269 5 Biggest Mistakes

This week’s topic:  The 5 biggest mistakes Chiropractors make!

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’ CEO Dr Michael Perusich, a well known expert 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:

• Why patient retention matters more than constantly replacing dropouts.
• Why understanding insurance medical policies protects your practice.
• How friend-advice can lead to costly business decisions.
• How poor billing oversight can increase audit exposure.
• Why tracking the right KPIs is essential to profitability and growth.
• …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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Transcript

The 5 Biggest Mistakes

Top Five Practice Leaks

[00:00:00] 

Dr. Michael Perusich: Doctors, are you making one of the top five mistakes that's hurting practices today? Hi, everybody. Welcome to the KC ChiroPulse podcast, brought to you by Kats Consultants, where innovation meets practice success. I'd like to thank our co-sponsor, Chiro Health USA, here before we get started. I'm your host today, Dr.

Michael Perusich, and yes, I'm in the studio by myself. So today you're gonna hear the rantings of one doctor. Anyway I wanna talk a little bit about the top five mistakes that chiropractors are making that are damaging their businesses. And, and this is taken from just a lot of the things that we see and hear in the chiropractic marketplace today, as well as from our clients and things.

We see a lot of bad mistakes taking place. And these are, these are mistakes and, and problems that are costing you not only patients, but they're costing you profit, they're costing you profitability, they're costing you predictability, and potentially creating really some [00:01:00] unnecessary compliance risks in your practice.

We all know how scary and dangerous audits can be. So anyway, um, y- you know, here, here's the thing. A lot of practices are leaking right now. Most practices are struggling because... not because they have a new patient problem. In fact, the new patient phenomenon in our profession is rampant, and it's almost like, kinda like a disease.

And don't shoot me for this, but, you know, we've, in, in this profession, we've guided our businesses for so long based on the new patient, and that's just not how you run a practice today. In a lot of practices, in- instead of a new patient problem, they have a business management problem. They're just operating under an old and worn-out model.

You know, and a, a busy schedule can disguise a lot of things, like weak retention and poor billing discipline inadequate payer knowledge, and unfortunately, it can hide bad business decisions. You know, there's a dangerous phrase in this profession, and it's, "Well, we've [00:02:00] always done it this way." And that is like nails on a chalkboard to me.

So today's question isn't simply how do I grow? It's more about what am I doing right now that may be quietly damaging the business I already have, and not only damaging it today, but damaging it for the long term. So I wanna go through these top five mistakes and spend a little time discussing each one of them and kinda diving into this just a little bit.

I realize today will be kind of a, a surface trajectory on some of this, but I want you to at least realize what some of the mistakes might be, and then, and then quietly analyze your own business to see if you're making any of those mistakes. And if you don't know how to unwind out of them, obviously we're here at Kats Consultants to help you with that.

So we're gonna take a quick break, and we'll be right back, and we're talking about the top five mistakes that chiropractors make today that are damaging their businesses. We'll be right back

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All through a compliant discount medical plan. The result, doctors stop undercharging, raise fees, and increase income by about 20% without sacrificing care. That's not a discount strategy. It's a business strategy. Learn more at chirohealthusa.com

Mistake 1 Dropouts

Dr. Michael Perusich: Okay, everybody, we are back. We're talking about the top five mistakes that doctors make that are really hurting their businesses right now.

And so let's dive into the first one. Mistake number one is obsessing over new patients while ignoring dropouts. Now, th-this is really important. Chir- chiropractors have absolutely become obsessed with new patient acquisition, and we see it all over the place. We're inundated with the idea that we need more leads, we need more Facebook ads, we need more screenings, we need more [00:04:00] Google reviews, we need more new patients.

And while a lot of this is important, it's not really the underlying factor for developing a good business or not. Now, if you're fairly new in practice, less than two years, yes, you need to be out doing talks and maybe screenings and, and doing all these things. But in the long run, acquiring patients while allowing existing patients to just disappear is like filling a bathtub with the drain open.

