Practice Management

The Financial Report of Findings: Say It and They Will Pay It!
Practice Management
Written by Kathy Mills Chang   
Monday, 25 April 2011 20:49

ne of the most overlooked areas of practice management, meaning the management of your practice, is in the area of finances. For whatever reason, doctors of chiropractic have struggled with this area due to lack of knowledge, lack of the ability to confront the situation or lack of effective team members to assist in this important area. The most important concept when asking for payment from a patient is that of perceived value.  The patient must assess a value either at or greater than what they are being charged in order to be on board with the cost of the service.  It’s equally, if not more important, for the staff member dealing with the finances to understand the perceived value of the service for themselves. As the saying goes, it’s difficult to sell what you don’t own. I have consulted with many offices where the primary staff member whose job it is to collect payment, has confided to me that she just can’t ask these poor people to pay for what she couldn’t afford.

billsMy favorite chide to doctors:  “Stay out of the patient’s pocketbook, because you don’t know what they can or can’t afford.” Do not prejudge what a patient can or can’t do financially.  How many times have you had a patient who complains the most about money drive up to an appointment in a very expensive car?  Or a patient who you never would believe can afford your care write a check for a large sum of money?  It all centers on the value that a patient places on the care.  I wish I could tell you how many times in my career I have had a patient tell me they couldn’t afford the care recommended to them, then, a week later, I ran into them coming out of the nail salon.  This is a patient who did not have perceived value instilled upon them by the doctor. Our job is to tell the patient what they need to hear, and then let them make their own financial decisions.I believe that the “why” is easy to figure out. More important is the “how.”  First, let’s look at some ways to maximize your results when asking for payment from a patient or describing their financial responsibility.

  • Assume you will get what you ask for! If you assume you can’t, you’ve already lost.
  • Be prepared! The Boy Scouts know what they are talking about! Have the doctor’s treatment plan, the insurance verification information, and everything else you will need to formulate an appropriate financial plan with the patient.
  • Know when NOT to talk!  Don’t try to fill the silence while we wait for the reply from the patient. Be clear about your request, and then wait.  For example, say, “Mrs. Jones that will be $45 for today.”
  • Have an array of options. If a patient can’t pay for a visit’s charges, be prepared to offer alternatives, such as a pre-addressed envelope they can mail back with the payment as soon as they reach home.
  • NO! is not the end of the world: Remember that the most important technique of all is to know you can get what you want by asking and, if it doesn’t happen, be prepared to say, “Next!”

The following are some helpful scripts that you can use in your financial report of findings to help increase your odds of getting to Yes!

Know when NOT to talk!  Don’t try to fill the silence while we wait for the reply from the patient.

Objection #1: The patient wants to wait till next visit to decide. Our problem is that we expected to put both the balance of yesterday’s visit and ongoing care into a plan for them.

“It's not a problem, Mrs. Jones, if you need to speak to your husband. I know that I wouldn't want to make a decision like this without my husband present, either. That is why we hoped he would be able to attend this visit, so that he could better understand what's going on with your care. Let's go ahead and take care of your balance to date, so we can start with a clean slate on the next visit. After you've had a chance to visit with Mr. Jones, we will be able to recalculate a payment plan that will work well in your budget. Today's charges added to yesterday's balance will be $150.”

Objection #2:  The patient wants to make a further decision about care beyond insurance coverage  once insurance visits are used.

“Mr. Smith, I understand what you may be thinking. However, if we were to only recommend the amount of care covered by your insurance, this would be a tremendous disservice to you. Your third-party coverage was never meant to cover all of your care. That's the reason  we've joined companies like ChiroHealthUSA, to be able to extend to you a contracted discounted rate for the portion of your care that needs to come out of pocket. I would much rather look at how we can spread this across more time and work with your monthly payment, than have you consider not taking all of Dr. Jones's recommendations. The 15 visits covered by your insurance will only be the acute phase of your care. As Dr. Jones explains, to stop your care at that point would be like taking your braces off after just a couple of months of treatment. Again, that's the reason why we try to make this affordable.”

