Creating Effective Wellness Plans That Patients Will Follow

All right well hello everyone and welcome back to Chirocast the podcast by

chiropractors for chiropractors I am Dr Stephanie Brown and I'm Danielle Habinz

We’re so glad you're tuning in today because we're tackling a challenge every chiropractor faces at some point how to

get patients to stick to their wellness care plans yeah that's right so it's one thing to recommend long-term care but

it's another to get that buy in and build a lasting follow through so we're bringing in someone who has really

mastered this at his own practice Dr Ron Sims of Back to Health Chiropractic

yeah dr sims has built Good good how are you doing well um Dr sims has built a

thriving wellness focused practice where patients actually complete the care plans he creates and they come back for

more so today he's sharing his approach his tools and some real world examples that you can take back to your own

clinic yeah so let's dive in um Bronn if you don't mind if you could

just tell us a little bit about yourself maybe start with why you became a chiropractor and what your practice was

like when when you first started yes gosh um like most of us I got

injured playing sports in college had never heard of the word chiropractic and thankfully the gym I was working out at

had a lady chiropractor come in and do a spinal screening and check my spine out

and put me on an old fashioned machine called a SAM it was a spinal analyzing

machine it showed how crooked I was showed how uneven my weight was I was like 15 pounds more on my left side I

was a wreck and then she did these cool things called adjustments on me I was so

intrigued and I went to work for her part-time just to get in the middle of that because I was thinking that maybe was

the direction I would go in I was premed don't ask me why but um it was kind of

through my own experience so then I had a great associate ship down in Long Beach California with Dr Gregory Jud

amazing mentor taught me so much about chiropractic uh the philosophy the art the science and really got to kind of

learn early on in my career how to uh set up processes and systems so that I

could be successful in helping people reach their health goals and so that was kind of how it started then I moved to

Northern California where I was originally from started my own practice as the primary lead doc and that was in

1996 I’m dating myself here so now I have two locations I have four

associates I have an amazing team and I work equal amounts of time on my

practice as I do in it uh so I've learned to create balance so I could be

the leader that my practice needs them to be and so that our practice can be vibrant because I realize I can only

help so many people with chiropractic I physically am limited as a human being to only handle so much in a given week

and when I was doing that max load I looked around and realized the impact on

the community wasn't really what I had hoped it had would have been because one man can't do it all and so that's when I

began to figure out and be able to build a team and now our community we're able to help two communities now to a much

greater scale than I ever could have as an individual practitioner by myself so that's kind of been my journey and it

definitely ties into today's conversation so I'll let you take it from there but yeah I think there's a

lot that we can unpack there um so let's just dig in this is going to be kind of

broad but could you answer in a I don't know

succinct way even though there's so much involved here but how do you create a wellness plan that a patient follows

yeah that's great well in our practice there are two phases of care that

someone has to go through first before they slide into this wellness care it's

an often for us overutilized term what does that really mean you know um is

that preventative care is that maintaining care you know what does that really mean I guess is the first thing

and the second thing is for us most of our clients come in in crisis not too

many folks show up unless they moved to my area and they had a great chiropractor where they came from come

into my office and say "Hey I'm here for wellness." Usually they come in with something they don't want and they're

hoping we can help them and so it's really a challenge to take them from that over to this concept of wellness

and so what we're really good at I think is we have really good systems really good communication strategies

where we really kind of unpack that and reverse engineer that for people and

like we say in our practice when we take on a new patient we have to make sure that their goals meet what our

exam findings might require if there's a big disconnect between what they're expecting and what their goals are and

what you think you can deliver on based on your exam then you need to not go

into a relationship there that's in congruent you're asking for trouble you'll never get them to wellness now

for us we often take them through a journey in how we educate on day one and two we don't adjust on day one so on day

one it's all about discovery curiosity they're usually curious there's even a lot of scarcity because we want to be

authentic and transparent to tell them whether or not we can help them you know we have to be more transparent and more

upfront with them as chiropractors to say "Yes I can help you but here's the degree to which I think I can." You know

versus overpromising and underlying that's why we lose people as well and so then you start them off on at least for

