Kats Chiropractic Consultants CHIROpulse

240:Buried by Capacity

• Michael Perusich

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This week’s topic:  Is your capacity generating profits or just chaos?

The KC CHIROpulse Podcast is designed for Chiropractic professionals ready to elevate their practice to new heights.  This week, the show is hosted by Kats Consultants’ coaches Dr Michael Perusich and Marisa Mateja, seasoned experts in Chiropractic business management.  This podcast provides invaluable insights and actionable strategies to help you create a flourishing and sustainable Chiropractic business.

In this episode, we discuss:

  • How your capacity should be part of your playbook for success
  • How poor scheduling systems can negatively impact revenue
  • How well trained staff can help you maximize capacity and reduce chaos
  • How understanding the flow and timing in your clinic is imperative to having effective capacity management 
  • …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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Episode: 240 Buried by Capacity

[00:00:00] 

Dr. Michael Perusich: Doctors. Is your capacity taking you down? Hi everybody. Welcome to the KC ChiroPulse Podcast, brought to you by Kats Consultants and Chiro Health USA. I'm your host, Dr. Michael Perusich, and I'm joined by my co-host today, Marisa Mateja. Hello, Marisa. Hello, Dr. Perusich, how are you today?

I am great. You and I've talked about this many times, we both talked to clients and non-clients every day. And one of the common themes is, my schedule's a mess or I can't see enough patients in the day. I'm too busy, but I'm not turning a profit. Or I'm so busy that we just can't manage it all.

And you and I both know this comes back to capacity and how you schedule and those kind of things and not really understanding. How to turn your capacity into a playbook, so to speak. 

Marisa Mateja: I like that. Yeah. I, first, this is one of my favorite subjects. I find we know that when you are a over planner, it's probably [00:01:00] where I would categorize myself when you're an over planner and that's 

Dr. Michael Perusich: an understatement, everybody.

Marisa Mateja: I think. You become hyper aware of how much our systems, how much our scheduler, how much all of these things play together, and how they can affect your practice if you're not paying attention to them. So I see, yeah, big time. I see this a lot, with. Doctor capacity or room capacity or team capacity, it's like all of these things go together and if you're not paying attention to how they fit together and what you have on your schedule and you're not reevaluating your schedule, or often I feel like your capacity stays the same and that's why you can't change.

Understanding and Managing Capacity

Dr. Michael Perusich: Okay, so you bring up a really. Interesting and important topic, and that's the fact that capacity is not one thing. [00:02:00] Capacity also is not a constant. Correct. And there are so many things that affect capacity. And I, we need to take a quick word from our sponsors, but I want to dive into this idea because I don't think a lot of doctors and a lot of staff really understand what capacity is and how it affects you.

And you mentioned several things that affects, the big thing is your profitability. So I really wanna dive into that. We're gonna hear a word from our sponsors. We'll be right back.

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Dr. Michael Perusich: Okay, everybody, welcome back. We are talking about being a hyper overplan. Oh, no, wait. 

Optimizing Scheduling and Staff Utilization

Dr. Michael Perusich: We're talking about, we're talking about capacity and how capacity is affected by really so many different things. And Marisa, you touched on it a little bit before the break that it's affected by it's affected by the.

Your staff. It's affected by your procedures. It's affected by your systems. It's affected by therapies, new patients. So many things play into [00:04:00] capacity, and we have to take all those things into consideration when we're trying to design our capacity. Because capacity can't happen by accident. 

Marisa Mateja: It can't. It's definitely a planned out event. So every day on your schedule should be planned out. It's not willy-nilly, let's just throw people on the schedule and get 'em in, right? It can't be that. And if it is in your practice, then number one, you're gonna hit burnout a lot faster. That's number one.

That's number one. So you, if you spend the time to plan out. A, how many people do you want to see? Like where are you? What are your goals? Spend the time to plan that out. True capacity then comes from then looking at how many people can you actually put on your schedule, right? So in an hour, how many people can you see?

