Kats Chiropractic Consultants CHIROpulse

198 The Resilient Chiropractic Practice

• Marisa Mateja

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Welcome to the KC CHIROpulse Podcast.  


This week’s topic:   Is Your Chiropractic Practice Resilient?

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 Alex Kallio.  Drs Perusich and Kallio are both seasoned experts in Chiropractic 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:

  • Are you being resilient in your practice
  • What are the common challenges Chiropractor’s face   
  • What are some of the strategies for making your practice more resilient
  • Why creating patient loyalty and building a strong brand image in your community is so important
  • …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 personalized 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, and represents the opinions of the speakers.  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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KC CHIROpulse Podcast. Helping Chiropractors keep their pulse on success. Thanks for listening.



Dr. Michael Perusich:

Chiropractors, how resilient are you in business? Hi, everybody. Welcome to the KC Chiro Pulse podcast brought to you by Kats consultants and Chiro Health USA. We are your host today. I'm Dr. Michael Perusich. This is my good friend, Dr. Alex Kallio. resilience, adapting to change challenges. We face all these crazy things in business. And we have to do something with it. We have to figure out how to manage it.

Dr. Alex Kallio:

Yeah. Well, that resiliency comes in a lot of different forms within our offices.

Dr. Michael Perusich:

Oh my gosh. Doesn't it? I mean, you can come up with so many factors there. You've got, you've got patients that you have to manage. You've got staff. where you really need to be resilient and flexible. You've got to interface with the community. You've got all these rules to manage compliance, potential audits, insurance stuff, changes in healthcare, whoo, the list goes on and on and on.

Dr. Alex Kallio:

Yeah. Never ending.

Dr. Michael Perusich:

Yeah. So this topic is kind of a bad piece of meat. The more we chew it, probably the bigger it's going to get. So hang on everybody. Here we go. So, you know, one of the things that we see a lot of doctors kind of struggle with is financial challenges. And I think that's probably a good place to start because if we don't manage the finances, what happens? We don't get to stay in business. And one of the biggest places we see that happening is fee strategies seem to be incredibly random. We set our fees based on what the guy down the street is doing, or we set them to the reimbursement levels from the insurance company. And so we're leaving money on the table and we have to really understand how to set a good fee strategy so that we create profit in our clinic.

Dr. Alex Kallio:

And it doesn't,

Dr. Michael Perusich:

it doesn't matter if you see, you know, some, some people say, well, I'll just see more patients, but if you're. If your cost per patient visit isn't matching your, your revenue side, then you're, it doesn't matter how many patients you see, you're not making any money.

Dr. Alex Kallio:

Yeah. And, and revisiting it occasionally. Cause you know, you can set it, but if you don't look at it again for. Five years, you've probably spent a bunch of time in there losing revenue as well. So it's, you've got to kind of stay up on that and at least annually probably be going through and taking a peek at those insurance reimbursement rates. Or again, looking at that cost per patient visit. Which maybe a whole nother discussion if you're not doing that or know what that is. For sure, for sure. But, you know, taking a look at those at least annually, if not, you know, even quarterly, just to make sure that's all in line.

Dr. Michael Perusich:

Yeah. And you know, the other side of the finances is making sure that you're setting some money aside. So if you don't have a good retirement plan, you should get started on one. Simple IRAs are. literally simple to set up and you know, that can be a great benefit for your staff. But as an owner of a practice, you can really put away quite a bit of money doing that. So that's one part, but also saving for the clinic. You know, we always say that you should, you should save about 10 to 15 percent of your monthly collected revenue just in a good interest bearing account so that you've literally got money for a rainy day.

Dr. Alex Kallio:

Yeah, absolutely. And, you know, and obviously that's, I mean, that's everything that comes in the, in the, those, those storms, you know, it's taxes, it's, you know, a piece of equipment breaks. You've got additional staff that you've got to hire or trainers, any of those kinds of things that come up, none of those never happened at a good time,

Dr. Michael Perusich:

you've

Dr. Alex Kallio:

got to have some slush fund sitting there in order to weather some of that and absorb that, that hit.

