chiropractic. Even when there is coverage, it's always limited in some way, shape or form. Compared to chiropractic insurance benefits, medical benefits might as well be unlimited — and sometimes are.

This situation has unfortunately resulted in many greatly skilled chiropractors closing their doors. The fact is, to thrive as a successful chiropractor in the current practice environment, a chiropractor must not only provide great service to their patients, but they must also be skilled in marketing, sales and administration. In today's health care arena, the chiropractor must not only be the doctor, but must also wear or delegate these other vital hats. For those of us who wish to only wear the "chiropractor" hat, this can be frustrating. Chiropractors do not currently have this luxury that most medical doctors enjoy due to the fact that medicos are plugged into a larger system where others do those services for them.

However, should the entire medical system fall apart (not outside the realm of future possibility), the chiropractor will find themselves much more prepared than their counterparts that currently depend on that established system. There is nothing lost in enjoying however little bit of solace that thought might provide. So, what is one to do in present time? Simply stated, get skills in marketing, sales and business administration. More practically given the length of this article, learn how to improve your patient retention!

Since no doctor should ever provide a service to a patient that is unnecessary, you must first start by figuring out exactly what the patient does, in fact, need. This probably sounds over simplistic, but most doctors have never thought this all the way through.

Figuring out what the patient needs can include delivering a more complete service. For example, if you've traditionally offered more of a pain relief type service to patients, you might want to explore other chiropractic services such as functional rehab or structural rehab. These additional services can be completely necessary to a particular patient, whereas further treatment for pain relief might not be indicated. Also, incorporating nutrition for the patient's condition can also increase revenue and retention. Nutrition along this line can be for the acute stage of care and can also be recommended for general health maintenance.

Of course, there is also a place for routine spinal maintenance. Depending on your technique goals, as well as the condition of each individual patient, the recommendations will vary. In theory, this service should last as long as the patient is alive. Most of the population takes better care of their teeth than they do of their spine. The two reasons this is true are, first, they have been educated as to the importance of having healthy teeth and also how to go about having healthy teeth. Secondly, people are able to see their teeth. So, unhealthy teeth are a bit more real to them than an unhealthy spine. This is one reason why spinal imaging is an important part of patient care.

Determining patient needs can also include looking outside traditional chiropractic practice and incorporating more advanced nutritional handlings for conditions not normally handled by chiropractors, such as weight loss, diabetes or thyroid conditions. To get an idea of what could be most beneficial to your patients and also your bottom line, take a survey of your current patient base to discover what other health conditions they currently suffer from — this can be done via their charts or face to face. By adding additional services, you broaden the likelihood that you will have a service that the patient actually needs.

Once you discover WHAT you should deliver, you must then decide or learn how to promote it. To "promote" means "to make known or well thought of." In this case, you would be making known what services you provide both inside and outside your practice. Also, you would want to "make known" to each individual patient what you recommend for further or continuing care.

Here is where the rubber meets the road. It's time to sell! If you have back-off on the idea of selling, there could be several reasons for it. However, one area to look at is: did you really determine exactly what the patient needs? If so, how could you possibly have back-off from selling it? To be quite frank, get over yourself! If the patient needs it, you better do your best to sell it, and for your sake and theirs, they better buy it! Because if they don't buy it, and they really need it, then they are worse off for not buying. And if you had back-off in selling it, you let them down! Once you realize this, the thought of a failed "sale" becomes a little bit difficult to live with, not because you lost income, but because you let somebody down — somebody who must have thought enough of you or your clinic to trust your opinion.

If you are unsure of the validity of this concept, here is THE test. Think of someone who you really love and would never harm. Maybe this is a parent, a child or a friend. Now, if they had whatever condition your patient had and needed the service you determined that the patient needed, how would you handle the parent/child/friend? If you would insist that they follow your recommendations, then you should handle your patient the same way.

If you are sure they need what you are recommending, then you should skillfully, politely and professionally insist that they buy. If you care as much for your patients as you do for those you love, you will treat them the same in this regard. I don't know any other way to say it. It's your responsibility as their doctor. If the patient can't count on you to do what is right, what chance do they have with regard to attaining/maintaining health?

With the background for this topic set, here are some key points to patient retention.