You're never going to hold water. So whether you're new in practice or you've been in practice fifteen years, we gotta realize a dropout isn't merely a lost visit. It represents dozens of lost future visits. It represents lost referrals, lost family members, lost ancillary service revenue, lost maintenance and wellness revenue, lost lifetime patient value.

And we talk a lot about lifetime patient value at Kats because we really have to think in terms of not what does [00:05:00] a new patient brings, brings into the practice, what does a patient itself bring into the practice over their lifetime? In order to really understand this new patient versus dropout versus retention idea, we really have to understand, first off, our numbers.

What is our retention rate? What is our dropout rate? What are our unique patient visits? And this is, this is a super important, um, statistic today in really understanding how your practice is actually growing. We have to understand our average patient tenure. In other words, how long are they staying in the practice?

A lot of doctors don't realize that the average patient stays in your practice less than four months. And think about that. Every three and a half, roughly, months, you have to replace a new patient, and in some practices it's even quicker, 'cause some patients are dropping out as early as the first, second, or third visit.

So we have to be really cognizant of how we're churning [00:06:00] our patients. We have to look at our maintenance care conversion rates and where in the care journey are patients most commonly disappearing. A lot of times we'll see consistency with that, and we can create strategic opportunities to overcome those issues when we understand it.

But we have to understand it first, which means we have to dive into the numbers and realize it. So we have to stop asking only how many new patients and patient visits did we have last month, and we have to start asking, "What happened to patients we already earned? Why did they leave us? Where did they go?"

And this is where the patient experience really comes into play. You know, retention isn't simply about just getting good clinical outcomes. It's heavily influenced by the patient experience. Patients evaluate absolutely everything in your practice, from the first phone call, how they're greeted when they walk in the door, how long they have to wait to see the doctor, whether the doctor [00:07:00] appears rushed or sometimes doesn't appear like they're a doctor or doesn't act like a doctor.

Whether patient recommendations, your treatment plan recommendations make sense to the patient. Are they attached to the patient's goals, or do they feel like the doctor's goals? Whether the team, whether your chiropractic team is involved in the process, whether progress is communicated to patients, that's important, and whether patients understand what happens next.

All these things are important. You see, we have to be the leader for patients, and if we're not leading them, then they don't know why they're still coming in. And a patient can appreciate the adjustment, but they can still lead the practice. Clinical competence gets them through the front door, but experience, the patient experience, is what gives them a reason to stay.

You know, I often say the most expensive patient in your practice may not be the patient you failed to acquire. It may be the patient you already paid to [00:08:00] acquire and then allowed them to disappear. So think about that. 

Mistake 2 Payer Policies

Dr. Michael Perusich: Here's mistake number two: not reading the insurance company's medical policies. Now, some of you are thinking, "What in the world is that?"

This is the policy about how they treat, how they allow every type of provider to bill services, and these documents are incredibly valuable, and they can usually be found through your y- your portal with the third-party payer, the insurance company. So too many doctors are operating from assumptions because they don't read these directives.

They're, they're thinking, "Well, they've always paid this code, so I'll just continue billing it," or, "My biller says it's okay," or, "Everybody bills this," or, "I heard from friends that you can do this." None of those statements represent a payer policy. Doctors should understand that the applicable payer requirements affecting the services they provide and bill are important to understand.[00:09:00] 

You see, medical policies can address many things. It can give you coverage criteria. It can tell you how to document medical necessity. It can give you documentation expectations overall. It can give you frequency limitations. A lot of... I hear a lot of doctors say, "Well, we don't know how long we can bill for."

