When Practices Fail: Warning Signs (and Solutions)

Television programming has changed in recent years and, as you know, reality television is exceedingly popular. There is a fairly new show known as "Hoarders," in which individuals or couples are featured for hoarding intense amounts of household materials. The one fascinating concept from these shows is that all the individuals seem stupefied by how quickly and how intense the hoarding has become.

Unfortunately, many chiropractic practices suffer from a similar fate. Doctors and their staff leave one day and return wondering how on earth the practice suffers.

Suffice it to say, many practices fail. According to the Bureau of Labor and Statistics, 98 percent of most small businesses fail within the first five years. Just because you are a chiropractor does not mean the odds are not against you. What becomes necessary is to look for warning signs and know when to turn it around quickly.

Before I get into cause-and-effect, when I visit many chiropractic colleges and speak with the soon-to-be graduates, there is a general notion that they will never fail. Ironically, many believe their practice will be an instantaneous success and they will never go under. All chiropractors young and old will have volatility in their practice; therefore it is necessary to understand where you might have issues and how to quickly resolve them.

Poor Patient Awareness

Jeff Foxworthy, the American comic, has an act that typically begins with a round of "If this ... then that!" The same thing can be said about your chiropractic practice when it is failing. If you are beginning to see less volume in the business and your expenses are higher than your income, then you might have a huge problem. Reasons for low patient volume include, but are not limited to, poor marketing activities, lack of patient referrals and most of all, a lack of activity that creates awareness in the local community.

Chiropractors must remember that there are three types of people who aren't using their services: 1) patients have no idea who you are; 2) patients who are already with another chiropractor; and 3) patients who don't have a want or need for chiropractic care.

The latter two groups are the hardest to reach; therefore, when the practice begins to fail, the very first remedy for any chiropractic practice is to intensely begin activities that create awareness and help build brand recognition within the community. Potential activities to accomplish this include patient referral systems, networking, speaking and even writing articles in regional periodicals. The more intense you are about these activities, the more capability to bring back patients into your waiting room.

And then there are the fundamentals of all successful businesses. Are you tending to those? Let's discuss a few.

Tracking the Numbers

Many reading this article have a clear idea of how many patients you serve weekly or even monthly. However, when I engage certain chiropractors in conversation, I typically ask about expenses or even ask about account receivables; unfortunately, they often do not know the answer. And chiropractors who do not stay close to the numbers do not have a successful practice.

Chiropractic operates in one of two ways: cash or co-pay. Yet no matter what, every patient must pay for service. Unfortunately, too many chiropractors are shortsighted and see the money coming in and quickly buy material goods, forgetting to invest back into the practice or, more importantly, save for the future. The effect of not saving money or investing back into the business will deeply impact your practice for years to come.

The solution is to measure every inflow and outflow so you are close enough to the numbers and understand how to run a profitable practice. The best methods of measurement include spreadsheets that illustrate the number of patients you're seeing per week and the amount of payables and receivables. Additionally, breaking down your receivables by insurance carrier and type will help you to understand how quickly or slowly money arrives

In terms of marketing activities, you should also monitor the amount of marketing conducted each week to illustrate how those activities assist in producing more income.

Ultimately, chiropractors are best off reviewing profit and loss statements and producing sales forecasts so that the practice runs in the black.

Delegation

One of the biggest challenges with any small business, including chiropractic businesses, is learning how to delegate. Chiropractic, much like any other business, especially when starting out, tends to rely on a "poor man's syndrome." In other words, many chiropractors will say they do not have money to pay for particular services. This has them treating less patients because they are busy with coding, billing, scheduling and a myriad of other responsibilities. Chiropractors can't do it all and a poor man's mentality will make the practice fail.

[pb]Chiropractors must learn to delegate. They must hire the right people to assist them. Even a few hours a day delegating tasks allows the doctor to focus on one of the most important assets of the practice: patients. Failing to delegate can only lead to business failure. You simply cannot be a jack of all trades.

Appointments

Without sounding too fundamental, every practice is built on the number of patients scheduled and examined. However, much like any businesses, there are many rescheduled or canceled appointments. Yet I often find that if the chiropractor is busy or the staff lacks proper training, patients are never called to reschedule their missed / cancelled appointments. This is one of the easiest things to miss in any chiropractic practice, but it can have serious consequences in terms of your bottom line.

For example, a doctor I'll call "John" recently had 22 appointments in a week canceled and none of them were rescheduled. That is missed income, pure and simple.

Reschedule Immediately

The only way to mitigate the cancellation problem is to ensure that patients are asked to reschedule if they call in the cancellation; or in the event that they simply don't show up on time, that they are called immediately after a missed appointment to get it rescheduled.

There is technology available that allows you to confirm appointments with the use of text messaging, e-mails or even voice mails to remind patients. These tools cut labor on your part and reduce opportunities for patients to miss appointments.

In addition, chiropractors should develop and implement a clear canceled appointments policy. Your time is valuable and when a patient misses an appointment, it is essentially as if two patients cancelled, because someone else may have called for that same time slot. Moreover, it dismisses the value of your time and expertise.

Patient Service

Ron is a chiropractor who, after eight years, built a practice of approximately 100 patients per week. But currently, he is only seeing 22.

After some mystery shopping, it was discovered that patient service is not top of mind. In fact, it was his poor patient service that caused his volume to drop over 80 percent.

No matter what, patient service has to be the primary emphasis of every practice. Patient services must be enculturated into the entire practice. This begins with hiring the right people, as well as having a doctor who is concerned with total patient care from the inside and out.

Creating Service

Telephones must be answered on the second ring, e-mails must be answered within six hours and staff must clearly understand that patients are not an interruption of the practice, but the very purpose of it! Additionally, confirmation of appointments, handling of insurance claims and ensuring that all paperwork is submitted timely is all part of the patient experience and must be prioritized.

Finally, your patient experience begins with the Report of Findings, so make certain that patients know how much you care from the moment of their first treatment.

Practices need not fail if the proper protocols and procedures are installed.

Be Proactive

Chiropractors today must be more proactive in protecting their practices from demise. This includes installing sound strategies that provide adequate foundation so the practice remains above water during good and bad times.

But the only way to ensure that your practice never fails is to remain on top of it. Your practice is not an avocation, but an occupation that must be protected daily. Never should any chiropractor walk into a situation and say, "How did I get here?" With the proper systems your practice should never have to worry about dealing with any warning signs. Rather than just survive, you will thrive, no matter what!