Dr. Michael Perusich:

Yep. And you should also have a low interest rate line of credit with your bank. You know what lines of credit are great because if you're not using it, it doesn't cost you a dime. It might cost you a 150 renewal fee every year or something, but if you're not using it, it's not costing you. So

Dr. Alex Kallio:

there

Dr. Michael Perusich:

are times though in business, I don't care what kind of business you're in. that sometimes your cash flow drops enough that you might need to tap into it for just a short period of time. Or you might have a piece of equipment that breaks down and you don't want to just implode all of your savings to buy a new x ray machine, for example, but you don't want to finance it either. So, you know, there are times when it's okay to have a little bit of debt. I hear this a lot. I don't want any debt. I don't want any debt. We have to realize there's good debt and there's bad debt. So what's the difference? Well, a seven or 8% Working capital line of credit that doesn't cost you anything if you're not using it as opposed to a 24 percent credit card, that one's bad debt. The first one's not, that's good debt. And you can really leverage yourself pretty darn well.

Dr. Alex Kallio:

Well, it becomes one of those two of getting a good relationship. With a bank in town, getting that established, you know, we had, we had the president of the bank we used that was a patient, so he knew our business inside and out both in terms of from the patient end, but also then knew all of our finances, knew all of that stuff that I could literally. Call him up and practically anything I needed he would have for me within typically a couple of days You know, it was just boom boom and we'd have it so getting that relationship can save you a ton of hassle down the line and just even just that fear wondering of what you could could get or need that kind of thing They'll let you know right ahead of time and they usually want to work with you

Dr. Michael Perusich:

Well, here's here's the flip side of having a banker as a patient as well as as your banker They know everybody in town And they will, if they're a patient of yours, they will refer tons of patients.

Dr. Alex Kallio:

Absolutely.

Dr. Michael Perusich:

Yeah. We had the same relationship with our banker and you know, practically everybody that worked at the bank was a patient. And so, you know, I would ask people who referred you in, well, I was over at the bank. It's amazing. Absolutely. It's amazing, you know, and if they're gonna finance you, they want you to do well. So they're happy to refer patients and, and other people to your business. And, you know, a, along with finances and kind of going back to setting our fees, sometimes we're paying too much attention to what the other chiropractors in town are doing. And we see somebody drop their fees down to do a promotion or something, and we think, oh my gosh, I've gotta compete. So I, I'm gonna tell you that the Dr. Peru rule. I'm competing on fees. Never compete on the way down. Never compete on the way down. Force the market up. What you do has incredible value and you can force the market up. I know we did this in in our community. We forced the market to go up instead of down. So be the leader in in setting a good market. Reasonable fee for chiropractic, not a, not a giveaway, not a constant promotion. You don't need to do that.

Dr. Alex Kallio:

Yeah. Let's go skip the 1799, get the house for a, you know, kind of deal.

Dr. Michael Perusich:

Yeah. You know, there, there are times when, An injection of new patients is fine into the clinic, but it shouldn't be your usual and customary.

Dr. Alex Kallio:

You know, but our office, we discovered, you know, years ago when we stopped doing the promo deals like that, our new patients didn't drop. We didn't, we didn't see a drop in new patients was an increase in revenue because now we were charging full fee for those things. And you know, it took a little bit for some of our existing patients to get out of that mindset of, Oh, Hey, when are you having the next. Deal that I can send in my friend or family member, but after, you know, a couple of months where we were just not doing that anymore, they kept sending those people in anyway. So it, you know, it kind of writes itself over a little bit of time. It's really our mindset that just needed to change.

Dr. Michael Perusich:

It is, you know, people don't refer other people in or people don't search out doctors. Typically good patients don't search out doctors for the deal. They're looking for the experience and that's really what brings people in. And that's what gets people to refer to you as well.

