0:00

What are today's trends and the future trends

0:02

in chiropractic business management?

0:06

Hi everybody. Welcome to the KC chiro pulse podcast

0:09

brought to you by Chirohealth USA and Kats

0:11

consultants. I'm Dr. Michael Perusich

0:13

joined by my cohost, Dr. Troy Fox.

0:16

Troy, you and I talk about this all the time

0:19

off camera, and there's

0:22

probably some things that we talked about that we can't put

0:24

on camera, but sure, but nonetheless,

0:27

You and I see and always

0:29

have, we always see where the profession

0:31

is going in a lot of regards. And

0:34

I thought it'd be interesting for us to just talk

0:36

about some of that today. And

0:38

I'm going to prime the pump here

0:40

a little bit by talking about

0:43

reimbursement, insurance reimbursement. And

0:47

you, we post this question all the time

0:49

to the profession is reimbursement

0:51

going up or down 99. 9

0:54

percent of the time. It's going where everybody

0:57

deal with me down, down. It's

0:59

going down. And so as

1:01

insurance reimbursement goes down, do

1:04

you make more or less with

1:06

those patients who have that insurance?

1:08

You make way less because you're also chasing

1:11

it harder. You are. And

1:13

a lot of it on the EOB goes to

1:16

write off. So you can raise

1:18

your fees all day long. If

1:21

what you're billing out to the insurance company, if

1:23

reimbursements going down, that means your write

1:25

offs are going up. So you're just,

1:27

you're fighting a losing battle. And

1:29

one of the trends that we see is

1:31

doctors trying to make that up by increasing

1:34

capacity, by increasing the number of patient

1:36

visits, which I'll

1:38

be honest, that's a valiant way to overcome

1:41

it in some ways, but

1:43

it's also a valiant way to burn yourself out really quick.

1:47

You get into that mode. Oh my gosh I can't

1:49

see a thousand patient visits a month. I just can't

1:51

physically do it. I know I couldn't

1:53

do it anymore. And

1:56

you realize you can't do it. You immediately think

1:58

I'll just hire a bunch of associates and come in. And,

2:00

that's not always the answer. And but

2:02

we see this trend happening where

2:05

doctors are trying to see more and more patients

2:08

to try to make up for the loss of reimbursement

2:10

and the loss of fee control, and

2:13

then hiring a bunch of doctors. And now,

2:16

and I'm not saying the multi doctor

2:20

idea doesn't work. I'm not saying that at all. But

2:22

we wind up hiring people and wind up hiring

2:24

the wrong doctors. And so now quality

2:27

of care begins to degrade. There's

2:29

unhappiness in the clinic. There's low retention

2:31

rate. And now we're swimming even harder

2:34

to bring patients in. And what do we do? The

2:37

low

2:37

cost promotion. I

2:40

was just going to say that, because that's exactly

2:42

what comes next is now we need to flood our practice

2:44

with new patients. So we're

2:46

going to do a 1999 special

2:49

that, gives away an adjustment at exam

2:51

and a free massage. And, maybe we're going to throw

2:53

in a 20 gift card to,

2:55

hardies or something like that on top of

2:58

that. And. Yeah, I just picked

3:00

hardies out with large fries could

3:02

be Starbucks. I don't know. It could be wherever you want to

3:04

go, but unfortunately

3:06

we create a situation where

3:08

now we have brought

3:11

associate doctors in and in

3:13

a lot of cases, and I'm just telling you what we

3:15

see in a lot of cases, what

3:18

we see is doctors that are semi

3:20

burnt out already. Because they've been running

3:23

on the wheel as hard as they can. And

3:25

they're like, Oh my God, get me off of

3:27

this thing before I die. I'm

3:29

going to bring in some associate docs. Guess what?

3:31

They're so tired and so burnt out that they don't

3:33

have the time or the energy to spend

3:36

time with these young docs that they brought

3:38

in. To get them up to speed, to get

3:40

them ready, to get them to where they

3:43

actually have the

3:45

skillset needed to work with today's patients.

3:47

And that's, you don't learn that in school.

3:50

You learn that out in practice, you cut your teeth.

3:53

Yeah. And

3:53

so it's so true. And

3:55

the big part of what they don't have and

3:58

the big part of what we need to spend time training and

4:00

associate on is communication

4:01

skills. Yeah. So add

4:04

to the complexity of that by, and

4:06

I'm going to say the word enticing.

4:09

Patients to come into your practice of the low

4:11

cost special. And so the quality

4:13

of patient that you're bringing into your practice

4:15

is low. Now

4:18

you don't have people that are

4:21

seasoned when it comes to working

4:23

with the public and they're working with some of the

4:25

hardest individuals on the planet.