And then you multiply that per day. Are you where you need to be? And I think a lot of people don't actually spend [00:05:00] the time to. Again, do the planning in their scheduler to see where they're even at. And when I say your scheduler, this goes back to how much time you spend with patients and how many patients you can see at once.

I know you're thinking how many, I can only see one patient at once. No, you should be overlapping patients as they come into your practice. You have staff that can be handling some patients. You probably have therapy rooms where patients can go. It's a. Dance, if you will, of who you are seeing at once as they're coming into the practice.

Yep. So you're moving people through your practice in different stages and different ways to maximize how many people you can see per day. So I think that's important to know. Then how long do those things take, and is your scheduler correct? [00:06:00] 

Dr. Michael Perusich: Yeah, and I wanna give just a really simple example to illustrate this process.

So if you're only seeing. That traditional one patient at a time in the traditional sense. Let's break that down a little bit. Okay. So you as a doctor, you spend five minutes with the patient to adjust them, and then you take 'em to a different room to do some muscle st stem, and they're there for 10 minutes.

Okay? So now the patient's been in the clinic for 15 minutes, and in the traditional sense of scheduling. If you're waiting for that patient to be fully processed out of the clinic, it may take a whole 20 minutes for that patient to cycle through. So let's back into it. How many 20 minute periods are there in an hour?

I'll do the math for you. There's three. Okay. So that limits your capacity if that's your thought process. And so what you're talking about is, okay, if it takes the doctor five minutes to see a patient. Let's send 'em to a staff member to do the muscle stem in that example. [00:07:00] And the doctor can adjust two or three more people at once at that, during that same time.

And you parallel schedule those patients, if you will, and divide them out like that so that you can increase your. 

Marisa Mateja: Yeah. And that starts with how you build your scheduler. So if, we have to remember capacity is not how many patients you personally can see before you collapse. And I think that's the key.

Wait a minute. It's felt like 

Dr. Michael Perusich: that in our practice. 

Marisa Mateja: You're telling me there's 

Dr. Michael Perusich: another way, 

Marisa Mateja: there's another way. True capacity is really the maximum. Profitable patient visits in your office based on your space, your team, you right? All of these things can then go together. So we have to then start with, on the scheduler, are you allowing for that parallel scheduling?

Are you allowing for more than just. 20 minutes with a patient and that's all that you're scheduling. And so this goes back to, [00:08:00] you have to train your staff to understand capacity. You have to train them to understand the scheduler. It can't just be, I'm gonna look and I don't see an opening, so we're full.

I'm sorry we can't get you in. And I hear that from doctors that are saying, my staff are telling people they can't get in. There's a major problem then with your capacity, number one. And are you in the model we just discussed? 

Dr. Michael Perusich: And somebody people taking that phone call and trying to schedule somebody are just trying to find little shoehorn spots where they can slam somebody in without taking into consideration.

How long does it take to process that patient? Maybe it's a new patient and yes, we want to try to get new patients in as quickly as possible, but at the risk of shoving them in somewhere and throwing the entire schedule off and making six or seven patients mad because you get behind and then we want to blame the doctor because we got behind.

Yeah, you need to move [00:09:00] faster and that's, that's sometimes the case, but not always the case. 

Marisa Mateja: Yeah, 

Dr. Michael Perusich: it's just mishandled scheduling. 

Marisa Mateja: Absolutely. Absolutely. 

Dr. Michael Perusich: So we have to look at all those different kind of things and there are some major. 

Advanced Tips and Conclusion

Dr. Michael Perusich: Tricks to scheduling and we're not gonna give all the tricks away here on the show.

Yeah. So you gotta go a little bit further than that. 

Marisa Mateja: You can call us for that. Yeah, 

Dr. Michael Perusich: you can call us for that. But there, there are some major tricks to understanding how to build a schedule template. 

