If the last time you raised the fees in your practice was when there was a different President in the office and/or if the thought of setting your chiropractic fees a little higher brings a bit of anxiety your way, this post is for you. If you avoid raising fees because of what your patients may think about you, yes – this post is for you. If you raise your fees randomly, with no science, timing or other solid rationale, yep — this post is for you too.
The good (or bad) news is that this applies to many chiropractors out there.
The definitely bad news is that if this shoe fits, you may be guilty of setting your chiropractic fees out of fear.
The better news is that we are going to address this issue head on — and help you out of a place where your emotions can hurt your bottom line.
4 BIG FEE MYTHS THAT CAUSE CHIROPRACTORS TO MAKE BAD CHOICES
The first step to solving your fee issues is to dismiss the myths that are swirling around in your chiropractic head. Let’s begin with three big myths that affect many, if not most, chiropractors.
My Patients Will Leave or Be Upset: This strikes fear in the heart of many, many chiropractors but the reality of the situation is there are is massive “price elasticity” in chiropractic. If someone were to waste the time calling 100 different chiropractic offices, they would easily see that chiropractic fees are all over the map. Save yourself the trouble and let Mr. Google do the work and you will find articles that quote chiropractic visit fees in the range of $30-$200 “per session!” That wide range should tell you that patients are willing to pay what you ask. Furthermore, there is minimal evidence that price is the primary decision-influencer in service-based businesses – including chiropractic practices. The fact of the matter is that in a service-based business, buyer decisions are going to be made based on referrals, trust, confidence, quality, perception of skill, convenience and yes, price. But price is actually way down the line. If “cheap” were the primary reason people chose service based health care providers, you would see precious few plastic surgeons or cosmetic dentists — yet those specialties are being flooded by both patients and practitioners.
Fee Raises Will Cause My Cash Patients To Suffer. The second objection is really a variation on the first, but with an extreme fear of running your cash (self-pay) patients out the door. Here, you need to keep things in perspective and raise your fees anyway because the simple math says its foolish not to. The average DC is 80% insurance and 20% cash. To create a fee structure that is so low that it keeps all your cash patients happy is allowing the tail to wag the dog.
Raising fees is useless because of contractual write-offs. Yes, if you plan to participate with every payer and you never plan to ever charge your patients for anything the insurance doesn’t cover, I agree that the increased profits gained by raising fees may be limited. But even a half percent increase is still an increase! On the other hand, if you find yourself in a position where the fee raise doesn’t add to the bottom line, it’s may be a sign that the payers you are dealing with aren’t serving you well and it’s time to kick some of those low paying insurance companies to the curb as they are shackling you to a level that is unprofitable. Get out of network with the stinky plans and value your own care enough to charge your patients what you are worth. You deserve it !
Raising My Fees Will “Red Flag” Me With Insurance Payers. This myth lives in the minds of those chiropractors who believe that they can still fly “under the radar.” Let me burst your bubble and let you know that we are way past the era where you can possibly fly under the radar. With the push of a button, the insurance payers know everything about you. Automated processes run silently in the background scrutinizing your every move, sending them through a vast array of statistical analysis that are constantly on the prowl for “outliers” — those who look significantly different than others. So, in a sense, yes – if you raise your fees through the roof, the insurance will know and they may wonder what you are doing. But for 99% of the chiropractors, that is not the problem. And for the extremely paranoid providers who believe that keeping their fees a hair (or more) below their colleagues, here’s the news: you are doing the insurance companies are great favor by charging them less and doing yourself absolutely no favors. But even low price won’t endear you to the payer if you couple it with over-utilization, poor coding, dismal documentation or any other number of “offenses” that will make them mad. So, drop the notion that you can fly under their radar as your excuse and face your fee fears!
Fee “Secrets” of the Big Boys
The good news is that chiropractors don’t need to re-invent the wheel or come up with some sort of complicated mathematical reasoning to support this simple idea of raising your fees. Way back in the 1980’s, the bean counters at Kodak did the work for us by commissioning a study on price setting. This study is worth revisiting today given the rising office overhead costs in chiropractic today. One of the reasons why overhead is increasing is that your fees have not kept up with the rising costs of providing the care. There are many variables involved in setting your fees and only you can determine an appropriate fee schedule, but here is something to think about.