4:28

To get them to understand and follow through with care,

4:30

because they didn't value you to begin with

4:32

when they walked in the door because of the special. So

4:35

we have created an absolute monster.

4:39

As a profession. And I see it in a lot of

4:41

large towns, small towns practices.

4:44

You don't see it as often as

4:45

much, but you get

4:46

into the cities, man, it's dog eat dog,

4:49

everybody on the block. It's got a special

4:51

going and basically a patient jumps

4:53

from one chiropractor to another, as soon

4:55

as the special changes. And

4:58

you're creating a situation where

5:00

you've got patients that don't value

5:02

your services and are just looking for the next great

5:04

deal. And then you wonder

5:06

why your retention is just

5:08

horrible. And we keep following

5:11

each other to the bottom of the pool, going

5:14

lower and lower on our price. I saw a deal for 9.

5:16

99 the other day. Nine, ten bucks.

5:20

What? We've devalued

5:22

ourselves so much in those situations.

5:24

The patients are never going to find value in it. And

5:26

then you want to bring them in for nine bucks and give

5:28

them all these things on day one. And then on day two, you

5:30

want to present them with a fifteen hundred dollar treatment plan

5:33

that just doesn't fly.

5:35

It just doesn't make sense to patients. That's

5:37

not how you build value. So we see this big trend

5:39

in the profession of declining value

5:42

along with declining reimbursement. And

5:44

the opposite should be is what should be

5:46

happening. As reimbursement goes down,

5:49

we should be unencumbering ourselves from

5:52

that horrible FEMA,

5:54

that horrible fee for reimbursement

5:56

model. Sorry, that horrible insurance reimbursement

5:59

model and getting away for it and

6:01

putting ourselves in a position where we can control.

6:04

Our fee

6:05

structure. And I'm going to interject

6:07

right here. If that's you, we usually, we

6:09

wait until the end of the show to actually

6:11

talk about, Hey, give us a call. If we can help

6:13

you, or if this sounds like you, if this

6:16

person sounds like you. You

6:18

need to jump on the website right now

6:20

and make an appointment to talk, because

6:23

quite frankly, you're not

6:25

going to change what your practice is doing. If you

6:27

continue, insanity is doing the same thing over

6:29

and over again, expecting a different result. Here's

6:32

the result you're getting. You're actually getting

6:34

a lessened return.

6:37

A diminishing return every year

6:40

that this continues on. And it's been going on

6:42

for years, but we're getting more

6:44

and more diminishing returns. And Dr.

6:46

Perusich and I have both have very strong opinions.

6:49

And I will tell you right now, I

6:51

walk the walk when it comes to

6:54

what we're doing. I run a cat,

6:56

I run a cash practice and I'm

6:58

going to throw, I'm going to throw

7:00

this out there. Lower overhead,

7:03

because here's what you're running into when we get

7:05

diminishing return.

7:08

In other words. You're not getting as

7:10

much reimbursement from those insurance

7:12

patients. But yet you're having to work

7:14

even harder to chase that insurance payment.

7:17

Your fixed costs are either remaining the same

7:19

or going up, but the pie's getting smaller.

7:22

So guess what? The percentage of what goes

7:24

to your fixed costs increases and

7:26

you feel the squeeze because your account

7:28

is getting smaller and smaller, meaning

7:30

that you're getting paid less

7:33

per hour than you deserve. It,

7:35

you can feel it. You're trying to figure

7:37

a way out of it. And instead.

7:40

You literally cannibalize your own practice

7:43

to do it because that's what everybody else around you is doing.

7:45

I hate it. I hate it. I'll be honest with

7:47

you.

7:48

Yeah. And we don't need to do that. So here's

7:50

what we do need to do. We do need to have a word

7:52

from our sponsors real quick, but I want to

7:54

come back and talk about this. We're talking about the trends

7:57

we see in chiropractic business management right now.

7:59

And we're talking about the fact that.

8:02

The insurance company's reimbursement is

8:04

declining and how it's affecting our practice

8:07

and the result of what it's causing us

8:09

to do to undervalue ourselves. So

8:11

let's hear from our sponsors, Chirohealth USA

8:13

and Kats consultants. We'll be right back.

8:16

So we all feel it. Rent,

8:18

or dining out, gasoline, or

8:20

movies. As a matter of fact, the dollar

8:23

is not going as far for a whole

8:25

host of reasons. And it's impacting

8:27

everybody, regardless of your financial

8:29

situation. Did you know that

8:32

38 percent of the overall population

8:35

is having to reconsider How they're spending

8:37

their money just to afford the health

8:39

care they need. And if you break it down

8:41

further, 26 percent

8:43

have actually delayed the health

8:45

care that they need, including going to

8:47

see you, the chiropractor. So

8:50

here's what we need to know about the breakdown in demographics.