us an intensive protocol but I always sell wellness care to them upfront on

day two and then I back off of that and for me to accept them they have to

say yes to lifestyle chiropractic like what you ultimately need once you're through this crisis once you've resolved

this and corrected it and you have a lifestyle built around it that helps it keep it under control then you're going

to move on to wellness care and that's where you just continue to follow these principles and you maintain your wellness that's how it works so for us

it's four months of stabilization care or we call it intensive care getting them out of pain getting them to where

they can even do some exercises then getting them to get great results at your re-exams you got to do re-exams it

can't just be subjective tableside you got to stop and measure stop and measure stop and measure um that's the best way

to keep people engaged to what their findings were because if it's subjective

they're going to be a flight risk when the pain goes away they're not tied to their condition anymore and so on so

forth so for us it's that four months to calm them down get them teach start teaching them start educating them we do

active care and corrective care so we usually do another 12 months of corrective care because I feel like

we're really good but we can't correct an adult in four months um that has a chronic spine condition from a computer

lifestyle and old car accidents we just can't so we have to be authentic and we have to be real with them we have to

tell them look this is a 16-month process to get to wellness care then it's a lifestyle and so that's how we

sell it and we have a really good conversion rate because we do these you know touch base points of objectivity we

use subluxation station and then we rex-ray periodically because we do um

corrective programs where we do modified u petty bone and stuff like that so we literally mean it when we say corrective

care got it that was a long answer you told me to do a short answer no that's all right that's maybe it's short for

you I don't know um so you did mention something really important I think there and that was your re-exams and I know

that was in the context of those first four months or the second phase of care as well but once someone is beyond that

and will let's say they are in that wellness plan or that wellness care plan

um do they uh do you do re-exams on your actual wellness patients and like what

does that look like because I think you are alluding to this but it's important to keep educating them as well even

after they're already in wellness and and a picture paints a thousand words so we do annual exams we have lettering

systems for them um you know R1 is kind of date or is kind of report

of findings is the kind of commitment r2 is time commitment r3 is financial

commitment for us r4 is the four month transition from the intensive phase they

signed up for into that continued corrective phase key re-exam for us there we actually sit down for 30

minutes with them after that re-exam and talk about where they were where they are talk about what are their next steps

we recclarify goals often because they're better than they thought they would be then every 12 visits in our

practice and by the way for us wellness is once a week for us maintenance is twice a month uh some of my clients can

only get every two weeks but they're kind of a wellness person so you know those are loose terms that fit together

in our practice but we have titles for the type of care now the other thing we

do is we do these annual more intensive exams where we would then do X-ray again

we do posture studies we always do palpation range of motion and then we do EMG thermal scans and pulse way profile

we have a person in our practice trained up somebody you maybe can't afford an associate but maybe what you should do

is what we did and that is train up a new patient concierge position that can handle these re-exams for you so that

they don't pull you out of the adjustment area and you have to go from this to that it's hard to go from clinical exam mode to adjustment mode

and so a new patient concierge does not have to be a chiropractor you can train them really really really well as we

have and my new patient concierge people mistake her for being a chiropractor she's like so smart and says all the

right words and anyway just helps you as a practitioner stay organized so you can stay in flow but then it's important to

go over the results of the re-exams and then also add a questionnaire with the re-exam it's a great little thing it's

unbelievable tool and it could be what level of subluxation did your x-ray show when you first came in or what are some

things at home you need more help with or what could I explain better to you now that you're at this stage of care

these questionnaires progress as they progress so they get a little bit more forward thinking or and then I always

review it so I'll do the re-exam on visit 12 then on visit 13 when you come in I do a tableside review at my

computer where I pull up your scans and I go over the objective improvements and I only in our practice we only

change care plan or um weekly frequency based on objective improvement not subjective improvement we have to be

objective um that's just the way our systems set up so you only move to the next phase of care when your objective

improvement is at a certain level now often objective and subjective are pretty close to each other but not

always and so we have to be careful there and so then these annual exams we would go deeper it'd be more of like

when they first came in it would be x-rays and maybe another layer of objectivity and then that re or that

report is more private in the office like day two would have been whereas the other along the way re-exams we do a