Objection #3: The patient feels the total amount for care is too far out of their budget.

“Yes, Mary, I understand that this amount may be outside your budget. We have already been able to discount your fees considerably by discussing ChiroHealthUSA, and my concern is that, if we go visit by visit, you will find that it gets out of hand. My experience is, patients tend to get out of pain and then think they can do it on their own. What can I do to help you make this more affordable so that you can commit to the full treatment plan recommended by Dr. Jones?”

In closing, remember that he who asks the question controls the conversation.  Not only is it our duty to ask for and collect payments from patients, it is a part of the healing process.  That patient who pays will stay and get better quicker.  Asking for anything increases the odds of getting it by 200%.  Once you master this skill, exercise the asking muscle often, and you’ll be surprised at how effective it is.


Kathy Mills Chang is the President and CEO of KMC University, a consulting and training company in the areas of Medicare, collections, documentation, coding, billing, patient finances, and audit protection. Kathy is also a sought-after speaker, and can be found delivering seminars at the most important events in the chiropractic field around the country. She can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or through

The Multidisciplined Approach to Growing Your Practice
Practice Management
Written by Susan Blackard, R.N., N.D.c, M.H.A., F.N.P.c   
Monday, 25 April 2011 19:46

o I bet you’re getting all the clients you can handle and don’t want any more right? Let’s be honest, we could all benefit by having at least a few morepuzzle people walk through the door.

But where do you start?

To get more information, I caught up with Dr. Mark Steenerson of Minnesota. A few years ago, he was asking himself the same question. He found his answer. In the last year, Dr. Steenerson’s practice grew by 48%. In fact, he made around $10,000 in just two hours by implementing a simple change. Dr. Steenerson’s practice became multi-disciplined.

When I speak to the most successful doctors, they say that the key is getting people in the door and proving that you can create a lasting positive impact in their lives. Many people do not understand what chiropractic is and how it can benefit them, so, in order to be successful “chiropractors must educate communities about the benefits of chiropractic care.” (Bureau of Labor Statistics 2010-2011 Handbook). This realization by the community changes a chiropractic practice forever. Referrals grow, income finally reaches desired levels and the doctors are able to build a name for themselves as local health experts.

The United States Department of Labor says that success prospects are best for chiropractors who operate within a multi-disciplined practice, because it allows patients to stay in house for their most pressing needs. A multi-disciplined practice simply means that the practice offers more than one service, such as weight loss, laser hair removal, nutritional services, acupuncture or massage. The other benefit of a multi-disciplined practice for chiropractors is that it gives them the ability to attract people who do not understand or would not otherwise pursue chiropractic care. If a chiropractor successfully demonstrates their value to a patient, that patient will be far more likely to evaluate, understand and purchase the needed chiropractic care regimen.

So, how do you decide on additional services to provide?

Well, a good business is always built around an unfilled need or opportunity. In order to decide which service will benefit your practice most, you need to figure out which service will benefit your community and current patients. What are their greatest needs?

For those of you who are still wondering, Dr. Steenerson chose weight loss. “I was having major problems getting people in the door for chiropractic, but when they come for weight loss and get great results, you better believe they are willing to listen.” (Dr. Mark Steenerson)

Dr. Steenerson uses his weight loss program to attract patients who are interested in losing weight. Once he helps them do so, they are easily converted to chiropractic patients in order to address further imbalances within their bodies. Dr. Steenerson kicked off his weight loss practice by putting on a two-hour “Weight Loss Information Night.” This event was open to the public and generated more than $10,000 in cash revenue. This number, however, is trivial when compared to the chiropractic and referral business that is still coming in the door. To make the event a success, he placed professional advertisements in two local papers, which yielded around 70 attendees. A year later, he is still reaping the benefits of this event and will be for a long time to come.

So, why weight loss?

With two in three Americans overweight and all of the highly publicized health risks, the weight loss industry is booming. I guarantee that hoards of people in your community and even your own clients are spending significant amounts of money on weight loss right now. To make matters worse, most of them are spending it on unhealthy, unsustainable programs with miniscule long term success rates.