8:53

You would think that That someone who's making

8:56

120, 000 or more

8:58

would be continuing their care right now. But

9:00

the actual number is 18%, 18

9:04

percent of that group is actually putting

9:06

off healthcare. And that's a group of people

9:08

making six figures. When you take

9:10

that same information all the way down

9:12

to a group making 40,

9:15

000, that number is much higher. It's closer

9:17

to 40%. So it's never

9:19

been more important than now to make sure

9:21

you've made it easy for your patients to come

9:23

see you. That you have choices for

9:25

them, and you understand what they're going

9:27

through at home. We want to make sure your practice

9:30

thrives during this time, and we

9:32

encourage you to learn about what ChiroHealth

9:34

USA can do for you, and your

9:36

practice, and making it easy for patients

9:38

to see you and continue care.

9:45

All right, everybody. Welcome back to the KC CHIROPulse

9:47

podcast. We are talking about

9:50

trends in chiropractic business that we see right

9:53

now and where things are going and.

9:55

Troy, you and I fell off the cliff into this whole

9:57

idea of what declining insurance

9:59

reimbursement is doing to us. And I'm going to add

10:01

a couple of other things to it. What else

10:03

is the insurance world doing to us? They're

10:06

putting more layers of audits on us, more

10:08

responsibility for medical necessity

10:10

and the proof thereof. And

10:13

they're squeezing us in a lot of cases

10:16

in our ability

10:18

to actually get paid for

10:20

proving medical necessity because a lot of the

10:23

insurance companies no longer pay for

10:25

progress exams and those kind of things. So

10:27

we're caught in this weird trap

10:30

and it's forcing us down

10:32

this road of as

10:35

reimbursement goes down, we're allowing

10:37

our value to go down with it. Because

10:40

we're just we're trying to bring in more new patients.

10:43

And so we're taking the new patient price and

10:45

then we're not getting patients to convert

10:48

into care.

10:49

And I can tell you right now that feeling better

10:51

about yourself because you had 35 new

10:53

patients last month does not feed the bulldog.

10:56

I'll tell you where the problem lies right now

10:58

is you guys are caught in a conundrum and you

11:00

understand that there are more layers of auditing.

11:03

You see it coming. You've seen it happen to people

11:05

around you. So 1 of 2 things is going to happen.

11:08

You either bury your head in the sand and continue

11:10

down the road that you're on. Or B,

11:13

you've already made the determination. Wow.

11:15

There might be some trouble up ahead. I'm going

11:17

to divert over here, meaning that I'm going to cut

11:19

this patient's treatment schedule below

11:21

what this person needs to get better. And so

11:23

the results that you're getting with patients are

11:26

also diminished. Yeah. So

11:28

instead of the outlier report and it's just

11:30

Oh my gosh, I stayed off the outlier report,

11:32

but my patients aren't getting better now. So

11:35

I'm stuck between a rock and a hard place.

11:37

Do I want to get audited? Or do I want

11:39

my patients not to get better or get

11:41

the results that they should? I won't say better because

11:44

some of them are going to improve to some extent,

11:46

but maybe they didn't get full resolution when

11:48

they should have. So it's a horrible

11:50

position to be

11:51

in. It is. And I'm going to throw a caveat in here.

11:53

It may sound like we're saying you have

11:55

to be a cash practice. That's not what

11:57

we're saying. Even though Petra and I both have cash practices,

11:59

but that's not what we're saying. You

12:02

can live in the world of

12:04

insurance. You

12:06

just have to balance it with

12:08

more cash services in your practice.

12:11

So you have to think about, what's covered,

12:13

what's not covered. What does the patient

12:15

need? Where

12:18

I'm going with this is I see a lot of

12:20

practices shy away from

12:24

sharing services that are cash

12:26

only, not covered by insurance,

12:29

but them not building that into their treatment

12:31

plans with their insurance patients. Cause they're

12:33

afraid to tell the patient, Oh, you

12:35

owe more than your 20 percent co insurance.

12:38

Yeah, some people get really stuck on

12:40

that, that basically you

12:43

are in a position where you

12:45

feel like that to pay. Really, it's a poverty

12:47

complex. We don't call it. We don't

12:49

call it that because you look at it and you're

12:52

like, oh, I'm telling the patient what they need. And this is going

12:54

to generate 1500 in

12:56

revenue from this case. But here's what

12:58

you're not doing. You're not recommending

13:00

any cash services because you're afraid

13:03

the patient's going to say no. And

13:05

I get that in an insurance model.

