Most chiropractors and their staff have an idea about the level of care they would most like to be giving their patients. If you poll DC’s you will also find that many (if not the majority) of docs would love to be rendering either comprehensive or wellness based care.
The “comprehensive” DC would like his patients to understand the need for care beyond the patch phase and incorporate a restorative plan of care which may also include spinal rehabilitation, therapeutic massage and other services in addition to chiropractic geared towards spinal correction. The “wellness” DC takes a different route towards their version of comprehensive care which may include nutrition, weight loss, body work or other holistic complements to their chiropractic care. Obviously, some chiropractors combine all of the above and more.
Few DC’s would truly admit that they like to treat the patients solely for pain and have them exit from their offices after a few visits, never to be seen from again.
Yet that is exactly what happens and whether you realize it or not, the blockage is often your fees — just not in the way that you think it is. Most of the blockage is not in the patient’s mind, but in yours. Here’s a quick exercise to show you why and how:
Regardless of what your definition of “comprehensive” care would be, estimate what the fees for that type of chiropractic care would be, including any fees required by other modalities or complementary therapies (i.e. massage, rehab, nutrition, weight loss, etc) would be involved in such a case. Do some quick math and write down a typical plan of what a case like that would look like in your office and how much those fees would be over the course of one year.
The Chiropractic Fee Tension Zone
Now that you have that number written down, let’s talk about the “Chiropractic Tension Zone.” On the graph above, chiropractic fees are represented on the horizontal axis and “Fee Tension” is represented on the vertical axis.
While the chiropractor (and/or their staff) may be comfortable recommending care in the lower fee ranges, at the upper ranges, things begin to get a little tense. At $250, virtually everyone is comfortable except for those who are suffering from an extreme poverty mentality. By $2500 half the chiropractors are uncomfortable and some would be visibly sweating if they had to say that number out loud. By $5000, most chiropractors have their knees shaking. And by $10,000 the vast majority have fled the building or worse, soiled the shorts and are now unable to move.
As you may imagine, the “Fee Tension Zone” varies widely from office to office, from doctor to staff and even among classes of patients. What does not change is what happens to you or your staff when you exceed fees that are above your “Tension Zone.” Unfortunately, patients can visibly see your discomfort, hear the stuttering in your voice or read your body language.
What Your Fees Say About You
Think about your “Tension Zone” number and write it down.
Now look at your two numbers: the fees you want to charge and the fees at which your tension zone discomfort kicks in. 90% of the time, your first number (the care you want to do) is higher than your second (the fees at which you are comfortable proposing). The bad news is that means the chiropractic care you would like to give your patients also gives you anxiety.
Alleviating Fee Tension Method #1: Relative Value
Here’s the good news: You cannot eliminate your “tension zone” (or that of your staff) but you can increase it in two ways.
The first is what I call the “Relative Value Method.” When I have had clients with extreme fee phobias, I have them do this simple exercise. Call a window cleaner or landscaper or some other “low barrier entry” service and see what they charge for a few minutes of their time. Better yet, PAY them to do it. Next, call a skilled tradesmen (plumber, electrician, mechanic) and see what they charge to do their work. Finally, go to a dentist, look at your children’s orthodontist bill or go get a mole removed at the skin doctor.
You will be surprised to see that the low barrier entry service probably charges the same as you do for your chiropractic adjustment, without the staff, the overhead and the $150,000 educational price tag. Of course, if he’s self-employed, he’s got overhead too, but the fact that he is charging the same should raise your eyebrows.
The skilled tradesman may charge the same as you as well, likely even more. Many DC’s would state that these skilled laborers are “union” and are not getting the full amount of services billed. First, off doc, neither are you – when you deal with insurance. Secondly, these guys don’t go into any debt to learn their trade and start making $20/hr immediately and progress up to $65/hr or more. With no educational debt to pay off. Sure they have a ceiling on their work – but so do you. Hint: its called your “tension zone.”
Finally, let’s take the professionals. The orthodontists have been quoting $5000 case fees for 30+ years and in many areas, that’s the cheapest you can get some braces done. The dentists don’t bat an eye at quoting fees equally as large and now they are looking for additional revenue streams through doing low-level orthodontics, sleep apnea treatments and botox to supplement that measly $5000 case average. And their educational debt load. Yep, about the same as ours.
Moral of the story: open your eyes and look around you. Unless you charge more, you better get ready to do your own lawn, your own housecleaning, your own plumbing work and don’t forget to go get some dentist’s tools: you are going to be doing that as well. You are a skilled professional. You deserve to make a commensurate fee. And the biggest thing that is stopping you from doing that stares at you in the mirror every morning.
Alleviating Fee Tension Method #2: Decreasing Resistance
The second way to increase your tension zone is to decrease the patient’s resistance. If you don’t think this is possible, I’m going to assume you live in a tent, don’t drive a car and have never bought anything on credit. The principle is simple: if people want something, they are willing to pay for it over time – provided the option is offered.
Imagine the home builder who must sell all his homes for cash. A lonely dude, for sure. If people were not ready to pay for things they want over time, few would even own a vehicle and almost none would own a house. Some wouldn’t even own a TV.
Why should your office be any different? Most folks don’t have $3000 saved up for a rainy day when their back gives out. And yet, they have been walking around with the problem for 20 years and you let them naively believe that their insurance’s 6 visits is going to get the job done?!
So, obviously the next step is to have a financing option readily available. Present the fee to your patient and them let them know that monthly payments are an option.
Interestingly enough, when you break payments down into monthly installments, the research is clear: fee tension alleviates. Staff (and doctors) are much more comfortable at quoting monthly fees and the numbers they quote are much higher before they reach the point of maximum tension. What’s even more amazing, is the same effect happens to patients! In other words, the same patient whose jaw dropped at $5000 for care is absolutely fine with payments of $400 some per month. Take a “downpayment” or deposit and the monthly figure (and the stress) decrease even more!
Action Steps and Final Thoughts to Conquering Fee Fears
a) Meet with your Team – and discuss the Fee Tension principle. See where their tension is and how you can relieve it.
b) Choose a flexible provider for payment plans. Unfortunately, thanks to CareCredit’s recent bad press, shady tactics and volatile hidden interest rates, I would recommend steering clear of them.
A much better option is ClearGage who offers financing for a transparent and much easier to swallow 8% — with no credit check.
c) Watch your “Fee Tension” change. As you and your staff get better at quoting fees and using monthly installments, you will notice an additional side benefit. The number that used to make them shake no longer even causes them to break a sweat. In effect, the tension has been reduced and therefore the comfort zone expanded! That’s great news because that means that your fees now have potential to increase even further.
d) Master this skill NOW. With the onset of Obamacare, lousy insurance and big deductibles, you already need this skill – and will likely need it even more in the future. So, start now!