With two in three Americans overweight and all of the highly publicized health risks, the weight loss industry is booming.

Weight loss is the perfect example of an effective, cash based service with ongoing profit potential; but just bringing a strong program into your practice is not enough. Jim Allchin, a former executive at Microsoft once said, “We’re obviously going to spend a lot in marketing, because we think the product sells itself.”

Just because you now have this high quality, in-demand product doesn’t mean people know about it. You need to make marketing a priority and do it effectively. In addition, explore opportunities to position yourself as an expert within the community by doing talks at local health food stores, churches and other health professional’s offices. Get creative!

Once people are coming in the door, develop and test a system for moving patients between the various services you offer to provide highest value to them and highest revenue to you. Remember, if you do not offer it to them, chances are they will get it elsewhere. Finally, be sure to leverage referrals. You can simply ask or research ways to get a little more creative. The key is to find something that works and stick with it.


Susan Blackard, R.N., N.D.c, M.H.A., F.N.P.c, is an expert on obesity, weight loss and detoxification at the Rejuvenation Weight Loss. For more information, visit or call 866.95.ANEWYOU.


Bureau of Labor Statistics. Department of Labor. Occupational Outlook Handbook. 2010-11 Edition.

Know Your Numbers
Practice Management
Written by Tom Owen III   
Saturday, 12 March 2011 20:29


ften times we have the misconception that success is something we enjoy only after we master difficult concepts and complicated theories. However, it may surprise you to know that you learned some of the necessary skills required for a successful chiropractic office when you were in Kindergarten.

Do you know your numbers?  If you don’t, then reading this article and implementing its message can turn your practice around.  It’s really as simple as One, Two, Three!

The failure to keep proper statistics is a weak area among most chiropractors for two reasons. The first reason is because there are plenty of other details in the practice that keep the doctor too busy to focus on their numbers. Secondly, if doctors do not know how to analyze their statistics, they fail to understand how important it is to know them in the first place.

Knowing your numbers will increase production and profit without having to increase any aspect of budget or overhead. Read that last sentence again. Keeping detailed monthly statistics in your practice does this by allowing you to correct mistakes (or avoid them altogether). It helps determine how much you should charge for services, if more staff training is needed, and guides you to an exact dollar amount that you should spend on marketing.

If you’re not keeping proper statistics, our guess is you are losing a ton of money. Doctors tell us all the time that they know what is going on in their office because they’re always there. However, once they start “learning their numbers,” they see a completely different situation than what they originally thought.

Here’s a million dollar formula on patient visit statistics that won’t cost you dime! To determine patient visit statistics, take your monthly overhead and divide that number by the number of patient visits you’ve had that month. The result is the amount that each office visits costs you. (Yes, YOU! Every time a patient walks through your doors, you’re paying something; don’t you want to know how much?)

If you know your numbers, you know it’s about practicing smarter, not harder.

Compare the resulting number to the amount you’ve collected per visit that month in your office and see if each visit is profitable. For example, we recently visited with a doctor whose overhead is about $5,000 a month. During the month of December, he had 200 patient visits. That means each patient visit cost him $25.  (We’ve shown thousands of doctors how to do this and the surprised expression on their faces when they see the results tells us that they’re stunned to see how little their actual profit per visit results in actual profit.) One had a very insurance dependent practice and would get as little as $10 from the insurance for adjustments. He was actually paying the patient $15 to come to his practice!

Listen, if you want to take care of patients out of the goodness of your heart and pay them to receive your services, that’s fine; but you’re not going to make a living that way!

If you know your numbers, you know it’s about practicing smarter, not harder. We’re not impressed with collections until we know these statistics. We can’t tell you how many doctors we’ve worked with that were paying patients to visit their clinics!  Don’t confuse motion with progress. Profitability comes down to what you’re really making after overhead is figured in and, if you’re not keeping monthly stats in your practice, then you don’t know what that number is. Just because you’re seeing high numbers of patient visits doesn’t mean that your overhead is low enough to net you some profit. If you don’t know your numbers, you’re not going to know how low your overhead should be, or what you should charge, or whether or not to spend money on marketing, etc. You have to know your stats, so you’ll know how to proceed.