13:07

In a lot of cases, the patient goes, yeah, do whatever

13:09

you need to do. As long as my insurance covers it.

13:11

We hear that a lot, but if it doesn't

13:14

cover, you actually have to give

13:16

them a valid reason why you're doing it. And if

13:18

you do, they're going to follow through. What

13:20

about. Sales of pillows, sales of supplements.

13:23

Simple things like that. Those

13:25

are things that are not covered under insurance. Do you think

13:27

that if you have a question, do

13:30

you think of a patient comes in with a cervical

13:32

problem and I'm going to put them on cervical decompression

13:35

and I'm also going to sell them a cervical pillow? Do you

13:37

think those are things that are unnecessary?

13:40

Or the things that just aren't covered by insurance.

13:43

And so you have to look at it from that standpoint,

13:46

but it takes time to

13:48

explain that to the patient. And

13:50

you actually, so now I've added

13:52

in more cash services. I've diversified

13:55

a little bit to where the patient isn't solely

13:59

stuck on what their insurance covers.

14:02

And I'm starting to wean that patient away. And

14:04

the other thing that helps wean them away is high

14:07

co pays. I like a copay.

14:09

I wish they were higher, honestly, even

14:12

better. Truth of the matter

14:15

is that's exactly how you start to balance

14:17

your practice. If you still want to dabble in insurance,

14:20

you've got to move into some cash

14:22

services. Yeah,

14:23

you have to balance yourself into a profitability

14:27

standpoint. And so again, it

14:29

sounds like we're. Saying you've got to go all

14:31

cash. We're not saying that at all. But if

14:33

you find yourself in this position where

14:36

you're really struggling with a good fee

14:38

strategy and communicating to patients,

14:41

the value of services

14:43

that may not be covered by insurance, give

14:45

us a call. This is one of the things we're teaching

14:48

chiropractic teams. Oh, to do in their

14:50

offices with huge success.

14:53

So there's a right way and

14:55

a wrong way. You don't have to. Ride

14:57

the trend to the bottom of the

14:59

barrel on pricing and value. There

15:02

is a way, and it's really

15:04

not hard. There's methodologies

15:06

where you can create great fee

15:08

strategies and this is, I'll

15:10

get off on that in just a second. Make me come

15:12

back to fee strategy. All right. But

15:15

there, there are methodologies by

15:17

which you can communicate

15:20

these things to patients and patients will pay for it all

15:22

day long. They just have to understand the value. I

15:25

want to remind you of a word called COVID.

15:28

Our clients during COVID because

15:30

of the strategies we were employing

15:32

and fee structures. And we'll talk about that

15:34

here in a minute, but because of the strategies

15:36

they were employing. In other words, we

15:38

were all out for patient care

15:40

at that point. Yeah, we were telling them

15:42

exactly what they needed to do, how they needed

15:44

to do it and the best way to shore up their defenses,

15:47

the best ways to make

15:49

their immune systems function, the best way they couldn't

15:51

just feel better practices. That

15:55

we're listening to what we were telling them to do were

15:57

exploding exploded. We haven't slowed

15:59

down. They haven't they've had well, because

16:01

they obviously at that

16:04

point realized what they were doing worked

16:06

and it was really

16:09

a super effective way to. To

16:11

get patients well, but they also

16:14

were listening because they were a little bit concerned

16:16

about COVID, but they, we had an

16:18

open ear to talk to them at that point.

16:20

People realize patients actually want to hear what

16:22

you have to say. If you're a voice of reason

16:25

and an expert, they're going to listen to you.

16:27

Absolutely. So back to being their leader, those

16:30

are the things that you have to employ.

16:32

When you are going to employ cash services

16:35

or become all cash, you really have to become

16:37

the doctor that they want to listen to. You

16:39

have to become

16:40

the authority. You do. And that's such a great point.

16:42

And I want to go back to this idea of fee strategy

16:45

for a second, because this is so important because

16:47

this is another one of those crazy trends

16:49

that we see. We see doctors

16:52

arbitrarily setting their fees. Arbitrarily

16:55

setting their fees. So they're setting them sometimes

16:58

to what the insurance company

17:00

reimburses. The insurance company reimburses

17:02

me 23 for nine, eight, nine,

17:04

four. Oh, so that's where I'm going to set my fee. No,

17:09

that's not a correct fee strategy or

17:11

we see doctors say everybody else

17:13

in my community, all the other doctors are charging

17:15

49 for an exam. Okay.

17:19

That's so random. I can't even see straight.