Dr. Alex Kallio:

Yeah, it kind of comes back to what we said as far as having proper fee set, you know, you don't need to be the deal to come in, but, you know, you don't want to be, you know, so far the other way either that, you know, once they do come in, it's that they feel like they're, you know, getting, getting kind of, So, you know, you got to have the proper fee structure there and I'll get them in, but then keep them in the office too.

Dr. Michael Perusich:

Yep, exactly. Exactly. So we need to take a quick break here from one of our sponsors. We're talking about how to be resilient in chiropractic business. We'll be right back.

Chiro Health USA:

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Dr. Michael Perusich:

All right, everybody. Welcome back to the KC Chiro Pulse podcast. We're talking about creating business resilience and adapting to changes and adapting to challenges that happen in practice. And, you know, we've, we've kind of gone through finances and setting your fees. And if you're having trouble setting your fees, feel free to touch base with us. That's a big thing that we do for clients at Kats consultants. But, you know, some of the other challenges that we face are good grief, all the compliance and regulatory stuff.

Dr. Alex Kallio:

Yeah, there's a few. Just a couple,

Dr. Michael Perusich:

just a couple. And it, and it seems like they're, they're not all, not just changing all the time, but there's just more and more and more layers added in, you know, so any more, we've got to be really careful about making sure that we're meeting the confines of medicalness medical necessity, for example. So we really have to be watching our diagnosis and our treatment cadence and you know, the CPT coding that we're using and our diagnosis. start date, those kinds of things, making sure diagnosis isn't getting too old and billing those progress exams along the way, whether you get paid for them or not, that's how the insurance company sees your story of I'm still proving medical necessity.

Dr. Alex Kallio:

Yeah. And you've got to jump those hoops while still paying attention to HIPAA. Still paying attention to No Surprises Act, you know, you start, you start hitting, you know, the gamut of these things and it's a lot, especially if you're on your own trying to do this, chances are you're, you're probably only doing maybe, maybe a quarter of what you, you know, you should be keeping an eye on. So that's really where, you know, having someone like, like, like ask consultant things on board to help manage that, point that out and get, have those resources available to you.

Dr. Michael Perusich:

Yeah, sometimes it's just too much to do on your own, especially if you're a heavy insurance based practice. It's a lot to manage to make sure you're meeting all the compliance issues, all the insurance rules and those kind of things.

Dr. Alex Kallio:

Yeah, and not that it takes it off your plate to not buy it. Do them, but certainly those that have gone more cash based, you know, there's a few things that are a little bit less intensive. There are certainly medical necessity in some regard there. You're not having to prove that so much. So, you know, that moved toward cash practices a little bit. There's a reason that's kind of hitting the groundswell.

Dr. Michael Perusich:

Yes, absolutely. That and the fact that reimbursements going down, down, down.

Dr. Alex Kallio:

I haven't really noticed that.

Dr. Michael Perusich:

There's a new term for, for a third party reimbursement. It's called the lead balloon or diving without a parachute. I'm not sure which

Dr. Alex Kallio:

one

Dr. Michael Perusich:

off the short

Dr. Alex Kallio:

pier,

Dr. Michael Perusich:

right? It feels like both. You know, another thing that can help kind of keep resilience in your practice is keeping up with technology. So things like E. H. R. And I think most of us have E. H. R. But You know, there's other things like, like appointment reminder systems and online scheduling and those kinds of things. There's, there's way to schedule your marketing out for several months. If you, if you plan correctly, you can have it already scheduled and it'll post on its own, you know, take advantage, taking advantage of those kinds of things is huge for making your practice not only resilient, but much more efficient.

