The year is now 75% over and most of my clients have failed to notice that their practice is “supposed to be” in a recession like the rest of the country.  If you have accepted the position that the economy is responsible for the downturn in your practice, I challenge you to read this.

In fact, I just reviewed statistics with three of the offices I consult with and here are a few of their results:  the first is on track to double his practice in 2009 will put him well into the seven figure range (with no additional marketing and one additional, non-chiropractic staff member added); the second had both May & June 2009 “best month evers” exceeding all monthly services rendered in 2008; the third cleaned up a four year collections mess and brought in an extra $37,000 in one month as a result.

Now, lest you think that this is going to turn into a long extended sales letter with lots of bragging about the fantastic results I can achieve as a result of my “secret” chiropractic practice building methods that were “accidentally” discovered in BJ’s bathroom, by channeling D.D. or some other such voodoo…I will tell you the key ingredient in each one of these success stories (and many other as well).

It is confusion – or more specifically, a lack of it.

Confusion is one of the biggest roadblocks to chiropractic practice success that I have witnessed time and again, regardless of practice size or style.

In any situation, confusion is often the chief enemy, not the economy.  In flush times, offices may get away with smaller “pockets” of confusion: systems that are ineffective, inefficient or inconsistent.  Challenging times tend to accentuate the need for clarity of purpose, efficiency of procedures and they may even sink the “confused” office, but the elements of destruction were already present.

Eliminating confusion, then, becomes a powerful method we can use to drive our practice towards the success that we long for.  Let me explain some more and give you examples:

Because of the traditional ways we have been taught to present chiropractic, we often become our own worst enemy.  If you have heard comments like “I need to think about it” or “What will my insurance cover” or “I have to discuss this with my spouse” or ‘I guess I can do that if my insurance pays” in your office, it is likely you have confused your patient in some capacity:

Here’s why: Because we have confused our patients, their only line of defense is to surrender the responsibility of the decision to their insurance company or spouse or someone else isn’t present.  After all, they don’t want to offend you, but you have not made the issues black and white enough that they can clearly give a “yes” either.  So, they delay their rejection of your care to when they are a safe distance from your office – at home.

The following is a short list of unfortunately common “mistakes of confusion” that will limit your practice growth.

Sending Conflicting Messages.  Think about it.  What are you “selling” and what is the patient buying?  If you are selling techniques and procedures, you are not on the same page with the patient.  Patients want to know what the end result benefit looks and feels like, not the many steps that it takes to get there including all possible options.  Can you make them feel well?  Can you allow them to get back to work?  Can you allow them to comfortably play with their children or grandchildren?  Answer these questions first and you have their attention.  Statistics about the degrees of curvature, phases of degeneration, or potential life altering affects of their spinal health may all be necessary to discuss, but only after you have addressed the patient’s questions and concerns.  If you fail to do this, you risk sending a conflicting message to the patient (well I am not sure he can help me with X, because he spent most of the time talking about Y) and confusion (I am not sure if A is really the problem because he kept mentioning B – maybe I need to get another opinion).  I have seen confusion kill more ROFs than any financial issues.

Not verifying insurance benefits prior to the first visit.  All elements of confusion need to be reduced or eliminated on the first visit to promote case acceptance success. For some patients, it is a big enough hurdle to just accept the idea of chiropractic. Not knowing the costs or their insurance coverage is simply too much to risk. By default, then, they will go back to the pharmacy or their MD or some safer alternative where they know what is entailed and what it costs.  Granted, it is not always easy to obtain benefits prior to the first visit, but it should be a major goal and achievable 98% of the time to avoid wasting both the doctor and the patient’s time in a visit that is essentially going to go nowhere until costs can be estimated accurately.

Not collecting at the time of service.  This problem is often related to insurance verification, but sometimes can be its own separate challenge as well.  Again, here the staff suffers from system confusion because either the benefits have not been verified or the costs per visit have not been calculated. This is especially important with patients who have co-insurances or deductibles to meet.  Instead of surprising the patient with a large balance when the insurance rolls in, staff can anticipate costs and have patients pay their portion at each visit.  This may include some tracking on your behalf; in other words, knowing what insurance companies pay for each service you offer.  It takes a little time to set up, but in terms of customer service it far exceeds telling a patient: “our average visit runs between $60-$180 and your portion should be somewhere between $20-$120.”  I have seen offices function this way

Too much talking.  In your daily visits, not enough listening also creates confusion as does too much information and detail.  In an attempt to educate the patient and establish credibility, we oftentimes introduce large roadblocks by talking more than listening.  When we talk more than the patient does, we communicate that what we have to say is more important than what they have to say.  I once observed a doctor who talked so incessantly that he frequently asked his patients the same questions two or three times in a visit.  For someone who could follow the visit in terms of the chiropractic procedures and tests going on, it was annoying to listen to this DC not listen.  For the patient, it created confusion. The patient left the visit confused about the source of her headaches (the reason she consulted the office) and now also confused about a hip problem she didn’t know she had.  My guess is after several more visits like that, she will leave to find a chiropractor who listens better and can help her understand her body’s signals.

Service Confusion.  While I certainly can attest to the benefits of providing services in addition to adjustments, some clinics create confusion by performing multiple modalities or services on a patient with no clarification or explanation of the benefits of such services to the patient.  As my practice is located Washington State, we cannot perform modalities such as electric stim or ultrasound.  Some DC’s would argue that this handicaps us, but I have seen many offices that would benefit from such a limitation.  Why?  They slap on stim pads and explain nothing of what they are doing to their patient; inevitably the day comes when the patient doesn’t have the time or the inclination to wait around for all their services and wants to skip a portion of their treatment. Educating your patient on WHY you are performing any service eliminates confusion, improves retention and solidifies the need for your treatments.  Ultimately it also creates a patient that understands what you are doing and is capable of referring others.

If you don’t think you are confusing your patients, stop a moment and reflect on whether you or your staff have ever heard questions like these: “Can I just come in twice per week instead?” “Now, what is it we are doing today?”  “Is what you are currently doing really working?”  “Is it taking too long?”  “Do I need to have the adjustment today or can I just lay on the roller table.”

If you have heard any of these, you might be confusing and complicating the process of case acceptance and/or patient retention with your systems, procedures or communication.  Simplify your life and stop making it difficult for the patient to make treatment decisions.  Re-focus your communication to be oriented around the patient’s needs, not yours.  Develop systems that serve patients by making everything crystal clear to understand.

Keep the intention on minimizing confusion and your patients will truly understand what it is you do and how things work in your office.  They may not all agree or accept what you have to offer, but you will at least communicate your services in a way that is consistent.  Consistency and clarity eliminate confusion, help retention and increase referrals. Docs are always looking for ways to do less and achieve more – clarity and lack of confusion will help get you there!