17:22

You have to tie your fee strategy back

17:24

to a couple of things. One,

17:26

what's patient tolerance as far as a

17:30

relative value goes and

17:32

what are your profitability points? And

17:35

this is the crazy thing that nobody's

17:37

looking at. We do with our clients, but

17:39

nobody's looking at this whole idea

17:41

of profitability. We're still stuck

17:43

on these old statistical models.

17:46

Here I go. I'm getting on my soapbox. We still get

17:48

stuck on these old statistical models of services,

17:50

collections, new patients, patient visits,

17:52

and PVA. And

17:56

we think that as long as those

17:58

are cooking along, I talked to somebody

18:00

the other day, he was all,

18:02

big chested kind of boasting about the

18:04

fact that they see 80 page, 80 new

18:07

patients a month. Okay. Great

18:09

number. Give me some relativity to it.

18:11

How many do you retain? And

18:13

his retention was 29%. Oh,

18:16

wow. So really, when you think about

18:18

that, call it 30%. Do the math.

18:20

So they're holding on to 18. If I did

18:22

the math, right? 20, sorry, 24

18:25

holding on to 24 patients a

18:27

month, new patients a month, but

18:29

they got to see 80 to do it. Who's

18:31

working too hard? And

18:34

the reason why they're seeing 80 new patients is because

18:36

they got a 29 deal. Okay.

18:41

Out of 80 patients paying 29.

18:43

I don't have a calculator right here

18:45

in front of me, but it's what? 2,

18:48

400. Maybe if I did the math, right? No. All

18:50

right. Everybody just told your horses, I gotta do this.

18:53

Usually I can do this in my head. Yeah.

18:55

It's 2, 300.

18:57

Okay. Yeah. You saw 80 patients who paid you 2, 300

19:00

who most of which will never be back, which

19:03

means most of what most of them are going to go

19:05

out and say bad things about your clinic. And

19:08

you're left with 24 patients

19:11

who might stay in care for a few visits

19:13

because some of those are going to drop out too. And

19:17

did you really make any money? No, all you

19:19

did was work hard. And so now you've created

19:21

a Ponzi scheme on yourself because now next

19:23

month you've got to get 90 new patients. And

19:26

the month after that, you've got to get a hundred just

19:28

to try to keep a little bit of that cashflow

19:31

coming in and get enough people to filter

19:33

out of the bottom, to stay into care

19:35

for a while that they actually become

19:37

profitable, which I'm going to tell you in today's

19:39

world with our rising population. Awesome

19:41

things is probably the fourth or fifth

19:44

visit before they become profitable.

19:46

If you brought them in for a low price, first day,

19:49

take it away.

19:50

And that is such an old

19:52

mantra that was

19:55

a coaching mantra

19:57

from years ago. We're talking eighties

20:00

and nineties where it was all about new

20:02

patients and PVA, new patients and PVA.

20:04

And I can remember, I'm going to date myself,

20:06

but yeah. And you too. Yeah.

20:08

We used to coach

20:10

this. Absolutely. We thought those

20:12

were big time numbers.

20:13

And then one day as we saw patient

20:16

mentality start to change, we

20:20

saw that wasn't necessarily the right way to

20:22

look at a business anymore, especially

20:25

when everybody around you in the profession

20:27

was diving to the same bottom of the pool. Yeah,

20:30

30 years ago, you might be the only one in your

20:32

community doing a 29 deal and

20:34

then you'd stop doing it and maybe another guy

20:36

would do it or chiropractor shouldn't, sorry,

20:38

I don't mean to be sexist, and then another,

20:41

we would take turns, but

20:43

today everybody does it all the time.

20:47

Yeah, you just basically look at

20:49

it from that standpoint as well. And what

20:51

did new patients in PVA tell me? They

20:53

don't tell me how profitable I am. And quite frankly,

20:56

the bottom line is that, if I get to the

20:58

end of the year, I'm not looking

21:00

at month by month numbers. And every month

21:03

I start over again. I

21:05

like year to date. I like year to

21:07

year. That's how most businesses look at themselves

21:09

year to date, year to year,

21:10

right? We start over every month. Yeah.

21:13

And so if you might as well file a 1040

21:15

every month.

21:16

So if you had, let's say it comes to December

21:19

and you've had just a banger year,

21:21

but you get to December and all of a sudden you're down on

21:23

new patients, you're down on yourself. You

21:26

don't feel like your practice is doing well. And

21:28

it's. You're trying to figure out why there's not enough

21:31

money in the account. If you would have started at

21:33

the beginning of the year, looking at profitability

21:35

and looking at, okay, you know what, this isn't

21:37

necessary. This isn't necessary. I can get a lower

21:39

price on this. Let's streamline

21:41

the staff. Let's make sure that we're doing

21:44

all the right things. And then let's make sure

21:46

that the service or the product that we're

21:49

providing to our patients is top notch.