Dr. Alex Kallio:

Well, and utilizing those systems where you are, you know, we term advanced multiple scheduling and getting your schedule scheduled out for weeks and months at a time where, you know, you're kind of bulletproofing against those big up and down, you know, in the schedule where, you know, the traditional chiropractic peaks and valleys of, well, it's July, we're going to have a terrible month because everybody's gone and on vacation and out of school or, you know, The holidays hit and you know, it's just, we have bad months then. Well, you don't have to, I mean, you don't have to pull up and down a little bit, but these don't need to be that roller coaster of schedule times. If you put some things in place, make that practice a little resilient against those kinds of times.

Dr. Michael Perusich:

You know, here's the funny thing, the traditional down period. And there's, there's about three of them. So, but the big one is Thanksgiving to Valentine's day. Okay. There's, there's also a couple around when school gets out and when school starts, but I see practices when they plan ahead, I see a lot of practices anymore, avoiding those down periods. And some of them are having record weeks in that Thanksgiving to Valentine's day period.

Dr. Alex Kallio:

Best months ever in December. Yeah. Yeah. And, and part of that was just having those systems and procedures in place to ride that through and not because, Oh, it's December. We're going to have a bad month. That's just the way it is. Right.

Dr. Michael Perusich:

So don't make the assumption just automatically that, Oh, it's the holidays, it's going to be down because the minute you tell yourself that guess what, it's going to be down because you're, you're going to put up a blockade from doing the things and the taking the steps to make it a great time period. And really the whole crux of it is just plan ahead, plan ahead. It's not that hard. You know, I kind of mentioned this a minute ago, but I think one of the other things that really makes your practice resilient and adaptable to changes is creating high end patient loyalty and creating that experience that people want to keep coming back to. And it's not just your, your chiropractic outcomes. It's way deeper than that. It's how friendly are, are you and your staff in the office? How much do you know about your patients? What does your clinic look like when they walk in in the building? What's Dr. Fox always say sight, sound, and smell. You know, how did those three senses, how are you hitting those three when they walk in? You know, does your, does your clinic smell like a locker room or does it smell like a spa? Those kinds of things. Is it clean? Is it picked up? Is it up to date? Have you moved the pictures around in a while? You know, all those things that play into that, what kind of music are you playing? Those are things that help create that great patient experience.

Dr. Alex Kallio:

Well, and I think some of that, you know, plays into, you know, not only what you mentioned, what type of music, you know, but are you playing music, you know, or do you you know, gone to, to a local office here now between, and it, I mentioned a minute, you guys need something going. It's like a Morgan here. I mean, it's just, it is so quiet. It is like, you know, what, what kind of atmosphere are you giving patients when they come in? And sometimes we get a little storm blind to that, you know, we're in it. That's it's the, you know, I see it every day, so I don't pay any attention to it. You know, the. The paint's peeling on the wall over there. You're like, I will get to that. You know, at some point the chair rubs up against it, you kind of get, you know, you don't really notice it anymore because you've been in it every day. But those patients that come in for the first time, it's like a neon sign going off in their face. So, you know, you, you've got to kind of reassess all of those things again, periodically, just like we talked about with fees. You got to take a peek at it fairly frequently.

Dr. Michael Perusich:

Yeah. And, you know, take, take a walk around your clinic, go, go walk in the front door. Like a patient does, what does it look like? What's it smell like? What's it sound like? You know, can you, can you hear the music? What kind of music are you playing? Is it the right kind of music? You know, what does it look like right outside your front door? We, our clinic was kind of behind a shopping center and, and yeah. A lot of times we had to be out there kind of picking up a little bit just because you know, it'd be trash blown around and stuff sometimes. And we had to be really conscious about keeping it clean and picked up. You know, what, what's it look like when you walk inside? Are the chairs in your lobby? Are they all jumbled up or is the clinic ready for patients?