To revise a statement coined by former President Bill Clinton’s campaign strategist, James Carville, It’s the profitability, stupid!

Use the skills you learned in Kindergarten. Know your numbers, then you’ll better know what decisions to make in every other area of your practice. Don’t continue to make weighty financial decisions based on faulty thought patterns, rather than factual statistics. What is it they say about insanity? Don’t do the same thing over and over and expect different results. Making a small change in your practice today can add up to BIG results (and profits) tomorrow!


by Tom Owen III, and Todd Osborne, D.C.

Dr. Todd Osborne, a 1989 graduate of Palmer College, ran a successful high volume multiple doctor practice, and is currently Vice President of AMC, Inc., as well as an author and lecturer. Visit or call (877) AMC-7117 for more information.

Choose Your Space Wisely
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Practice Management
Written by Glen David   
Saturday, 12 March 2011 17:52


hen opening a new practice, selecting a facility that best suits your needs begins with a solid foundation. Now, more than ever, countless chiropractors are being misled by representations from their landlord or realtor that, if not carefully understood, could cost you tens of thousands of dollars.  Start with good questions and learn their language.

A Different Language

Landlords and Realtors have developed a language of their own, developed to slant negotiations greatly in their favor. The art of negotiations is a game that everyone has to play, but it goes much deeper than cost per square foot and triple net leases.

An Informed Shopper

As you shop different locations and view different size facilities, the first details discussed by your realtor are cost, either per square foot or by the month, as well as CAM or triple net expenses. There may even be offerings of “TI”, Tenant Improvement money. This is money that they are willing to offer you to improve the facility. In this economy, this could amount to as much as $20-$30 per square foot. In a deal for 1,600 square feet, this adds up significantly but, before you jump up and down with joy that they are willing to pay to build out your office, it is important to understand the starting point for this expenditure.

Facilities are offered in many different ways, such as: “As Built,”  “Vanilla Shell,” and “Grey Shell,” to name a few. “As Built” means that you take it as it is and you are responsible for any changes and improvements needed. You get to save any walls that you feel you can still use; however, you are typically left with old and outdated infrastructure that will take more than just paint and carpet to fix. Old HVAC units may or may not function efficiently or at a level acceptable to you, and restrooms may not meet code. With the recent changes to federal building and accessibility guidelines, once you do any form of construction, you will probably be required to bring everything up to CURRENT codes. Just because a rest room has handicapped access bars on the walls does not make it ADA compliant.  What you typically find is that “Grey Shell” offices come with higher TI offerings. This is because a grey shell is incomplete. You are responsible for the HVAC, Rest Rooms, and even electric service and ceilings. Essentially, TI money is used to fix, repair, upgrade or complete their facility.  Nine times out of ten, the TI money won’t even get close to paying for the basic necessities and mechanicals, let alone anything you need to transform these bare bones into a chiropractic practice. A facility offered in a “Vanilla Shell” is the best way to control costs and avoid hidden nightmares.

Leasable vs. Usable

Facilities are offered in many different ways, such as: “As Built,”  “Vanilla Shell,” and “Grey Shell,” to name a few.

When looking for space, you will always be offered “rentable” square footage. While they never disclose this, the difference between rentable and usable can be significant. When comparing one site to another, all that matters to you is what is USABLE. Usable is the amount of space you can transform into a chiropractic  practice. Rentable starts with the same, but also includes the thickness of the walls, any exterior overhangs, your portion of the common areas, such as lobbies, elevators and mechanical rooms. Offices in High Rise buildings can have a difference between the two of as much as 35%. You pay for 3,000 square feet and can only use 2,000. In strip stores and free standing buildings, it is common to have this loss factor in the 5-10%. Professional buildings may be in the 10-15% range. When comparing facilities, divide the monthly cost by the usable space and then compare. All that matters to you is usable. 