21:51

Yep. Then guess what come about December,

21:54

you're looking year to date. You're like, we're blowing it

21:56

out of the water, even though it's December

21:59

and everybody is trying to leave for Christmas

22:01

break and they're doing this, that, and the other, maybe your new

22:03

patient numbers are down, but you're standing

22:05

there with a smile on your face going, we

22:08

killed it this year. We helped so many

22:10

people. It's

22:12

such it's literally that

22:15

thought process that takes you from

22:17

being down in the dumps come December,

22:19

January, February, some of the worst months in chiropractic

22:21

usually to really looking

22:24

at it from a standpoint of how

22:26

did I do this year and how am I doing in comparison

22:28

with last year? That's

22:31

what I like to look at. I like to look at where

22:33

I'm at and I like to look at my profit

22:35

because the bottom line is I'm not going to retire

22:37

on new patients.

22:39

Oh, gosh no. Retire or retention. Yeah.

22:42

Yeah.

22:42

You retire on retention and you retire

22:44

on the amount of money that you have in the bank.

22:47

And I'm not trying to turn this into a money conversation,

22:50

but we are all in this as a for

22:52

profit business, right? We're not

22:54

non profit. So it's not a dirty word to

22:56

talk about making some money. So

22:58

if I'm going to retire on something, it's going

23:00

to be on profit. It's going to be on that retention

23:02

of those patients. It's not going to be on new patients

23:04

and PVA.

23:06

Exactly. I can.

23:07

I could fix my PVA. I'll just quit

23:09

seeing new

23:10

patients. My PVA is going to go through the

23:12

roof. So

23:15

you bring up another trend here

23:18

that I think is interesting. We're a profession

23:21

that has very, we're very short sighted.

23:23

We look at 30 days at a time, 30 days,

23:26

30 days, 30 days. So I

23:28

just want to pose a question. When are we going to start looking

23:30

forward? When we, let's

23:32

just look forward 30 days, not backwards 30

23:34

days. Let's just look forward 30 days.

23:37

What does your practice look like in 30 days? What

23:39

does it look like in the next quarter?

23:41

What does it look like in six months? What does it look like

23:44

in 12 months? And here's the answer. 99

23:46

percent of you are going to give me, I have no

23:49

idea. And that looks

23:50

horrible or it looks horrible. If you

23:52

know how to look at it and see

23:55

it, it looks horrible. And I'm not going to tell

23:57

you. How, but

23:59

I can show you how that scares the bejesus

24:01

out of me. Oh, yeah, it

24:04

really does. What business

24:06

does that

24:08

none that I'm aware of that are profitable

24:10

usually. And so I think sometimes we're

24:12

profitable just by chance.

24:14

Yeah. So this is one of the things that we're turning

24:16

around for our clients and

24:18

I'm not necessarily trying to make it about cats, consultants,

24:21

cats, consultants. com. Come check us out. I'm

24:23

trying to make it about where you need

24:26

to be looking. And if

24:28

we're talking about trends, if your trend

24:30

is to never forecast where your

24:32

company, where your business is going, that's

24:35

crazy. Do you think Walmart doesn't forecast?

24:38

There's a reason why they make, what is it? 28,

24:40

000 in profit a minute. What

24:43

do you make a minute? You can only tell me

24:45

what your history has been, not your future.

24:47

You don't have a way. Or

24:49

you haven't created a way to forecast

24:52

it going forward again, this is one

24:54

of the things we're turning around for. A lot of our clients

24:57

is forecasting forward. And I'm telling you

24:59

it's a game changer when you start

25:01

looking out instead of back.

25:04

And that's a trend. This looking back

25:06

is a trend that we've got to get away from. We've got

25:08

to start being entrepreneurs. And

25:11

looking forward, you mentioned retirement

25:14

and we need to have exit strategies.

25:17

Now, I do think that's a trend

25:19

we're starting to see improve

25:21

because we're starting to get more and more calls from people

25:23

looking for help building exit strategies,

25:25

which we do. But

25:29

let me ask everybody out there listening. Here's another

25:31

question. What's your practice worth? 99

25:34

percent of you are going to tell me, I don't know, or you're going

25:36

to pull up an arbitrary number of what you think you want

25:38

for the practice, which is not the value.

25:41

How many of you actually put the value of your practice on

25:44

your balance sheet every year? So you can actually

25:46

see what your net worth is. Very

25:48

few of you, again, this is

25:50

just a crazy trend that we've

25:52

got to get away from. We've

25:55

got to be true business people here.

25:57

Yeah. That's a little tip for you right there.

