168 The Trends in Chiropractic

Welcome to the KC CHIROpulse Podcast.  

This week’s topic: The Trends in Chiropractic

The KC CHIROpulse Podcast is designed for Chiropractic professionals ready to elevate their practice to new heights, and is hosted by Kats Consultants coaches Dr Michael Perusich and Dr. Troy Fox, both seasoned experts in Chiropractic care and business development.  This podcast provides invaluable insights and actionable strategies to help you create a flourishing and sustainable Chiropractic business.

In this episode, we discuss:

• What are some of the common trends we see in practice
• How Chiropractors are under review by the insurance companies
• Why building up the cash side of practice can help insulate you from declining profits
• Why you may need to change your patient communication methods to create better retention
• …and so much more…

In each episode of KC CHIROpulse, we delve into crucial aspects of building a successful Chiropractic practice, covering topics such as establishing a strong foundation, adopting a patient-centric approach, mastering marketing techniques, achieving financial fitness, fostering effective team building and leadership, integrating technology and innovation, and navigating common challenges in the field.

Whether you're a seasoned chiropractor or just starting your practice, the KC CHIROpulse Podcast offers a wealth of knowledge and practical advice to help you navigate the intricate world of Chiropractic business. Join us on this journey as we explore proven strategies, share success stories, and connect with industry experts to empower you in your pursuit of building a thriving Chiropractic practice.

Don't miss out on the latest insights and expert guidance. Subscribe now and unlock the secrets to taking your Chiropractic practice to the next level. Your success is our priority at Kats Chiropractic Business Advisors.

DISCLAIMER:  The information presented in this broadcast is for educational purposes only and is not intended to offer legal, investment, accounting, or medical advice.  Seek the consultation of a professional for advice in those areas. And remember…your results using this information may be different than described.

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Transcript

Dr. Michael Perusich: 0:00

What are today's trends and the future trends in chiropractic business management? Hi everybody. Welcome to the KC chiro pulse podcast brought to you by Chirohealth USA and Kats consultants. I'm Dr. Michael Perusich joined by my cohost, Dr. Troy Fox. Troy, you and I talk about this all the time off camera, and there's probably some things that we talked about that we can't put on camera, but sure, but nonetheless, You and I see and always have, we always see where the profession is going in a lot of regards. And I thought it'd be interesting for us to just talk about some of that today. And I'm going to prime the pump here a little bit by talking about reimbursement, insurance reimbursement. And you, we post this question all the time to the profession is reimbursement going up or down 99. 9 percent of the time. It's going where everybody deal with me down, down. It's going down. And so as insurance reimbursement goes down, do you make more or less with those patients who have that insurance?

Dr. Troy Fox: 1:08

You make way less because you're also chasing

Dr. Michael Perusich: 1:11

it harder. You are. And a lot of it on the EOB goes to write off. So you can raise your fees all day long. If what you're billing out to the insurance company, if reimbursements going down, that means your write offs are going up. So you're just, you're fighting a losing battle. And one of the trends that we see is doctors trying to make that up by increasing capacity, by increasing the number of patient visits, which I'll be honest, that's a valiant way to overcome it in some ways, but it's also a valiant way to burn yourself out really quick. You get into that mode. Oh my gosh I can't see a thousand patient visits a month. I just can't physically do it. I know I couldn't do it anymore. And you realize you can't do it. You immediately think I'll just hire a bunch of associates and come in. And, that's not always the answer. And but we see this trend happening where doctors are trying to see more and more patients to try to make up for the loss of reimbursement and the loss of fee control, and then hiring a bunch of doctors. And now, and I'm not saying the multi doctor idea doesn't work. I'm not saying that at all. But we wind up hiring people and wind up hiring the wrong doctors. And so now quality of care begins to degrade. There's unhappiness in the clinic. There's low retention rate. And now we're swimming even harder to bring patients in. And what do we do? The low

