Building a Cash-Based Practice
FEATURE
Alan Smith
DC
Throughout my 17 years of practice, I have seen too many practices come and go. Many have struggled with diminished reimbursements from insurance companies or had a difficult time asking for money for services rendered. As a chiropractor who has built two cash-based practices in two different states, Colorado and Florida, it is possible to build a successful practice that is not dependent on insurance reimbursements, that provides free time, and whose patients are happy to pay for services.
My first two years in practice were difficult. I wasn’t succeeding mentally, emotionally, or financially. I had moved to a new location, felt the philosophy of subluxation-only was limiting, and I struggled with balance and being solely subluxation-based. It was difficult to comprehend due to my sound philosophy and aligmnent with the leaders in the profession who were of the same mindset.
On my second anniversary, I experienced two significant events that became pivotal for me and my practice. The first experience I had was talking to my father. He questioned why I would have a nutrition degree and not use it as a part of my practice. The question lingered as my understanding prior was obvious—the subluxation-onlybased principal did not have an emphasis on nutrition. Later that same day, I had a new patient who injured his ankle while skiing. After a few minutes, I knew what he needed, and for whatever reason, I could not allow myself to follow protocol and adjust only his Atlas. At that moment, my focus was setting his talus, which is precisely what I did. He then scheduled an appointment for later in the week and ended up being a devoted weekly patient until I sold that practice.
"Such a model understands that the subluxation is an effect and is built with other services offered to reduce the body’s negative reaction to stressors."
Through these two events, I became confident in the answer of whether services such as nutrition would be a part of my practice. I began to mold my practice into a “subluxation-centered” model that focused on the whole body. Such a model understands that the subluxation is an effect and is built with other services offered to reduce the body’s negative reaction to stressors. The very foundation of chiropractic is of a complete wellness mindset grounded in this holistic approach. Today, society is looking for holistic care, and your patients will appreciate the additional disciplines you have to offer.
Adding Services
Nutrition was one of the first services I added to my practice, and it is a must-have discipline for any practice. More than 65% of Americans take supplements daily with 40% of that number taking it to affect a specific response in the body. Sales of bottled water have surpassed soda. More people are buying either organic or non-GMO Foods. However, a big misconception is that these foods are more nutrient dense, which is not true.
Minerals make everything work in our body, including vitamins. Educate your patients that you are not only “what you eat,” but also what your body can absorb. Due to supply and demand, our foods are nutrient deficient. The Standard American Diet is just that— SAD. Implementing nutrition into your practice can be intimidating. Start with a complete, well-rounded, highly absorbable multimineral/vitamin for a minimum of three months. Any nutraceutical takes six weeks to truly get to the cellular level, and then another six weeks to make a physiologic change.
A second discipline I added was Foot Levelers custom orthotics. With one in two Americans having a musculoskeletal condition, the need for proper balance and support for the body has never been greater. Over-the-counter insoles may initially cost less, but they only support one arch in the foot. If dysfunction is noted in either of the two remaining arches, this will cause more harm than good.
The negative effects of repetitive stress on your body are something we all encounter. Gravity is constant, and with a trend focused on how many steps people get in daily, custom orthotics allow us to continually help our patients to achieve a more proper gait by activating the kinetic chain properly. In addition, with our technological society, being able to assess dysfunction qualitatively and quantitatively is powerful. With the Foot Levelers digital foot scanner, it is easy and efficient to evaluate all three arches of the foot, and it allows patients to understand the imbalances that they have as well as how they are impacting their body.
When choosing which services to add to your practice, the key is to add services in disciplines you believe in and use. It is important to practice what you preach. Today’s patients are very well informed. Knowing that you are offering your patients the very best because you use it and know it works speaks volumes.
Having multiple disciplines is not just a revenue source but also an extension of your belief in treating the whole body. By having the "subluxation-centered” model with disciplines offered to help strengthen the body's reaction to stress, it allows the practitioner and practice to grow.
Empowerment Through Educating versus Selling
The word “doctor” is derived from the Latin docco, which means to teach. I don’t sell my patients on services. I educate them about how they can improve their health based on their specific situation. Expanding on this premise is a foundational principle for a successful cash-based practice. A cash-based practice provides a deep level of transparency for you as a practitioner to give and for your patients to receive.
It is a known, accepted fact that healthcare practitioners have a difficult time asking for money for services rendered. The primary excuse is the practitioner wants to help the patient and does not value the business aspect and its necessity. The majority of chiropractors are in private practice, which would equate to being an entrepreneur. Something I often say when speaking to young practitioners is, “You must love your business so you can stay in business.”
The focus must be on the patient as well as the business aspect of your livelihood. Point being, if you can’t keep your doors open while concurrently helping others, then how can you expect to succeed and thrive truly? Remember, your patients see you because of you. They may believe in chiropractic, understand and appreciate its power, but they are receiving chiropractic because of you.
So what are the secrets to building a successful cashbased practice? A holistic approach evolving from being subluxation-centered that is informative, congruent, and empowering through education to both you and your patients. If you are afraid of cutting insurance reimbursements, don’t be. FEAR stands for “false evidence appearing real.” Remember you are the only one holding yourself back from truly having the practice of your dreams.
Alcin Smith, DC, runs Axiom Wellness Center, a cashbased practice where Dr. Smith focuses on restoring and optimizing the health of his patients. As a speaker for Foot Levelers, Dr. Smith helps chiropractors understand that you can be successful taking cash-only and what it takes.
Dr. Smith can be contacted at AxiomWC.com.