25:59

That should be on your balance sheet every year. It's

26:02

not a wait until I'm ready to retire.

26:04

And then I'll figure out what it's worth strategy.

26:06

Shouldn't be there. No, it shouldn't be that way.

26:09

You should already know. So that way, when you're getting close,

26:11

you have a very good, rough

26:13

idea of what your practice is worth before

26:15

you ever get to that point.

26:17

We just had a big live seminar with a whole bunch of doctors

26:19

there. And we talked about the. the dangers

26:21

of the natural bell curve of

26:23

practice life and practice value. And

26:26

you've got to understand what goes into

26:28

that and how to maintain

26:30

control over it. So that's a trend I would

26:32

really like to see happen in this profession. We

26:35

see far too many doctors struggling

26:37

financially. We see far too many doctors go

26:40

under because of poor financial

26:42

management and not Actually

26:45

building a business that has the ability

26:48

to create long term wealth

26:50

for you as the owner. And then isn't

26:52

that really your goal? And I know a lot of you are going

26:54

to say, no, my goal is to, see a lot of people

26:57

and I don't disagree with that. As

27:00

put my doctor hat on my doctor hat, my, my

27:02

goal with my doctor hat on and

27:04

he can say, I have my scrubs on today is

27:08

I want to help as many people regain

27:12

their lost function. As

27:14

much as possible, but that's my doctor at,

27:16

but at some point I got to take my doctor hat

27:18

off and I got to put my business hat on and

27:20

my business hat is I want

27:23

profitability to the point where I

27:25

create long term wealth for myself and my family

27:27

and my employees period. End of story.

27:30

That's a trend we need to create.

27:34

Yeah, and that's 1 that

27:36

unfortunately, so many people that

27:38

we talked to can't even see. I

27:40

know and it's easy to strategize.

27:43

It's easy to put it together, but you

27:45

have to be willing. And you also have to put the mirror

27:47

on yourself a little bit, point

27:50

it back at yourself and see if you're still breathing.

27:52

Yeah. That's part of the introspective

27:54

strategy. And that's part of what we use.

27:57

You have to be willing to

27:59

accept. Your responsibility

28:02

in this, whether that means that you've held yourself

28:04

back or whether that

28:06

means that you need to do some things to push yourself

28:08

forward, or in some cases, a

28:10

little bit of both and a little bit of, hey, you've

28:12

done a good job in these areas, that's

28:14

our part of the job is to

28:17

do an auditor and assessment of what

28:19

you've got going on to see where

28:21

you need to head. Because if you don't have

28:23

a road map, it makes it really hard

28:25

to move forward, and that road map

28:27

sometimes changes because you and

28:30

I are constantly talking

28:32

about, opportunities and things that we're doing,

28:34

and we're constantly veering around doing

28:36

changes in the road map. But it's one of those

28:38

things where we're constantly trying

28:40

to make changes for improvement,

28:43

and it's because we're constantly looking forward

28:45

what. What's going to happen to chiropractic

28:48

six months a year, five years down the road,

28:50

we're always innovating. And

28:53

yes, we're disruptive at times because

28:56

here's what we've learned by

28:58

the time everybody's doing the same thing.

29:01

You should have already been going in a different

29:03

direction. So you've always got to be

29:06

ahead, not behind these trends

29:08

that we're talking about. You've got to be

29:10

out there blazing the trail of the new

29:13

trend, the new innovation, the

29:15

new strategy, the new tactic, whatever it

29:17

might be. We've got to start looking

29:19

forward, putting that entrepreneur

29:21

hat on and becoming true business people

29:24

with our practices and

29:26

becoming leaders in our community. And

29:28

I'll get off my soapbox. And

29:30

you also have to look at that bell curve. We talked about

29:32

that a little while ago. You have to figure out where

29:35

you're at on the bell curve, because just like you said

29:37

earlier, you would struggle to see a thousand

29:39

patient visits a month right now.

29:41

Yeah. And I used to do it all the time. And

29:44

you did it with ease

29:45

with it becomes much more challenging

29:47

as we age. Unfortunately,

29:50

I can tell you for a fact, it's much

29:52

more challenging. And I can tell you

29:55

at age 58. I

29:57

have to employ better strategies. So

29:59

I'm constantly looking to see, okay,

30:02

what are the revenue streams that I can create,

30:04

not just in chiropractic, outside of chiropractic

30:07

with my investments, where am

30:09

I right now and what is my end

30:11

goal? And is there a way that I can actually divert

30:14

a little bit of the stress away from

30:16

my practice? Because I know

30:18

that I'm going to get a little bit of drop off. I have to be

30:20

aware of that. I have to be honest with myself

30:23

and go, you know what? You're not going to go

30:25

in and see the number of patients you're

30:27

seeing when you're age 30 at

30:30

age 70, you're not going to continue. It

30:32

doesn't do this. You're going to go.