Dr. Troy Fox: 2:37

cost promotion. I was just going to say that, because that's exactly what comes next is now we need to flood our practice with new patients. So we're going to do a 1999 special that, gives away an adjustment at exam and a free massage. And, maybe we're going to throw in a 20 gift card to, hardies or something like that on top of that. And. Yeah, I just picked hardies out with large fries could be Starbucks. I don't know. It could be wherever you want to go, but unfortunately we create a situation where now we have brought associate doctors in and in a lot of cases, and I'm just telling you what we see in a lot of cases, what we see is doctors that are semi burnt out already. Because they've been running on the wheel as hard as they can. And they're like, Oh my God, get me off of this thing before I die. I'm going to bring in some associate docs. Guess what? They're so tired and so burnt out that they don't have the time or the energy to spend time with these young docs that they brought in. To get them up to speed, to get them ready, to get them to where they actually have the skillset needed to work with today's patients. And that's, you don't learn that in school. You learn that out in practice, you cut your teeth. Yeah. And

Dr. Michael Perusich: 3:53

so it's so true. And the big part of what they don't have and the big part of what we need to spend time training and associate on is communication

Dr. Troy Fox: 4:01

skills. Yeah. So add to the complexity of that by, and I'm going to say the word enticing. Patients to come into your practice of the low cost special. And so the quality of patient that you're bringing into your practice is low. Now you don't have people that are seasoned when it comes to working with the public and they're working with some of the hardest individuals on the planet. To get them to understand and follow through with care, because they didn't value you to begin with when they walked in the door because of the special. So we have created an absolute monster. As a profession. And I see it in a lot of large towns, small towns practices. You don't see it as often as

Dr. Michael Perusich: 4:45

much, but you get

Dr. Troy Fox: 4:46

into the cities, man, it's dog eat dog, everybody on the block. It's got a special going and basically a patient jumps from one chiropractor to another, as soon as the special changes. And you're creating a situation where you've got patients that don't value your services and are just looking for the next great deal. And then you wonder why your retention is just

Dr. Michael Perusich: 5:08

horrible. And we keep following each other to the bottom of the pool, going lower and lower on our price. I saw a deal for 9. 99 the other day. Nine, ten bucks. What? We've devalued ourselves so much in those situations. The patients are never going to find value in it. And then you want to bring them in for nine bucks and give them all these things on day one. And then on day two, you want to present them with a fifteen hundred dollar treatment plan that just doesn't fly. It just doesn't make sense to patients. That's not how you build value. So we see this big trend in the profession of declining value along with declining reimbursement. And the opposite should be is what should be happening. As reimbursement goes down, we should be unencumbering ourselves from that horrible FEMA, that horrible fee for reimbursement model. Sorry, that horrible insurance reimbursement model and getting away for it and putting ourselves in a position where we can control. Our fee

Dr. Troy Fox: 6:05

structure. And I'm going to interject right here. If that's you, we usually, we wait until the end of the show to actually talk about, Hey, give us a call. If we can help you, or if this sounds like you, if this person sounds like you. You need to jump on the website right now and make an appointment to talk, because quite frankly, you're not going to change what your practice is doing. If you continue, insanity is doing the same thing over and over again, expecting a different result. Here's the result you're getting. You're actually getting a lessened return. A diminishing return every year that this continues on. And it's been going on for years, but we're getting more and more diminishing returns. And Dr. Perusich and I have both have very strong opinions. And I will tell you right now, I walk the walk when it comes to what we're doing. I run a cat, I run a cash practice and I'm going to throw, I'm going to throw this out there. Lower overhead, because here's what you're running into when we get diminishing return. In other words. You're not getting as much reimbursement from those insurance patients. But yet you're having to work even harder to chase that insurance payment. Your fixed costs are either remaining the same or going up, but the pie's getting smaller. So guess what? The percentage of what goes to your fixed costs increases and you feel the squeeze because your account is getting smaller and smaller, meaning that you're getting paid less per hour than you deserve. It, you can feel it. You're trying to figure a way out of it. And instead. You literally cannibalize your own practice to do it because that's what everybody else around you is doing. I hate it. I hate it. I'll be honest with you.

Dr. Michael Perusich: 7:48

Yeah. And we don't need to do that. So here's what we do need to do. We do need to have a word from our sponsors real quick, but I want to come back and talk about this. We're talking about the trends we see in chiropractic business management right now. And we're talking about the fact that. The insurance company's reimbursement is declining and how it's affecting our practice and the result of what it's causing us to do to undervalue ourselves. So let's hear from our sponsors, Chirohealth USA and Kats consultants. We'll be right back.