Marisa Mateja: Yeah. 

Dr. Michael Perusich: And not just be forcing people in willy-nilly. 

Marisa Mateja: Or train your staff too on. What that schedule looks like, and if all they can see is that there's zero openings and they can't see the big picture of the practice and really think through rooms and doctors and therapy staff and different things, where do we place that patient for that parallel scheduling? We need to [00:10:00] train them on how to see the bigger picture.

That's part of it as well is we can't just leave them to, their own devices. This is how we end up in spots where staff are telling patients we're full. 

Dr. Michael Perusich: I 

Marisa Mateja: can't get you in. 

And I've had, I've literally had a client recently tell me they're telling them to go down the street.

The doctor's saying, wow, I could see more. And so that's a major issue in your practice that you've got to look at if things like that are happening. 

Dr. Michael Perusich: Yeah. And there are just naturally a lot of little things that can get in your way in practice anyway. One of the bigger ones that we hear is, my EHR really slows me down.

Marisa Mateja: Yeah. And is it your EHR or is it bad habits? 

Dr. Michael Perusich: It's bad habits, yeah, that's exactly where I was going. Yeah, because what I hear most doctors doing is they're basically using their EHR system as a word processor. Because I hear all the time it takes me so long to type [00:11:00] everything. Wait a minute.

What all are you typing? Yeah. You've gotta take the time. You know the reason why in our practice, which was a very busy practice, why we were able to keep up on notes is because we took the time to build the system. Yeah. So that. Anything I wanted to put in a note, whether it was a maintenance patient or a PI patient, it didn't matter, was already built into the system and it made it click and go.

And so oftentimes I see doctors not taking advantage or taking the time to really build that system into something other than just a word processor. Yeah. 

Marisa Mateja: Absolutely. And that will slow you down. And that's a bad habit if you haven't stopped to build your EHR system. Yeah. So highly recommend that for sure.

Another thing will be letting therapy rooms sit for half the day. 

Dr. Michael Perusich: Oh, why would you let a profit center just sit there? 

Marisa Mateja: Exactly. So instead. Alternate who's coming in. Maybe you have an adjustment and a [00:12:00] therapy coming in at the same time. Oh gosh. Somebody can go to therapy first. And then vice versa, they can see the doctor after and maximize what your profitability is there.

Now it's, and doctors right there. I've just doubled your practice, 

Dr. Michael Perusich: right? Oh, at least. And doctors, at the end of every day, one of the things I used to do is I'd look and see how many patients we saw, and then I would look and see how many units of therapies and things like that we did.

If I felt like the percentage of therapies was too low, then I knew I wasn't doing a good job of driving revenue centers for services that patients probably needed, and so either I felt like I was too busy to get to, to order it, or I just was dropping the ball, and so it always kept me on point to make sure that I was creating profitable treatment plan.

Profitable treatment plans. Yeah. And that's probably a foreign concept to a lot of doctors out there. You need to look at your treatment plans and you're probably [00:13:00] thinking my treatment plans need to be built around patient outcomes. Yeah. But your patient outcomes need to generate a profit in your business or you're not gonna be producing outcomes very much longer 'cause you're not gonna be in business.

Marisa Mateja: So that topic just brings me into another one that's very important as the doctor. Are you doing things in the practice that take away from patient time slows down your capacity when you have a staff person that could be doing some of those services? And I know there's some of you out there, I've got Sure.

I've got a doc that still verifies insurance benefits. 

Dr. Michael Perusich: That's what I was gonna say. I'm, 

Marisa Mateja: why are we, I'm verifying insurance. Yeah. Why are we doing that? You should be. You're, you should be pay being paid at a rate at $450 an hour at least, right? That's the minimum. And so why are you doing services that you could have somebody that's being paid 20 or $25 an hour doing, 

Dr. Michael Perusich: right?