Dr. Alex Kallio:

Yeah. And sometimes it's just, you know, it might only be a five minute matter, you know, in the morning before you open up, you know, is there somebody Tasks to making sure each room is ready to go. It can be a simple two. Did somebody peek at the room before you took the next patient back? Exactly. You know, did you leave a gallon on the table? Did you have, you know, face paper crumpled up on the floor because you missed the trash, you know, before you left them, nobody's

Dr. Michael Perusich:

face paper still on the table.

Dr. Alex Kallio:

Yeah. Yeah. I mean, those kinds of things that, you know, you want to have tied it up before that next patient comes in. So it's, it's little things that, you know, will add up to a big thing if they keep happening over and over.

Dr. Michael Perusich:

Yep. That's exactly right. We're going to take another quick break and then we're going to come back and continue talking about making sure your chiropractic business, chiropractic practice is resilient. We'll be right back.

Kats Consultants:

Kats Chiropractic Consultants, your partner in chiropractic success. We are dedicated with one on one guidance to bring you all your practice management needs. Let's supercharge your practice. Give us a call today.

Dr. Michael Perusich:

Hi everybody. Welcome back to the KC ChiroPulse podcast brought to you by Kats Consultants and ChiroHealth USA. Alex, we're talking about keeping it resilient in the practice and in managing changes and things. And, you know, I think one of the things that we have to be really resilient to and monitor. is ourselves. And what level of self care and burnout are we headed towards? Because let's face it, I mean, the chiropractic business, the business of chiropractic is number one, very physical and number two, we have to manage a lot of little details.

Dr. Alex Kallio:

So you got to, yeah, sorry, jump in, jump in. Yeah, no, you're

Dr. Michael Perusich:

fine. Go for it.

Dr. Alex Kallio:

Yeah, it is. There's, there's just a lot day to day, especially when you're wearing so many hats of the marketing, you know, person, the, the bill payer, the you're managing staff, you've got your patients, you've got your family stuff. There, there's a lot of different strings getting pulled. But yeah, over, you know, practice 20 years, you know, we've all hit different points of a little bit of burnout feeling there. So it is, we've got to make sure we're taking time, taking vacations, taking time away you know, building those things in so that we stay resilient ourselves and that, you know, along with the practice.

Dr. Michael Perusich:

That's exactly right. So, you know, really focused in on that. And if you have staff, if you have a good office manager, that kind of thing, make sure they're kind of keeping an eye on you. We always preach this to our members at Kats. We always preach that you should take four weeks off of a year. Now, some of you probably just took a big, deep breath because, Oh my gosh, how can I ever afford to not see patients for days, let alone four weeks. Right, right. So what's a quarter. And they don't all have to be big, fancy, expensive travel vacations. I mean, none of them have to be, but just getting away from the clinic for a while. You know, I always took two of my weeks every year were vacations at home. And it was just an opportunity, excuse me, to, to just kind of catch up around the house and enjoy my home and my family. And, you know, then my wife and I would take two other weeks off during the year and actually go somewhere and do something, and there's a way you can do this. And we, we have some great method, great methods for this, but there's some ways you can do this and, and really never lose a patient visit if you do it right. But again, it goes back to something we just said a few minutes ago. You have to plan ahead. So doctors look at your calendars right now, plan out. When am I going to take some time off, get at least two weeks. on the calendar so that your staff can book around it and show them or talk to us and let's figure out ways that we can create strategies in your practice where you don't lose those patient visits while you're gone.

Dr. Alex Kallio:

Yeah. And you know, one, one really simple one that we did was, you know, we took, You know, 4th of July and Christmas weeks. And we just took both of those weeks. You already had a day off or more in those weeks anyway,

Dr. Michael Perusich:

a

Dr. Alex Kallio:

couple extra on, or look at, you know, some of those times where you're, you're already going to be closed. So you're missing less time, but you're getting more downtime. It can be the staff typically really appreciates it. Cause it's usually time they're having to take off or use vacation anyway. You know, and you can kind of really build that in and staff haven't, like you said, have time. They can plan around for vacations or travel ball or some of those kinds of things that are going on. And you as, you know, obviously as the doc and they have a little time to get away and recharge too.