8:16

So we all feel it. Rent, or dining out, gasoline, or movies. As a matter of fact, the dollar is not going as far for a whole host of reasons. And it's impacting everybody, regardless of your financial situation. Did you know that 38 percent of the overall population is having to reconsider How they're spending their money just to afford the health care they need. And if you break it down further, 26 percent have actually delayed the health care that they need, including going to see you, the chiropractor. So here's what we need to know about the breakdown in demographics. You would think that That someone who's making 120, 000 or more would be continuing their care right now. But the actual number is 18%, 18 percent of that group is actually putting off healthcare. And that's a group of people making six figures. When you take that same information all the way down to a group making 40, 000, that number is much higher. It's closer to 40%. So it's never been more important than now to make sure you've made it easy for your patients to come see you. That you have choices for them, and you understand what they're going through at home. We want to make sure your practice thrives during this time, and we encourage you to learn about what ChiroHealth USA can do for you, and your practice, and making it easy for patients to see you and continue care.

Dr. Michael Perusich: 9:45

All right, everybody. Welcome back to the KC CHIROPulse podcast. We are talking about trends in chiropractic business that we see right now and where things are going and. Troy, you and I fell off the cliff into this whole idea of what declining insurance reimbursement is doing to us. And I'm going to add a couple of other things to it. What else is the insurance world doing to us? They're putting more layers of audits on us, more responsibility for medical necessity and the proof thereof. And they're squeezing us in a lot of cases in our ability to actually get paid for proving medical necessity because a lot of the insurance companies no longer pay for progress exams and those kind of things. So we're caught in this weird trap and it's forcing us down this road of as reimbursement goes down, we're allowing our value to go down with it. Because we're just we're trying to bring in more new patients. And so we're taking the new patient price and then we're not getting patients to convert into care.

Dr. Troy Fox: 10:49

And I can tell you right now that feeling better about yourself because you had 35 new patients last month does not feed the bulldog. I'll tell you where the problem lies right now is you guys are caught in a conundrum and you understand that there are more layers of auditing. You see it coming. You've seen it happen to people around you. So 1 of 2 things is going to happen. You either bury your head in the sand and continue down the road that you're on. Or B, you've already made the determination. Wow. There might be some trouble up ahead. I'm going to divert over here, meaning that I'm going to cut this patient's treatment schedule below what this person needs to get better. And so the results that you're getting with patients are also diminished. Yeah. So instead of the outlier report and it's just Oh my gosh, I stayed off the outlier report, but my patients aren't getting better now. So I'm stuck between a rock and a hard place. Do I want to get audited? Or do I want my patients not to get better or get the results that they should? I won't say better because some of them are going to improve to some extent, but maybe they didn't get full resolution when they should have. So it's a horrible position to be

Dr. Michael Perusich: 11:51

in. It is. And I'm going to throw a caveat in here. It may sound like we're saying you have to be a cash practice. That's not what we're saying. Even though Petra and I both have cash practices, but that's not what we're saying. You can live in the world of insurance. You just have to balance it with more cash services in your practice. So you have to think about, what's covered, what's not covered. What does the patient need? Where I'm going with this is I see a lot of practices shy away from sharing services that are cash only, not covered by insurance, but them not building that into their treatment plans with their insurance patients. Cause they're afraid to tell the patient, Oh, you owe more than your 20 percent co insurance.

Dr. Troy Fox: 12:38

Yeah, some people get really stuck on that, that basically you are in a position where you feel like that to pay. Really, it's a poverty complex. We don't call it. We don't call it that because you look at it and you're like, oh, I'm telling the patient what they need. And this is going to generate 1500 in revenue from this case. But here's what you're not doing. You're not recommending any cash services because you're afraid the patient's going to say no. And I get that in an insurance model. In a lot of cases, the patient goes, yeah, do whatever you need to do. As long as my insurance covers it. We hear that a lot, but if it doesn't cover, you actually have to give them a valid reason why you're doing it. And if you do, they're going to follow through. What about. Sales of pillows, sales of supplements. Simple things like that. Those are things that are not covered under insurance. Do you think that if you have a question, do you think of a patient comes in with a cervical problem and I'm going to put them on cervical decompression and I'm also going to sell them a cervical pillow? Do you think those are things that are unnecessary? Or the things that just aren't covered by insurance. And so you have to look at it from that standpoint, but it takes time to explain that to the patient. And you actually, so now I've added in more cash services. I've diversified a little bit to where the patient isn't solely stuck on what their insurance covers. And I'm starting to wean that patient away. And the other thing that helps wean them away is high co pays. I like a copay. I wish they were higher, honestly, even better. Truth of the matter is that's exactly how you start to balance your practice. If you still want to dabble in insurance, you've got to move into some cash services. Yeah,