quick little cursory review tableside hey you're on track you're doing great still an issue there still an issue

there I want you to tighten up your exercise there I want you to start you know we talked about the food and the inflammation you got going on there you

know let's really work together this month to get to that next re-exam and um I'm excited for because you're way better than you were and so that kind of

stuff and then we just keep them engaged you know I feel like chiropractor's table talk is so lz fair and so these

objective kind of benchmarks are so critical to keeping their left brain

engaged because I mean every chiropractor on this call has those

relationships that you're like what happened to Mary I thought we were bffs

she told me all about the details of her relationship her vacation and you be try to become Mary's friend and you stopped

being her chiropractor I’m not saying don't be friendly and there's going to be certain patients that you click with

more than others I get it but yeah and you always want to build rapport with people too

you got to be careful I think the as I'm listening I think the common denominator

here and what's working for your practice is patient education and patient engagement you never want them

to stop learning but I also think humans are we're visual we want to see

those improvements over time so that constant reaffirmation from the

chiropractor you know how things are going and you know what you're you know you know what you're getting when you

walk in right um and ide like ideally you want your patients to become

evangelist patients they believe in it yeah you're right and by doing it the way we do it they go from

seekers they're seeking chiropractic like maybe this will help me we get a lot of people in their mid-40s who've

never been to a chiropractor shocking uh young people are turning to it quicker which I love but you know in that

relationship is really understanding their love language and how they are how

they think and then to take them from a seeker to a believer is usually rooted in results so if I get good results

Danielle you're going to believe in me right okay and now all of a sudden you're I I think we miss a step we

expect her to be like an evangelist for me and I haven't done enough to get

you ready to be good at that and so for us it's table talk we do a lot of workshops because we want to take them

from believers to understanders so they can understand chiropractic now and they can understand the role it has in their

life and they can understand the role that their own stresses have on their subluxation patterns so we start taking

them to a new place of intellectual understanding about how the body works it's really fun but that doesn't happen

overnight you can't change somebody that quickly paradigm shifting takes a while and you got to do it you have to be

thoughtful and it ties into wellness plans it really does and so you know then you take them from um you know from

believer to understander then my favorite is you can call it a couple things advocator influencer so now not

only are you somebody who believes in chiropractic and I always try to downplay the person involved like our

team we're super transparent like no it's chiropractic that's made the difference and your body heals itself

yeah I think we're pretty good facilitators I think we're good caregivers but you know we don't want to get out of order and get all puffy and

get an ego chiropractic clinic going so that's why I like multiple doctors because hey go see that one I don't take

it personal um and so anyway then that that advocator they're fun because now

they're better than I am out in public because doctors tend to get all sciency

because in a way we have some insecurities rooted in well I want this person to know that I'm super smart so

when I'm talking out in public I'm like no you know I'm I'm Mr. smart Guy right whereas me I just dumb it down and

my patients that are advocators they speak in a language that people get you know I don't know I had this bone

misplaced and it was affecting the nerve he went to my throat and you know it was believe it or not connected to my swallowing it was really weird or that

ringing in my ear and he did a couple things and taught me some stuff and it's just changed my life that's all they got

to say and then they're going to go who is that guy again it may not be till three months later when they're doing

yard work and they're like what was Bill's chiropractor he was raving about at dinner the other night I think I need

that guy you know and that's how it kind of happens but um I feel like we get too friendly and we forget our mission

our mission is to change our communities not to make bunch of buddies and um you

know again we love our clients you love your clients but anyway you mentioned to

um I don't know I think you might have said workshop but I was curious like do you guys just have one do you have

multiple different ones that people can come to is it required to what extent do you really require it because I think

that's one thing too chiropractors are afraid to do is like is require things essentially so I mean you're

requiring people right out of the gate to understand like this is what we do here and if you know if you want to

work with us we want to work with you and you lay it out so they have an understanding of what to expect um sorry

side note but I think that's really important too you know some like a Cairo might tell somebody you know you have

this acute thing going on you know three times a week for three weeks twice a week for two weeks once a week for one

week or something but they're not laying any foundation or groundwork for what happens after that and then the patient