The story: executives at Eastman Kodak were concerned about increasing competition in their industry. Prior to the early ‘80’s Kodak had a virtual monopoly on film in US. This changed when Japanese film manufacturers were able to introduce their film in the US at lower prices. Kodak decided to conduct a study to determine the effects of price increases and price decreases on their profitability. The Kodak study assumed a 25% profit percentage (75% overhead) which is rather convenient for our purposes because it is fairly close to the average chiropractor’s net income today (recent salary survey studies show the average DC has a 65% overhead).
The Huge Cost of Cutting Your Fees
Assuming an anticipated profit of 25% of selling price (after overhead is met), a 2% cut (discount) in that selling price means you must increase your volume of sales by 8.7% to make the same profit obtained before the price was lowered.
- A 3% cut means a 13.6% increase in revenues is necessary!
- A 5% cut means a 25% increase in revenues is necessary!
- A 7.5% cut means a 43% increase in revenues is necessary!
- A 10% cut means a 67% increase in is necessary!
- A 15% cut means a 150% increase is necessary!
- A 20% cut means a 400% increase is necessary!
The Big Impact of Fee Raises
On the reverse side, look at what raising your fees does!
- A 3% increase in fees means the same profit 90% of revenues!
- A 5% increase means the same profit on 83.5% of revenues!
- A 10% increase means the same profit on 77% of revenues!
- A 15% increase means the same profit on 71.5% of revenues!
- A 20% increase means the same profit on 55.5% of revenues!
In theory, chiropractors could afford to lose nearly half their patients with an increase of only 20%!! Fortunately, the likelihood of losing that many patients is slim. Unfortunately, the possibility of increasing revenues massively (by 400% or so) is also remote, due to the fact that most practices are not 100% cash and payers will limit the overall impact of fee raises.
Small Victories Won Frequently
However, don’t give up and abandon ship altogether! This is how many chiropractors go crazy. Since we can’t achieve a HUGE victory with one move (fee increase), we abandon the idea and move on to some other “sure bet” that will (supposedly) produce monstrous profits.
Instead of going for broke, what if we simply increased our fees and took the 3%, 5% or 8% boost it may achieve? And then move on to another small victory. Collectively, four small victories of 5% increase add up to 20% increase – not bad.
Since many chiropractors seem to be a bit fee-raise resistant, they have no idea of how a simple increase or decrease in fees and overhead can so dramatically impact their experience of practice and life and the quality of care they deliver. And how a simple thing like a fee increase doesn’t require any extra effort, doesn’t require you to change your whole practice style or attend a seminar in Bora Bora to learn how to do it.
The Final Obstacle
Some of you may still find yourself objecting in the face of this logic and research. If that’s the song playing in your head – stop it. Most objections to fees are there: in your own head. Over the years I have conducted several hundred chiropractic offices “on-site visits” and have spoken to thousands of chiropractors at my seminars. Two things become universally clear: (1) your patients love you and (2) many chiropractors also apparently don’t have the self-esteem to realize that in a tangible way (i.e. raise your fees).
There’s no correlation between the fees you charge and your skill set. I’ve seen relatively “average” chiropractors happily profiting from above average fees. Unfortunately, the more common scenario is superior chiropractors laboring away with inferior fees. Interestingly enough, in his Gary Vaynerchuk’s book The Thank You Economy, he quotes the Customer Service Impact 2010 Report as saying that “85 percent of US consumers say they would pay 5 percent to 25 percent more to ensure a superior customer experience.” If your patients are receiving truly great customer service, they will be willing to pay for it – including fee increases!
I’m not a licensed counselor (thankfully) and have no intention of becoming one. If you want to wait 20 years to charge an extra $5 for your services, that’s your problem. But please realize it is a problem. Consider the Kodak Study the next time you consider your fees, raise them and choose to solve that problem now so you can move onto something else. Or you can choose to ignore or rationalize your problem and pay later. You do good work, doc – raise your fees!
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