Less Is More

If you are starting a new practice or spinning off a satellite clinic or franchise, use the old adage that less is more. New graduates starting their career have had years of philosophy that says more is better. Seeing 450 or even 600 weekly visits is wonderful when thinking about improving the health of the planet, but be sure to match the growth of your practice to duration of the lease and, therefore, the size of your building. Balance your growth curve to the length of your lease. Think of your practice as an evolution, not a snapshot of your goals. Shorter leases are better when starting.

Scaling back in size does not mean scaling back volume. It is possible to see 2-300 or more weekly visits in 6-700 square feet (depending upon your clinical services offered). Leasing 1100 square feet instead of a 1600 square foot office can save you almost $70,000! Why pay someone else’s mortgage when you can keep this hard earned money in your pocket. This lowers your stress and financial burden, allowing you to focus on building a practice instead of how to pay your bills. Furthermore, your utility bills and staff payroll can also be lowered. Leasing 800 square feet instead of 1,200 will net you over $50,000 without having to do anything! Try to find that return in any financial institution!

Purchase or Lease

In starting a new practice, we disagree with most financial advisors’ suggestions to pay your own mortgage by owning instead of renting. Unless you have a 5-7 year business record that allows you to project your growth in volume and services, no chiropractor should purchase their own facility. Proof has shown us that doctors either over purchase and have huge overhead that they have to struggle to meet, or under purchase and grow out of their facilities long before their principal payments have made a dent in what they still owe.


Mark Victor Hansen always said that you never get anything unless you ask, ask, ask, ask, ask. We are seeing deals like never before, so be sure to ask for a better deal. You will be surprised at what you get.

So, when starting a practice, understand the foundations of negotiating, play the game better than they do, balance your growth, rent less than you think and purchase only when you are certain, design properly and, most importantly, ask!


Glen David has designed and outfitted over 4,700 chiropractic offices worldwide. More information on the evolution of your office environment as well as the efficiency and productivity concepts discussed can be found at  Glen and his team can be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or at 1-631-924-8686 .

Practice Management
Written by Steven Visentin, D.C.   
Saturday, 12 March 2011 13:57


hen doctors help high numbers of patients consistently for years with excellent results, other doctors want to know their secret. What is the one factor high-achieving doctors have in common? After three decades of interviewing the best, the one commonality I found in this group of ultra-high achievers is focus. I grilled a doctor about his huge following, asking, “How do you help so many people?”

He paused, and then replied, “One at a time.” He explained he worked on each patient at the exclusion of everything and everyone else around him, until he was done. Working this way was essential to his success.

I’ve watched leaders in our profession practice and received care from them, as well. The level of concentration they bring to their art has always impressed me. B.J. Palmer, in particular, had this quality. Old films from the 1920’s, showing him adjusting patients, reveal a man who was absolutely centered. One gets the feeling, if the entire world fell around him while working, he would have continued serving his patient.

Why Is Focus So Important?

Where is your mind when you adjust? The old timers called extreme focus, “being one with the bone.” Isn’t this the kind of care you would want?

Patients need focused care. They come to you after having little success with other doctors; they deserve your absolute attention. If you can put everything aside and lend your full attention to them, this may allow them to heal. This amount of caring can be profound and restorative, in and of itself.

In remembering the best adjustments I’ve received, the intense focus, the level of concern, and the precise delivery was life changing. Our patients will recall the same about us. A few moments of laser-beam focus can create a memorable event in patients’ lives. When patients are cared for this way, they will repeat their story, and chiropractic will keep growing. Isn’t this what you want for your practice?

Let Your Life’s Work Become a Work of Art

Something magical happens when we are totally involved in our work. It’s described as “being in the flow” and is one of the aims of the truly successful. Extraordinary people lose themselves in their work. Like great artists, they are in a meditative trance while working, yet they are fully present. The greats in every field love to experience this state: in a chaotic world, they enjoy moments of absolute clarity through focus.

How to Become More Focused

Often, growth in practice is counterintuitive. A close friend urged me to cut back my hours, saying that, if I did, my practice would grow. Although I was convinced he was lying, I finally reduced my hours after he continued to badger me. Suddenly, my practice grew. It grew so much, that I did it repeatedly. This worked because shorter hours demand more focus and higher energy. Allowing too much time to get things done decreases the quality of care by letting distractions into the workplace. If you must focus to get the job done, you get organized and do it.