Dr. Michael Perusich: 14:23

you have to balance yourself into a profitability standpoint. And so again, it sounds like we're. Saying you've got to go all cash. We're not saying that at all. But if you find yourself in this position where you're really struggling with a good fee strategy and communicating to patients, the value of services that may not be covered by insurance, give us a call. This is one of the things we're teaching chiropractic teams. Oh, to do in their offices with huge success. So there's a right way and a wrong way. You don't have to. Ride the trend to the bottom of the barrel on pricing and value. There is a way, and it's really not hard. There's methodologies where you can create great fee strategies and this is, I'll get off on that in just a second. Make me come back to fee strategy. All right. But there, there are methodologies by which you can communicate these things to patients and patients will pay for it all day long. They just have to understand the value. I

Dr. Troy Fox: 15:25

want to remind you of a word called COVID. Our clients during COVID because of the strategies we were employing and fee structures. And we'll talk about that here in a minute, but because of the strategies they were employing. In other words, we were all out for patient care at that point. Yeah, we were telling them exactly what they needed to do, how they needed to do it and the best way to shore up their defenses, the best ways to make their immune systems function, the best way they couldn't just feel better practices. That we're listening to what we were telling them to do were exploding exploded. We haven't slowed down. They haven't they've had well, because they obviously at that point realized what they were doing worked and it was really a super effective way to. To get patients well, but they also were listening because they were a little bit concerned about COVID, but they, we had an open ear to talk to them at that point. People realize patients actually want to hear what you have to say. If you're a voice of reason and an expert, they're going to listen to you. Absolutely. So back to being their leader, those are the things that you have to employ. When you are going to employ cash services or become all cash, you really have to become the doctor that they want to listen to. You have to become

Dr. Michael Perusich: 16:40

the authority. You do. And that's such a great point. And I want to go back to this idea of fee strategy for a second, because this is so important because this is another one of those crazy trends that we see. We see doctors arbitrarily setting their fees. Arbitrarily setting their fees. So they're setting them sometimes to what the insurance company reimburses. The insurance company reimburses me 23 for nine, eight, nine, four. Oh, so that's where I'm going to set my fee. No, that's not a correct fee strategy or we see doctors say everybody else in my community, all the other doctors are charging 49 for an exam. Okay. That's so random. I can't even see straight. You have to tie your fee strategy back to a couple of things. One, what's patient tolerance as far as a relative value goes and what are your profitability points? And this is the crazy thing that nobody's looking at. We do with our clients, but nobody's looking at this whole idea of profitability. We're still stuck on these old statistical models. Here I go. I'm getting on my soapbox. We still get stuck on these old statistical models of services, collections, new patients, patient visits, and PVA. And we think that as long as those are cooking along, I talked to somebody the other day, he was all, big chested kind of boasting about the fact that they see 80 page, 80 new patients a month. Okay. Great number. Give me some relativity to it. How many do you retain? And his retention was 29%. Oh, wow. So really, when you think about that, call it 30%. Do the math. So they're holding on to 18. If I did the math, right? 20, sorry, 24 holding on to 24 patients a month, new patients a month, but they got to see 80 to do it. Who's working too hard? And the reason why they're seeing 80 new patients is because they got a 29 deal. Okay. Out of 80 patients paying 29. I don't have a calculator right here in front of me, but it's what? 2, 400. Maybe if I did the math, right? No. All right. Everybody just told your horses, I gotta do this. Usually I can do this in my head. Yeah. It's 2, 300. Okay. Yeah. You saw 80 patients who paid you 2, 300 who most of which will never be back, which means most of what most of them are going to go out and say bad things about your clinic. And you're left with 24 patients who might stay in care for a few visits because some of those are going to drop out too. And did you really make any money? No, all you did was work hard. And so now you've created a Ponzi scheme on yourself because now next month you've got to get 90 new patients. And the month after that, you've got to get a hundred just to try to keep a little bit of that cashflow coming in and get enough people to filter out of the bottom, to stay into care for a while that they actually become profitable, which I'm going to tell you in today's world with our rising population. Awesome things is probably the fourth or fifth visit before they become profitable. If you brought them in for a low price, first day, take it away.