Have you read the medical policy? It might tell you. It tells you about coding requirements and whether you can bill certain things. It's, it tells you if they're gonna bundle certain, uh, services together. It tells you whether or not you need to have prior authorization, and it tells you about non-covered or excluded services

Okay, little back office detail there. Sorry about that. Payment does not necessarily mean your claim was billed correctly. I'm gonna say that again. Payment reimbursement does not necessarily mean your claim was billed correctly. You see, reimbursement comes from one side of the third-party payer, but the [00:10:00] audit comes from another.

Third-party payers are typically under a rule of having to pay you within about two weeks, or they have to pay you interest on your claim. So they'll kind of hurry up and pay you, but it's whether or not they're gonna ask for the money back. So a claim being paid today does not guarantee that it will survive retrospective review tomorrow Build a payer intelligent file for the practice.

This is important. Read those medical directives, those medical policies, and record, create a profile on each third-party payer and understand what their relevant policies are, their documentation requirements, their coding requirements, their authorization rules, their policy limitations, and update those frequently.

They change their policies quite often. So don't expect that what's effective January one may still be effective September one. It may not be, because they change their policies and they don't... they rarely, [00:11:00] okay, they probably never actually tell you about that. If an insurance company represents a significant portion of your revenue, understanding their rules isn't just clerical work, it's executive level business intelligence.

This is incredibly important to understand. So that's mistake number two. 

Mistakes 3 and 4 Compliance

Dr. Michael Perusich: Here's mistake number three: running your business based on friend advice. Oh my gosh, this one's terrible. Chiropractors routinely ask other chiropractors, "What are you charging? What codes are you billing? Are you getting paid on those codes?"

"Oh, I found a loophole in their system, so if you build this code with this modifier and this code with that modifier, you'll get paid more." But is that legal under the medical policy? Do you think I need an ABN or how are you using the ABN? What are you paying your associate? Should I hire an associate?

Should I hire another CA? What software are you using? All these are valuable questions, yes. But are you getting expert advice? [00:12:00] Borrowing someone else's strategy without understanding their economics is incredibly dangerous. Your friend's practice may have, probably does have different overhead, a different payer mix, different state requirements if they're in another state, different staffing costs, different patient demographics, different reimbursement, different goals, different everything.

What works beautifully in their practice may be financially disastrous to yours. So we have to replace friend advice with real data about your practice. That means looking at the statistics and KPIs, analyzing your profit and loss statements at least frequently, if not every month Having good expert compliance guidance and business coaching behind you and understand strategies in your model that you can use instead of just operating the way my friends do or because we've always done it this way.[00:13:00] 

We have to stop running million-dollar businesses on hallway conversations. You wouldn't ask your golfing buddy to interpret, interpret a complex tax issue simply because he also owns a business. Chiropractic practice ownership deserves the same level of professional decision-making. Don't leave it to your friends.

We're gonna take another quick break before we dive into the next two mistakes, so hang in there. We're talking about the five big mistakes that chiropractors are making today that are damaging their businesses for tomorrow. We'll be right back

Speaker 4: Patient numbers, dipping staff overwhelmed, and another marketing idea, promising the world, but delivering nothing. These pressures feel familiar to nearly every Chiropractic clinic today across the country. Chiropractors work hard, yet many find themselves stuck. Balancing patient care with the nonstop demands of running a business.

That's where the real strain begins. [00:14:00] Most clinics face the same set of hurdles, inconsistent new patient flow, operational bottlenecks, and the constant challenge of staying visible in an overcrowded digital space. National reports show that over 60% of clinics struggle with scheduling efficiency alone and even more lack of clear marketing strategy that reliably converts.

But the good news, these challenges aren't roadblocks. They're signals with the right procedures, smarter outreach and guidance built specifically for Chiropractic practices, clinics can turn daily stress into sustainable growth. Stronger clinics start with smarter strategies. Grow your practice with confidence.

Book your strategy session with Kats Consultants.

Dr. Michael Perusich: Okay, everybody. We are on mistake number four, and that's not paying attention to billing, which potentially puts yourself on the audit screen. I hear this a lot, "Well, my billing company handles that." And I'll be honest, that's [00:15:00] not a sufficient management strategy. You have to understand what the billing strategies are and if they're compliant or not.