Another counterintuitive way to develop focus is through rest. People who don’t relax can’t muster the intense focus necessary to build a great practice. These same doctors will protest about the high cost of having someone help them around the house and do it all themselves. By not resting adequately, they lose their clinical edge, and it costs them and their patients dearly. Intense focus demands a recovery period to recharge and perform at higher levels. B.J. Palmer often napped in the afternoon. During the rest of the day, he ran a college, sanitarium, cafeteria, two radio and one television station(s), wrote many books, and developed our great profession. Rest allowed him to be this productive. Are you well-rested? Discipline yourself to nap, meditate, take breaks, and play. Regenerate with regular vacations, seeing friends, and having fun.

Get Organized to Focus More on Patients

Rules for providing a quality service include:

1. Patients Always Come First
2. Doctor’s Time Is Primetime, and
3. Delegate Everything.

Patients Come First

In times past, patients expected to wait for a busy doctor and would tolerate a poorly-run clinic. Years ago, seeing a doctor required hours, but patients waited willingly because it was normal.

Today, this arrogant behavior is not well tolerated. Offices are usually better run, and the best offices provide the finest service. When a patient shows up, everything stops. The assistant hangs up the phone, or at least signals the patient, it won’t be long. The doctor drops his pen. All extraneous conversation stops and patients receive the attention they deserve.

In the best centers, doctors and staff anticipate every question and need patients may have. They are led through a seamless experience and receive appropriate care without much waiting. Ideally, the patient walks away thinking, “Wow, these people care about me. I can’t wait for my next visit.”

Doctor’s Time Is Primetime

Assistants in a busy office maximize a doctor’s time by minimizing interruptions. Experts in efficiency note that, every time someone is interrupted, the time to complete a task doubles. They also say that interruptions multiply the odds of errors dramatically.

In the best offices, phone calls, extraneous conversations, and other interruptions are tactfully limited, so that the doctor can offer his/her best. The staff dutifully runs interference for the doctor, so there are no distractions. Does your practice work this way?

Delegate Everything

Ideally, all work not requiring licensure to perform should be delegated. Assuming they can do everything better, delegating can be the hardest thing for doctors to do. Most doctors would rather do it all themselves than allow any aspect of care to suffer. When doctors won’t delegate, quality eventually suffers.

The greats throughout the centuries received support from qualified staff. Michelangelo and Leonardo had others stretch their canvas, mix their paints, and hand them brushes. They reserved their attention to the details only they were qualified to perform. Working this way, they contributed a vast body of work to the world.

Learn to hire well, train, and delegate. Give aspects of your work to people who can do it, and monitor their work. Manage so that you can focus on what you do best.


No discussion of focus would be complete without covering what to say as we attend patients, and when to say it. This is often when we lose our focus.

There should be no conversation immediately before, during, and after the actual adjustment. Conversation should abruptly stop to allow absolute focus on this event.

Before and after the adjustment, the doctor should focus and talk about the patient’s needs, issues, and benefits of care; answer a question; explain his/her progress, results, how he/she adjusted, how he/she might feel; and give instructions and suggestions for self-care. As a rule, the focus of the conversation is on him/her. Is your “table talk” like this? If it gets off track, does it always come back to the patient?

Focus to Build Your Practice

The chiropractic champions have one thing in common: uncommon focus. They offer exceptional care and enjoy extraordinary results through this discipline. This is why patients flock to them. In the end, doctor and patient benefit. The patient enjoys wellness and the doctor his/her art. Do whatever it takes to center yourself on your patients needs. Retrain staff, rest more, and lead productive conversations. Lead your practice forward by managing your attention.

Dr. Steven Visentin, D.C., is a solo practitioner and clinic director for Care Chiropractic in Denver, CO. He authored an e-book entitled “Blow Your Head Off Practice Building Secrets” for the chiropractic profession.

As an accomplished public speaker, he is available for corporate events, training seminars, and other group functions as well as private consultations on a limited basis. For additional information, visit


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