Dr. Troy Fox: 19:50

And that is such an old mantra that was a coaching mantra from years ago. We're talking eighties and nineties where it was all about new patients and PVA, new patients and PVA.

Dr. Michael Perusich: 20:04

And I can remember, I'm going to date myself, but yeah. And you too. Yeah. We used to coach

Dr. Troy Fox: 20:10

this. Absolutely. We thought those were big time numbers.

Dr. Michael Perusich: 20:13

And then one day as we saw patient mentality start to change, we saw that wasn't necessarily the right way to look at a business anymore, especially when everybody around you in the profession was diving to the same bottom of the pool. Yeah, 30 years ago, you might be the only one in your community doing a 29 deal and then you'd stop doing it and maybe another guy would do it or chiropractor shouldn't, sorry, I don't mean to be sexist, and then another, we would take turns, but today everybody does it all the time.

Dr. Troy Fox: 20:47

Yeah, you just basically look at it from that standpoint as well. And what did new patients in PVA tell me? They don't tell me how profitable I am. And quite frankly, the bottom line is that, if I get to the end of the year, I'm not looking at month by month numbers. And every month I start over again. I like year to date. I like year to year. That's how most businesses look at themselves year to date, year to year,

Dr. Michael Perusich: 21:10

right? We start over every month. Yeah. And so if you might as well file a 1040 every month.

Dr. Troy Fox: 21:16

So if you had, let's say it comes to December and you've had just a banger year, but you get to December and all of a sudden you're down on new patients, you're down on yourself. You don't feel like your practice is doing well. And it's. You're trying to figure out why there's not enough money in the account. If you would have started at the beginning of the year, looking at profitability and looking at, okay, you know what, this isn't necessary. This isn't necessary. I can get a lower price on this. Let's streamline the staff. Let's make sure that we're doing all the right things. And then let's make sure that the service or the product that we're providing to our patients is top notch. Yep. Then guess what come about December, you're looking year to date. You're like, we're blowing it out of the water, even though it's December and everybody is trying to leave for Christmas break and they're doing this, that, and the other, maybe your new patient numbers are down, but you're standing there with a smile on your face going, we killed it this year. We helped so many people. It's such it's literally that thought process that takes you from being down in the dumps come December, January, February, some of the worst months in chiropractic usually to really looking at it from a standpoint of how did I do this year and how am I doing in comparison with last year? That's what I like to look at. I like to look at where I'm at and I like to look at my profit because the bottom line is I'm not going to retire on new patients.

Dr. Michael Perusich: 22:39

Oh, gosh no. Retire or retention. Yeah. Yeah.

Dr. Troy Fox: 22:42

You retire on retention and you retire on the amount of money that you have in the bank. And I'm not trying to turn this into a money conversation, but we are all in this as a for profit business, right? We're not non profit. So it's not a dirty word to talk about making some money. So if I'm going to retire on something, it's going to be on profit. It's going to be on that retention of those patients. It's not going to be on new patients and PVA.

Dr. Michael Perusich: 23:06

Exactly. I can.

Dr. Troy Fox: 23:07

I could fix my PVA. I'll just quit seeing new

Dr. Michael Perusich: 23:10

patients. My PVA is going to go through the roof. So you bring up another trend here that I think is interesting. We're a profession that has very, we're very short sighted. We look at 30 days at a time, 30 days, 30 days, 30 days. So I just want to pose a question. When are we going to start looking forward? When we, let's just look forward 30 days, not backwards 30 days. Let's just look forward 30 days. What does your practice look like in 30 days? What does it look like in the next quarter? What does it look like in six months? What does it look like in 12 months? And here's the answer. 99 percent of you are going to give me, I have no idea. And that looks

Dr. Troy Fox: 23:50

horrible or it looks horrible. If you

Dr. Michael Perusich: 23:52

know how to look at it and see it, it looks horrible. And I'm not going to tell you. How, but I can show you how that scares the bejesus out of me. Oh, yeah, it really does. What business does that

Dr. Troy Fox: 24:08

none that I'm aware of that are profitable usually. And so I think sometimes we're profitable just by chance.