[pb]Most clinics lose patients because of:

1. Inability to help the patient understand their condition and how it negatively impacts their overall health — particularly with how it will be in the future.
2. Inability to help the patient understand the difference between acute care, corrective care and wellness care.
3. Inability to help the patient understand how your recommendations handle their current health problems and how other "options" (such as a pain reliever) are different.
4. Poor administration at the front desk with regard to keeping patients on the recommended schedule.
5. Vague financial arrangements.
6. A non-comprehension on the part of the chiropractor and staff with regard to how often a patient needs chiropractic and their condition explained to them—always in simple terminology that they can understand.
7. A failure to re-examine and provide new recommendations. All recommended care must contain a start point and an end point with goals either achieved or not achieved.
8. Failure to have care recommended and paid for in programs rather than one visit at a time.

The solutions to these problems can include (Each number corresponds to the problem above):

1. An exam which is targeted to not only find what is really wrong with the patients, but also is geared to measure related problems that will demonstrate to the patient the relative severity of their health concern. In addition, a well-thought-out report of findings which will allow the patient to have a cognition or multiple cognitions regarding the condition of their health and how it will impact their future.
   
   A good way to bring a patient to understanding on this point is help them to figure out how their condition will be in the future if they do not handle it appropriately. You can also find out from them what goals they have for their future. You may very well have to help them with this as most people do not set goals. Once you have these two pieces of data, allow the patient to see if these match up. In most cases, they will not. The way the patient is currently choosing to handle their health will not match up with the kind of future they want to experience.
   


2. This should be thoroughly handled in a report of findings, since the patient will need to know what type of care they currently need and also where they are headed in the future. This will also need to be reinforced continuously throughout each stage of care. Hold on to your chair, maybe at least every third visit — and only that infrequently because you need time to educate them on other concepts relevant to their care program.
   


3. Number three above should also be thoroughly handled in the report of findings. However, this also needs to be repeatedly brought up during visits throughout the patient's care. On almost every visit the chiropractor should be reminding or teaching the patient how their treatment is impacting the patient's condition or overall health.
   One of the most significant barriers for patients is that they often do not understand how your recommendations differ from other "options" they have, such as over-the-counter pain relievers or going to the gym. Despite the fact that you may have clearly told them exactly how your solution works, it's quite possible that the patient did not get it. In communicating with your patients, keep in mind that the goal is not for you to tell them, but for them to understand. This means you must take full responsibility for their understanding. If you do this, you will achieve better results in the patient education process.
   


4. Poor administration at the front desk must be handled with training, drilling and written policy and procedures. Don't be afraid to drill/train a lot! How often does a championship sports team practice? In most very successful clinics, staff drill or train weekly, even if only for 15 minutes.
   


5. Patient financial arrangements should be well understood at the start of care. It is also important to have standard financial arrangements across the board, with the possible exception of an occasional hardship. It should not be "let's make a deal chiropractic." And you should be collecting whatever deductibles and co-pays are necessary. Patients who don't pay co-pays and deductibles won't likely pay for care once insurance runs out. Not to mention the potential legal ramifications of not playing by the rules.
   


6. The simple fact is, the patient is bombarded with false information regarding health on a daily basis. From television ads to print articles to the internet, the patient's head is full of ideas that will lead them toward ill health. No one, except you and your office staff is promoting chiropractic. You should do it EVERY TIME THE PATIENT IS IN YOUR OFFICE. There are many ways to do this. Pick a few and become really good at them!
   


7. This is one of the most perplexing outpoints to be found in many chiropractic offices. So many doctors "sell" their patients in a report of findings using problems located on x-rays, and then never take follow-up x-rays once a program of care has been rendered. Or, the doctor does take follow-up x-rays but gets little to no change on the films, and the follow-up recommendations have little to nothing to do with the follow-up films. This sort of practice always leads to doctor burnout — usually because the doctor himself feels a bit unethical about the whole thing. The solution is to make sure there is congruency between what you sell and what you deliver.
   
   Once a patient finishes a program of care, over several weeks, or months then the patient should be re-examined and a new program (if appropriate) recommended.
   
   The key here is that whatever method of measurement was used to determine or locate the initial problem, and then used to educate the patient at the start of care, should be used again following a program of care to determine the success of the treatment regiment and also help determine if further care is needed.
   


8. Offer care in programs. If you truly believe that your patient only needs one visit (and the patient is not an out of town traveler), then you could benefit from looking into what other services your office can provide. In most cases, if only one visit is truly warranted from your point of view, then the scope of what you are offering is tremendously narrow. There is nothing wrong with offering a narrow scope of services, but it is also true that it's not overly beneficial to you or your patient to practice in such manner.
   

There are many sources of help for chiropractors in practice — from management companies to patient education product companies to a successful friend willing to share with you. The reason for your success or lack of success is always under your control. You can always do something about it!

Offer your patients only what they need and insist that they follow through. This is a game where everyone wins!