Marisa Mateja: This is a big issue in this [00:14:00] profession is the doctor takes on too much, right? They think they can, oh, I'll just get it done. I'll move the patient. I'll put 'em on the therapy. I'll put 'em. Why are you doing so much? Yeah. So I'll be honest. Affects your capacity. 

Dr. Michael Perusich: It does. And the only loss leading service the doctor should be doing is the exam.

And why do I say loss leading? Go back to your four 50 an hour minimum that you should be making. If a exam takes you 15 minutes, are you getting paid a hundred, $110 for that exam? Probably not. If you are great, but we have to realize that for the most part, we need to make sure that doctor time is spent at the high level stuff.

And we need to slough off as much as we can, which includes the lower cost therapies and those kind of things to our staff. When we can, doctors should not be verifying insurance, doctors should not be doing billing, doctors should not be doing collections, making appointments, those kind of things.

And I don't mean [00:15:00] to say that those things are too minuscule for the doctor to do, but the whole idea is we are the ones that produce the high level income in the practice. And. We've gotta push off, if nothing else from a profitability standpoint, we gotta push off those other things like muscle stem, great example.

How much do you get paid on that? Not enough to support your $450 an hour that you should be making. Yeah. So we've gotta push that off to where it's does become more profitable with a lower paid ca in the practice. 

Marisa Mateja: Yeah. Another. Topic I would bring up would be the checkout.

If you've got one ca in your practice and they are spending. Five, 10 minutes at checkout with every single person that comes into your practice. That's a bad habit, right? We don't have good systems in place, in my opinion, if that's taking that long. That tells me that we are collecting every time that they come in.

That tells me that we are scheduling one appointment at a time. Every [00:16:00] time they come in, we're spending too much time in tasks. Oriented things when that same ca could be helping you take somebody off of therapy or put somebody on therapy as well as have all those things done automatically. So we have to think in terms of, there's a lot of benefits to.

Technology today and we have to take advantage of some of those. 

Dr. Michael Perusich: Yep. There are. We need to take another quick break, but I wanna come back and I wanna talk just for just a minute about a slow schedule that's got a lot of holes in it. So we're talking about capacity and how important it is and how you have to really think through it.

'cause there's a lot of things that affect it. So we'll be right back in just a minute.

Pat's ChiroPulse Consultants, your partner in ChiroPulse 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 [00:17:00] today.

Dr. Michael Perusich: Okay, welcome back to the KC ChiroPulse podcast. We're talking about capacity, and Marisa, I just had this fleeting thought, sometimes we hear doctors talk about the fact that they've got holes in their schedule where they might not see a patient for 30 or 45 minutes, or or from two to three.

It's always dead. Or Friday mornings, we're open from eight to noon and we only see four patients. Why are we allowing our scheduling to even remotely look like that? 

Marisa Mateja: Yeah. We're not managing our schedule. This goes back to being the over planner, right? It's over planning our schedule to the fact that we even have built in those pockets of time that allow the doctor to go catch up on notes, get some of those paperwork items done, and then cluster book patients in later times that allow them to.

Have multiple patients in the practice at once, and it keeps 'em busy. They're moving. We keep a better pace, and then what happens? [00:18:00] We don't create bad habits. We've talked a lot about bad habits today. Okay? We don't create bad habits with the doctor thinking, oh, I'm just gonna sit down and chat with this patient, or I'm gonna spend more time with this patient than need be and create bad expectations, even on the patient side of things.

So I think a lot of that all comes down to planning. 

Dr. Michael Perusich: It does, and it comes down to planning too, from the standpoint of doctors. Your staff should be telling you where the holes are in the schedule for the week, on, on Monday. What does Wednesday, Thursday, Friday look like on 

Marisa Mateja: and even into next week.

Dr. Michael Perusich: Yeah, on I just, what I was gonna say on Wednesday. Starting on Wednesday, what does Monday, Tuesday, Wednesday, next week look like? There are opportunities that are in front of you guys all day long. To get patients who need it, of course of. An extra adjustment. They've got a new treatment plan for something.