Dr. Michael Perusich: 24:14

Yeah. So this is one of the things that we're turning around for our clients and I'm not necessarily trying to make it about cats, consultants, cats, consultants. com. Come check us out. I'm trying to make it about where you need to be looking. And if we're talking about trends, if your trend is to never forecast where your company, where your business is going, that's crazy. Do you think Walmart doesn't forecast? There's a reason why they make, what is it? 28, 000 in profit a minute. What do you make a minute? You can only tell me what your history has been, not your future. You don't have a way. Or you haven't created a way to forecast it going forward again, this is one of the things we're turning around for. A lot of our clients is forecasting forward. And I'm telling you it's a game changer when you start looking out instead of back. And that's a trend. This looking back is a trend that we've got to get away from. We've got to start being entrepreneurs. And looking forward, you mentioned retirement and we need to have exit strategies. Now, I do think that's a trend we're starting to see improve because we're starting to get more and more calls from people looking for help building exit strategies, which we do. But let me ask everybody out there listening. Here's another question. What's your practice worth? 99 percent of you are going to tell me, I don't know, or you're going to pull up an arbitrary number of what you think you want for the practice, which is not the value. How many of you actually put the value of your practice on your balance sheet every year? So you can actually see what your net worth is. Very few of you, again, this is just a crazy trend that we've got to get away from. We've got to be true business people here.

Dr. Troy Fox: 25:57

Yeah. That's a little tip for you right there. That should be on your balance sheet every year. It's not a wait until I'm ready to retire. And then I'll figure out what it's worth strategy. Shouldn't be there. No, it shouldn't be that way. You should already know. So that way, when you're getting close, you have a very good, rough idea of what your practice is worth before you ever get to that point.

Dr. Michael Perusich: 26:17

We just had a big live seminar with a whole bunch of doctors there. And we talked about the. the dangers of the natural bell curve of practice life and practice value. And you've got to understand what goes into that and how to maintain control over it. So that's a trend I would really like to see happen in this profession. We see far too many doctors struggling financially. We see far too many doctors go under because of poor financial management and not Actually building a business that has the ability to create long term wealth for you as the owner. And then isn't that really your goal? And I know a lot of you are going to say, no, my goal is to, see a lot of people and I don't disagree with that. As put my doctor hat on my doctor hat, my, my goal with my doctor hat on and he can say, I have my scrubs on today is I want to help as many people regain their lost function. As much as possible, but that's my doctor at, but at some point I got to take my doctor hat off and I got to put my business hat on and my business hat is I want profitability to the point where I create long term wealth for myself and my family and my employees period. End of story. That's a trend we need to create.

Dr. Troy Fox: 27:34

Yeah, and that's 1 that unfortunately, so many people that we talked to can't even see. I know and it's easy to strategize. It's easy to put it together, but you have to be willing. And you also have to put the mirror on yourself a little bit, point it back at yourself and see if you're still breathing. Yeah. That's part of the introspective strategy. And that's part of what we use. You have to be willing to accept. Your responsibility in this, whether that means that you've held yourself back or whether that means that you need to do some things to push yourself forward, or in some cases, a little bit of both and a little bit of, hey, you've done a good job in these areas, that's our part of the job is to do an auditor and assessment of what you've got going on to see where you need to head. Because if you don't have a road map, it makes it really hard to move forward, and that road map sometimes changes because you and I are constantly talking about, opportunities and things that we're doing, and we're constantly veering around doing changes in the road map. But it's one of those things where we're constantly trying to make changes for improvement,

Dr. Michael Perusich: 28:43

and it's because we're constantly looking forward what. What's going to happen to chiropractic six months a year, five years down the road, we're always innovating. And yes, we're disruptive at times because here's what we've learned by the time everybody's doing the same thing. You should have already been going in a different direction. So you've always got to be ahead, not behind these trends that we're talking about. You've got to be out there blazing the trail of the new trend, the new innovation, the new strategy, the new tactic, whatever it might be. We've got to start looking forward, putting that entrepreneur hat on and becoming true business people with our practices and becoming leaders in our community. And I'll get off my soapbox. And

Dr. Troy Fox: 29:30

you also have to look at that bell curve. We talked about that a little while ago. You have to figure out where you're at on the bell curve, because just like you said earlier, you would struggle to see a thousand patient visits a month right now.