30:34

No, you're going to start to go off,

30:37

but if you plan correctly, maybe

30:39

your patient visits drop down as

30:41

you get older. Exactly. But your profitability

30:44

doesn't have to. If you

30:46

plan right, this goes

30:48

back to the correct fee strategy. This goes

30:50

back to not being sucked into

30:53

completely sucked into the trap. Oh,

30:56

okay. Maybe that's the wrong way to put it being in

30:59

a position where you're just writing the wave of

31:01

reimbursement down the slope and

31:03

not creating other profitability in your practice

31:06

and not diversifying those income streams.

31:08

These are the things you have to think about today

31:11

because I don't know about you,

31:13

but the world's not getting less expensive.

31:16

No, it's not. And some of that could be

31:18

involved. If you've got multiple income

31:20

streams or multiple different entrepreneur,

31:22

if you're an entrepreneur, like some of us are

31:25

you may have an opportunity to even, when

31:27

you're trying to create a situation where you,

31:30

maybe you're starting to drop off in numbers a

31:32

little bit, maybe you're able to divert

31:34

staff to. One

31:36

of your other entrepreneurial ventures. That's

31:39

not always the option that you have. Some of your just

31:41

in practice, but you have to look and be creative

31:43

and go, you know what? I've got an absolute

31:46

star that works for me.

31:49

Why don't I convert that person? He

31:51

or she over here for 20 percent

31:53

of their time to reduce it. There's so many

31:55

different ways you can look at things, right?

31:57

You can look at a smaller, smaller physical

31:59

plant. You can look at. Changes

32:02

and hours that might affect, there's a lot

32:04

of things,

32:05

a lot of things you can do, there's a lot of things

32:07

you do and get, get diversified, look for

32:09

opportunities. You and I are incredibly well diversified

32:11

and have our fingers in several different

32:13

things, but, um, get,

32:17

just open your eyes, take that doctor

32:19

hat off a little bit, look up, we're

32:21

always looking down, look up a little

32:23

bit and find the opportunities and the opportunities

32:26

are not in the old trends that are

32:28

pulling everybody else down. Okay.

32:32

What do you think? Yeah.

32:34

I think we did great. The only thing I'm going to add

32:36

to this is when we talk about trends, I'm talking

32:38

about trends in marketing and that sort of thing,

32:40

when you look at trends in chiropractic

32:43

care, sometimes what I see

32:45

is we get gimmicky and

32:47

we're looking for the next greatest latest shiny

32:50

thing. Oh, we're

32:52

so attracted to the shiny thing.

32:53

I think sometimes that

32:56

the, that we forget that

32:58

the bread and butter that

33:00

we started with those adjustive

33:02

skills to, to lay hands on

33:04

people and get them better are

33:07

a trend that you may want to make

33:10

a circle and go back to because

33:12

they're very effective and you know what patients desire

33:15

it, I get that they like the shiny

33:17

things, but that's going to wear off the

33:19

actual chiropractic adjustment has lasted

33:22

a hundred years. Plus,

33:24

I'm aging, I'm dating myself because

33:27

it was a hundred years quite a while back,

33:30

maybe a couple of years ago, but anyway,

33:32

we're well past a hundred years now, but

33:35

the truth of the matter is the adjustment was important

33:37

then and it's important now. And

33:39

so sometimes trending means

33:41

remembering what made you profitable to begin

33:44

with. The Paisa form has been profitable

33:46

for 129 years

33:48

and it will be for another 129 and

33:50

more. Yep. Yep. Good

33:53

point. Good point. All right, everybody.

33:56

Keep keep tuning into the KC CHIROPulse podcast

33:58

brought to you by Kats consultants and Chirohealth

34:00

USA. Be sure to subscribe wherever

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34:05

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com. Check us out. There's free downloads on

34:09

there. Listen to the podcast every week

34:12

and we appreciate everybody listening.

34:14

And remember, if you want to talk about

34:17

your practice, if some of these things that we talked

34:19

about today, ring a bell with you

34:21

and you want to talk about it a little bit more, go to the

34:23

website. You can schedule a breakthrough call with

34:25

us. Let's talk about your practice. We do those for

34:27

free. Cause we care about you guys. All

34:30

right, everybody. Thanks for tuning in. We'll see you next

34:32

time. So yeah.

34:34

Pat's Chiropractic Consultants,

34:36

your partner in chiropractic success.

34:39

We are dedicated with one on one guidance

34:41

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34:44

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