For the last 20 years, my business has been the business of chiropractic, helping doctors run stronger, healthier better businesses across the country and contributing and rendering better care to their community by doing so. Today we are going to talk about Collection Visit Average (CVA). You may call this a different term, but it is basically dollars generated or gross revenue generated per patient visit on average. Whatever you call it, it’s all about the bottom line in your clinic. What is the gross revenue generated on a per visit average?
Before we begin and get into that, we need to get on the same page about something. The ethical standard in our profession is to render care that is needed and efficacious. We never render care that is not needed and that isn’t beneficial because that is not what our ethical standard is. Don’t be tempted to do that! You can run an ethical business without going into any type of grey area and render the care that is needed and best effective for that patient.
Are you worth it?
With that being said, if you if you are adhering to that standard then you are a great candidate to talk about collection visit average. Why talk about collection visit average?
It’s easy to change
Number one, it’s easy to do. Honestly it’s one of the easiest things I’ve found to change in an office because it doesn’t tinker with any of the clinical approach, it doesn’t mess with any of the methodology that the doctor uses, and it doesn’t create new systems for the staff. It is simply just changing the structure of the clinic on the business side of the clinic, not the clinical side so it’s super easy to do.
We want balance
Secondly, we talk about it because many people now want better balance between their professional and their personal sides. When I graduated chiropractic school decades ago the thought of the day was, “You see a lot of people and you have a string of clinics.” That’s great if that is still your driver and that’s your mission and you feel that’s how you were called to serve, but a lot of us decided we wanted better balance. We had obligations and hobbies and commitments outside of the office and we weren’t able to be in the clinic 60, 70, 80 hours a week. If you’re going to have a limited approach like that you have to look at what you are generating on a per person average. Otherwise you don’t generate enough to make your obligations, pay your staff, and take home money for your family budget.
Third, the question shouldn’t be “Why?”, the question should really be, “Are you worth it?” It’s not about why do we do it. It’s really about “Are we worth it?” That’s an important question because there is no such thing as something for nothing. If you are providing care to your patients and you’re getting the amazing results that I suspect you are, that care is valuable. It is pennies on a dollar compared to what the patients can get elsewhere, especially through the medical model. We are typically undervalued. Why is that?
Reasons for undervaluing chiropractic care
The number one reason: Fear. Chiropractors feel that if they price their services up to a point or beyond it is going to cost them patient visit volume in new patients and somebody will go down the street for cheaper. Look, you’re not selling gasoline. People are not only basing their decision to do business with you because you are the cheapest person in town; in fact, it’s really just the opposite. In the patient’s mind what you charge is a big, significant determination of how good they think you are. As my doctors raised their prices and set equitable fees, they’re actually getting better results and the patients are more compliant. Why? Because there’s better appreciation for what the patients got.
The truth of the matter is the health care consumer wants the very best they can find at an affordable price, and that affordable price is what they can budget. You must get out of the fear game and the “What if?” because I can tell you from looking at thousands of stats over the past 20 years. If you do it the right way the new patients won’t change, the referrals won’t change, the patient visits won’t change, and the maintenance won’t change. Literally your clinic just takes a stair step up in financial health and the relationship that you have with your patients is still retained and maintained.
Are my chiropractic services worth it?
The other reason I think doctors don’t do this more it is they’re not sure their services are worth it. I promise you, if you are decent at your adjusting technique and you know how to manage your patients through a problem and you’re getting results that are pretty consistent, then your care is worth it. I have family who work in the medical field and compared to what we do there is really no comparison. We keep patients working and moving, and we keep them functional. There are no side effects to what we do except good health. So are you worth it? Absolutely, you’re worth! I believe it, and if you don’t believe it, you talk to me and I’ll try to help you see straight, okay?
Fixing the problem
Now, how are we going to do it? This is very easy. First, we have to have to give you a word of caution. You need to make sure that you are using a comprehensive patient management system that manages the patient not just through pain control but really into a better quality of life and manages them to a rehabilitated and stable state. If you don’t have a strong, comprehensive patient management system that would be the first thing to look for. If you don’t have that that in place on the front side the things that I’m going to recommend will really fall apart for you.
Once we have that comprehensive management system place here is step number one: simply increase fees. Increase fees to where they should be. Not where your buddy is charging them, not where the guy down the street is charging them, not what the insurance company says they are worth. You charge and set your fees based on what they are legitimately and really worth. If you don’t know that, reach out to me and I’ll guide you through that process.
Charge for your services
Number two: you charge for your services. This is all your services. One thing I love about chiropractors is that we all have that that patient that we just give care to they can’t afford it and they’re down on their luck, or whatever the case is. I think that is a noble thing that we do in our profession. The other thing that I know about us is that we tend to give away to store. We will do extremity adjustments and will do exams and will do therapies and we won’t charge people.
You must get out of that habit. Get out of their purse and out of their wallet and let your fees stand for what they are and expect to be paid. You have to stop sabotaging the financial health of your clinic by getting in the way and saying, “We’re going to no-charge that,” or “We’re not going to charge that fee today,” or “We’re going to give it to you for free.” I understand doing that on a limited basis, but you cannot always have that as a blanket policy and apply it to everyone in your clinic.
End counterproductive discount programs
Third: you want to end those counterproductive discount programs. I see so many doctors who do that because they think it entices commitment and entices payment. It is one of the most insidious, counterproductive things I’ve ever seen chiropractors do. What happens is that you discount, discount, discount for plans and for families and others. The more the discount is applied, the more the patient is thinking, “Is this care even really worth it?” You get into a dynamic where you’re treating the patient and you’re giving the very best that you can, and they have little to no skin in the game. Their compliance isn’t good, they’re not doing their home instructions, and when they have setbacks they blame you and they’re really grumpy with you. They do that even though you are giving all this discount away.
Think about it: do you want to see a clinic full of your family and friends? Why not? They don’t stay, they don’t pay, they don’t refer, and they are headaches to work with. That is what you are actually creating by enticing people with these discount programs. I know that may be counterintuitive and it may be completely opposite from what someone else has told you, but I can tell you without any doubt that is a problem to get your fees where they need to be and get you compensated equitably for what you are doing for your patients.
Add Ancillary Services
The last step: add ancillary services. Some of you already have that shiny object that attracted your attention way back when. Maybe you have laser, or you have STIM, or you have rehab, and it kind of fell out of favor once the once the novelty wore off. You forgot about it and it is in a back room collecting dust. Dust that thing off if that service is efficacious! If it’s real and it does something beneficial to your patient, let’s recommend it!
Let’s put it in your plan for that patient to get the results they need to get and let’s get paid for that. It doesn’t matter to me what the ancillary service is. What matters to me is that you know it is helpful and needed for that patient. Nutrition, orthotics like foot orthotics pillows, home stretching devices, TENS units therapy, massage, you name the ancillary service that is outside of chiropractic, not the adjustment. If you feel that is needed and beneficial for your patients, you recommend that, and you charge for that service.
Don’t be afraid
Raising fees and getting your revenue where it is, these are some of the easiest things that you can do. However, you have to make sure that you aren’t afraid of it and that your clinic is structured the right way so that this will be a win for you and actually a win for your patients. What they acquire too cheaply they esteem too lightly, so if you’re having problems with patient compliance or if you’re not getting the referrals, you need to see if you are undervaluing your fees and your services.
– Dr. Shannon McMurtry