While billing may be delegated, responsibility and oversight can't be delegated. It has to be under your guise. Practice owners should routinely evaluate billing patterns for anomalies and compliance risk and get a professional to help you with it. Don't wait until you get the audit letter. Let's audit ourselves on a continual basis every month.

Potential area- areas that are warranting atten- attention, and make a list of this, okay? These are the areas you wanna watch: repetitive coding patterns, unsupportive services, documentation that doesn't substantiate billed services, modifier misuse, billing patterns that are inconsistent with payer requirements, excessive utilization, and I'll give you an example.

Billing way too many nine eight nine four ones when you have a nine eight nine four O diagnosis. [00:16:00] Lack of indivi- individualized documentation, that's important, so you can't have your documentation look exactly the same for every patient. And coding intensity that's inconsistent with the underlying record, in other words, over-billing.

So the question you should be asking isn't just, "Are we getting paid?" The question you should ask is, "Can we defend why we got paid?" So because of that, we have to conduct periodic internal chart and billing audits and compare what was performed, what was documented, what was coded, what was submitted, what was paid, and do we have the supportive documentation for medical necessity?

Getting the claim paid is not the finish line. Being able to defend the claim is. All right, drum roll. 

Mistake 5 KPI Scoreboard

Dr. Michael Perusich: Mistake number five Managing the practice by bank balance instead of a scoreboard, instead of by your stats. So [00:17:00] many doctors, we know today's schedule, we know what this week's new patients look like on the schedule, we know what's in the checking account.

But ask them for the business critical KPIs, and the answer oftentimes becomes incredibly fuzzy. Your bank balance isn't a result. It's not a management system. It's the after effect of what hap- what is happening in your practice. So at minimum, owners should understand collections, overhead, accounts receivable, your unique patient visit numbers, your profit per patient visit, that's usually important, your retention, your dropouts, your patient visit growth, your new patient conversion rates, your maintenance conversion rates, and your pay- payer mix.

The objective isn't more statistics. The objective is identifying problems in the statistics from the statistics before they become financial problems. And did you notice your checking account balance is not one of the [00:18:00] primary statistics? You see, you can't manage what you refuse to measure, and your checking account tells you what you alread- what-- it tells you what's already happened and not what's about to happen.

So we can't go by that. So The challenge for every listener today is to answer five questions this week. Number one, how many patients dropped out of my practice in the last 90 days, and why? Number two, when did I last review medical policies of my largest payers? And quite frankly, it should be all your payers.

Which business decisions have I made based primarily on another doctor's opinion rather than my own data? Number four, when did I last independently audit my billing and documentation? And number five, can I identify my critical practice KPIs without asking my staff or opening five different reports?

They should be right on top of your head. So final takeaway. Great practices aren't [00:19:00] built simply by doing more marketing and driving more patient-- new patients in the front door. They're built by eliminating the little leaks along the way that are killing your practice. So stop driving new patients so hard and understand how to retain patients in your practice.

Stop allowing patients you've already acquired to drop out of your practice. Stop poor billing habits. Stop poor coding habits. Learn how to document and understand how medical necessity actually affects your practice. See, the next evolution of your practice may not require adding another thing to your practice.

It may begin by fixing the five things quietly costing you business you should already have. So dive into these five mistakes. How many are you making? And if you need help, go to katsconsultants.com, schedule a call with us. Let's talk about your practice. We do that for free. Why do we do [00:20:00] that? Because we've all had great practices.

Chiropractic has been an amazing paradigm for all of us, and we want you to have the same experience. So give us a call. Let's talk about it. So I appreciate all of you tuning in. I, I wanna thank Chiro Health USA for being one of our sponsors, and from all of us here at Kats Consultants, make it an awesome day.

We'll see you next time