Dr. Michael Perusich: 29:41

Yeah. And I used to do it all the time. And you did it with ease

Dr. Troy Fox: 29:45

with it becomes much more challenging as we age. Unfortunately, I can tell you for a fact, it's much more challenging. And I can tell you at age 58. I have to employ better strategies. So I'm constantly looking to see, okay, what are the revenue streams that I can create, not just in chiropractic, outside of chiropractic with my investments, where am I right now and what is my end goal? And is there a way that I can actually divert a little bit of the stress away from my practice? Because I know that I'm going to get a little bit of drop off. I have to be aware of that. I have to be honest with myself and go, you know what? You're not going to go in and see the number of patients you're seeing when you're age 30 at age 70, you're not going to continue. It doesn't do this. You're going to go. No, you're going to start to go off,

Dr. Michael Perusich: 30:37

but if you plan correctly, maybe your patient visits drop down as you get older. Exactly. But your profitability doesn't have to. If you plan right, this goes back to the correct fee strategy. This goes back to not being sucked into completely sucked into the trap. Oh, okay. Maybe that's the wrong way to put it being in a position where you're just writing the wave of reimbursement down the slope and not creating other profitability in your practice and not diversifying those income streams. These are the things you have to think about today because I don't know about you, but the world's not getting less expensive.

Dr. Troy Fox: 31:16

No, it's not. And some of that could be involved. If you've got multiple income streams or multiple different entrepreneur, if you're an entrepreneur, like some of us are you may have an opportunity to even, when you're trying to create a situation where you, maybe you're starting to drop off in numbers a little bit, maybe you're able to divert staff to. One of your other entrepreneurial ventures. That's not always the option that you have. Some of your just in practice, but you have to look and be creative and go, you know what? I've got an absolute star that works for me. Why don't I convert that person? He or she over here for 20 percent of their time to reduce it. There's so many different ways you can look at things, right? You can look at a smaller, smaller physical plant. You can look at. Changes and hours that might affect, there's a lot of things,

Dr. Michael Perusich: 32:05

a lot of things you can do, there's a lot of things you do and get, get diversified, look for opportunities. You and I are incredibly well diversified and have our fingers in several different things, but, um, get, just open your eyes, take that doctor hat off a little bit, look up, we're always looking down, look up a little bit and find the opportunities and the opportunities are not in the old trends that are pulling everybody else down. Okay. What do you think? Yeah.

Dr. Troy Fox: 32:34

I think we did great. The only thing I'm going to add to this is when we talk about trends, I'm talking about trends in marketing and that sort of thing, when you look at trends in chiropractic care, sometimes what I see is we get gimmicky and we're looking for the next greatest latest shiny thing. Oh, we're

Dr. Michael Perusich: 32:52

so attracted to the shiny thing.

Dr. Troy Fox: 32:53

I think sometimes that the, that we forget that the bread and butter that we started with those adjustive skills to, to lay hands on people and get them better are a trend that you may want to make a circle and go back to because they're very effective and you know what patients desire it, I get that they like the shiny things, but that's going to wear off the actual chiropractic adjustment has lasted a hundred years. Plus, I'm aging, I'm dating myself because it was a hundred years quite a while back, maybe a couple of years ago, but anyway, we're well past a hundred years now, but the truth of the matter is the adjustment was important then and it's important now. And so sometimes trending means remembering what made you profitable to begin

Dr. Michael Perusich: 33:44

with. The Paisa form has been profitable for 129 years and it will be for another 129 and more. Yep. Yep. Good point. Good point. All right, everybody. Keep keep tuning into the KC CHIROPulse podcast brought to you by Kats consultants and Chirohealth USA. Be sure to subscribe wherever the button is subscribe. Tell your friends about it, go to kats consultants. com. Check us out. There's free downloads on there. Listen to the podcast every week and we appreciate everybody listening. And remember, if you want to talk about your practice, if some of these things that we talked about today, ring a bell with you and you want to talk about it a little bit more, go to the website. You can schedule a breakthrough call with us. Let's talk about your practice. We do those for free. Cause we care about you guys. All right, everybody. Thanks for tuning in. We'll see you next time. So yeah.

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