If you're paying attention, these are in front of you all the time and you can fill a lot of those [00:19:00] holes in your schedule. Yeah. If you're just paying attention to those patients who are going, who are doing something right now or are getting ready to do something, like for example, you hear a patient say they're gonna go till up their five acre garden over the weekend.

Do they need a couple of extra adjustments? Sure. So tell 'em, recognize the opportunity, from your staff that Monday and Tuesday are light. Tell the patient, I wanna see you back on Monday or Tuesday. Guess what? We just started to fill the hole. 

Marisa Mateja: Yeah. And that's 

Dr. Michael Perusich: a way to increase your capacity from a standpoint of getting your patient visits up.

Marisa Mateja: I see those opportunities a lot in practice, especially around holidays. Yeah, so think about holidays as a great opportunity. Somebody says, I'm gonna be traveling for the next four days. I'm sitting in a car, I'm driving 20 hours. Oh my goodness, are they gonna be stiff when they get back?

More than likely. Sure. There's not very many of us that if we have a 20 hour drive, are gonna slow down and stop and get out and take the [00:20:00] appropriate time to stretch and move and walk a little bit and do all those things right. So it's important to let them know, Hey, I expect you to be store when you get back.

I want to see you when you get back from your trip. There's an opportunity. Yeah. And it happens every year around major holidays. 

Dr. Michael Perusich: Sure. And if you have a day part that is really slow and you can't ever seem to get it to grow consider adjusting your hours a little bit. Yeah.

One of the things that you want to do to make yourself look and feel busier, especially to, to your patients, because a busy clinic has a tendency to get many more referrals. Is we want a cluster book. Yeah. And make sure that, we're not just scheduling one patient every 15 or 20 minutes, or we're not scheduling four people on a Friday morning just because we're open Friday morning.

Let's adjust the schedule to when the patients are coming in instead of having this great [00:21:00] capacity in a wide open schedule and only seeing four patients. If you see four patients in a day part, are you profitable? The answer is the eminently. No, I don't even need to look at your stats to know that.

Marisa Mateja: Yeah, you 

Dr. Michael Perusich: are not profitable. 

Marisa Mateja: Yeah, I think it's important, and that goes back to knowing your schedule, being a planner. Are you paying attention to when your busy times are and when your slow times are, and utilizing that. Appropriately in the practice, right? 

It's huge. Yeah.

Dr. Michael Perusich: Yeah. So there are so many components, everybody that go into capacity and how to develop your schedule and so many areas and loops of understanding and training and development for your staff is incredibly important. You can't just teach them how many new patients you want to see in a day. How many patient visits you expect?

It's got to be a team effort to develop a schedule that actually creates the capacity and the profitability that you need in your [00:22:00] practice. And remember, capacity changes over time. It does not say stay constant. So as your practice grows. Your capacity management has to change as well. Yes. Marisa, anything to add?

Marisa Mateja: Yeah, just one quick statement. Your capacity seldom your doctor, just for the record. So Docs, it's probably in your systems, so make sure that you are planning and doing the appropriate things to watch those things. 

Dr. Michael Perusich: Perfect. So doctors, if capacity management is something you need help with, give us a call.

That's one of the major things that we do. If you're having trouble with any component of your practice, we do almost everything to help doctors create profitable practices, more efficient practices. The only thing we don't do is come see your patients for you. All right, everybody. We're checking out here.

Thanks for tuning in to the KC ChiroPulse podcast. Thank you to Chiro Health USA, for being one of our sponsors. Be sure to like and subscribe wherever that button is. We appreciate all of you. Our podcast is growing like crazy and it's because of you listeners out there. So Marisa, thanks for being [00:23:00] here today On behalf of all of us here at Kats Consultants, we'll see y'all next time.

Marisa Mateja: See ya.