Dr. Michael Perusich:

Yeah, exactly. You know, spring break week. That's another good one, especially if you have kids, you know, that's a great time to just go have some downtime with your family.

Dr. Alex Kallio:

Yeah, absolutely. It makes such a huge difference. It does energy your, your outlook things, but you know, I mean, not to say that, you know, okay, you're planning these vacations in and you're not going to have any issues, you know, coming stress coming back in the office, but it becomes super important to, especially for your patient care. And again, kind of going back to building that. patient relationship and loyalty, we've got, you know, doctor staff have to be able to hang those issues, your own personal stuff at the door when you're there to see patients. It's got to be about the patients. You've got, you've got to keep it about them. So, you know, so important to get those time away so that you're minimizing that stress and strain when you're coming in and feeling more energized and ready to tackle those day to day issues that come up.

Dr. Michael Perusich:

Yeah, that's exactly right. And you mentioned staff in there. I think that's another area where you can really maintain your resilience is by training your staff to be a success partner with you. Don't just have staff that all they do are tasks every day and then they go home, help them build into and develop into true success partners with your practice. You know, there's so many things that they can do to help drive revenue, help drive patient relationships, help drive referrals, you know, All these things help drive efficiency because they're seeing and doing a lot of those things that you, us as the doctors can't do. So let's give them the authority to be our, our practice partners, our success partners, and help really drive the clinic to true success.

Dr. Alex Kallio:

Yeah. I mean, we want those people in the office that, you know, say people that, that know what we don't know, or we'll do what we, you know, we don't do and, you know, put those people, hire those people in your, in your office and have those people in your circle where you can be the doctor, do your adjustments, do the things that you have to do and have other people around you to do the rest of it.

Dr. Michael Perusich:

Yeah, you know, Dr. Kats used to always say, if somebody can do something 80 percent or better than you, 80 percent as well or better than you can, then delegate it to them. And I think that's one of the things that sometimes as maybe entrepreneurs, doctors, I'm not sure which it is. Maybe it's all the above. We have a hard time delegating. We think we have to do it all.

Dr. Alex Kallio:

Yeah. You fall into that mindset of, well, you know, I want it done, right. I've got to do it myself. Yeah. You know, certain things maybe, but, but way too often. I think we think that on way too many fronts, way

Dr. Michael Perusich:

too, way too many. Yeah, exactly. Exactly. So these are just some of the steps. I mean, we could talk about this all day long, but these are just some of the steps that you can implore to just make your practice more resilient, adapted changes. And I'm going to add one more thing in here just real quick. Make sure that you're innovating because the healthcare world is constantly changing. I don't know if you've looked outside lately, but in the last five, six years, it's changed dramatically and it's not going to stop. That's just the future of what we do. So you've got to be ready for these changes. We're seeing changes in insurance reimbursement and these kinds of things. So make sure that you're. staying on top of things. And if you need a good coach to help you stay on top of things and help you adapt, help you see the future changes coming down the pike so you can have the right strategies in place. Give us a call at Kats consultants or check us out on, on our website at Kats consultants. com and see all the great things that we're doing for our clients out there. We're helping doctors really build successful practices. Alex, anything to add?

Dr. Alex Kallio:

I think the big thing is, you know, we started off the, this podcast talking about the planning, you know, just make sure you guys have a little bit of planning, you know, we can really bulletproof our practices on a lot of these fronts, but it takes a little legwork up front, you know, but, but that, that is time well spent. So, you know, again, you need kickstart with it. Let us know.

Dr. Michael Perusich:

Absolutely. And plan to tune into our podcast every week and be sure to subscribe and tell, tell all your friends about us too. We're growing like crazy with our podcast because of all of you out there. So we greatly appreciate it. And from all of us here at Kats consultants and Chiro health USA, we appreciate them as well. We'll see you next time.