becomes totally surprised when it's like okay you know here's the idea of

maintenance or wellness it's just comes out of left field so I think pre-framing that is important but yeah I wanted to

get back to your the workshops or whatever you guys call them and what that looks like in your office that's a

great qu a great thing to talk about because again it all ties into wellness um compliance right you know it's one

thing to have I want a wellness practice but I want people who are compliant who are showing up their paying and they're

referring why because you've been their serpa you've been their guide and that

started on day one when you had that empathetic connection and you actually did something quite remarkable that

they're not used to and that is you listened to them and you interviewed them and you took the time and didn't do

it on the fly and you onboarded them properly by educating them we take their story in first quickly three five

minutes don't take any notes tell me your story why now why are you coming to the chiropractor today like

why not a month ago or why didn't you put it off longer you know and then then we get through that and then we get

to their then I tell them briefly about who it is we are and what we're looking for in this day one process and I feel

like we don't preframe things enough so I'll preframe how our visit's going to look to you and I get your story first

because I want you to know I I'm I care and I've already toured you in my office and we do a Socratic tour we we always

say we want you to you're on a journey of 100 yeses when you sign up for a new

patient appointment you said yes you showed up that was another yes then I toured you in every stop on the tour my

kids area my active care area my active seat area my adjustment table area my exam area my report area my wall of fame

testimonial area I hit every stop and explain to you what this is all about

and then I stop and go do you hear me are you tracking because I want those yeses yes wow they're excited I know you

worked on kids that's crazy want to hear more about that later you know seed plant seed plant seed plant and then I

get into the back this is we're going to spend our time together today we're going to get to know your story and and

then it's at that point I'm going to say why now and then it's at that point I'm going to say what type of chiropractic

were you under was it only for crisis were you on wellness so I really want to know just because it was Cairo does it

mean it's the same as your office no maybe not you might have some real If you don't ask that question I mean that's that's a lowhanging fruit

question and then I always edify referrals man people don't do that enough um I got referred to a new um

biological endodonist and when I walked into their office on this cool sign it was really neat it was kind of it was in

a beautiful area and it had my name like big like welcome Ron I’d never met them yet I was like wow that was really a

cool touch it wasn't a hippo violation people love seeing their name the board

wherever it is mhm you're like so our day one our day two then day day two's

report then the mandatory thing is they do a better results faster workshop on

visit three that we pre-tape it's a 15minute video so they have to watch it like you you can't come in sorry built

in it's built into their care do they watch it in the office or do you send it to them or uh they watch it in the

office on visit three okay so this part of their visit though you're not asking them to at least for this one to come in

at 7 o'clock on their only one live a month and we like that as a as it

relates to educating a bigger crowd of people we'll bring food in and we'll do a big one a month for each office

because it it it serves a lot of purposes for us fun people want to get out and have a free meal and I go invite

your friends and family people that are in your group that you think would benefit from hearing information about health and wellness and staying

injury free and who doesn't want to know more about that and then the other thing for me in that is it's just better but

the the ones that are the type A person we make them watch a video and it's

really good it's quick and then we ask questions at the end and we have a quiz so they take a little quiz then they vi

visit three they set up all their appointments we map people out and that's if you're not mapping people out

you're not going to have a wellness practice you got to map people out chairoach makes it super easy to set up your mapping and your care plans um

there's multiple ways to do that within the software um I mean we we leverage that on the cloud quite effectively uh

and but back to that workshop we also do advanced workshops we've pre-taped a lot of them because we do a lot of move well

eat well think well biohacking we're we're pretty pretty straight principal chiropractors that

believe in teaching people about lifestyle because we know that's why they're subluxating their spine so we

need to come alongside them to say "Look you're the problem you know not that little car crash you got in you were a

train wreck going into that you know and that's why it had such a big impact on you." And so it's important we teach them all these in these steps because

once they start feeling better they're going to lose sight of that and by the way when they first come in we always say it's the elephant you're talking to

not the writer but down the road you're talking to the writer the elephant's emotional I’m in pain I’m hurting it's

not the time to give them a dissertation on their x-rays do you go over them yeah high level do you explain to him you can

help him yeah high level now if you got a left brain engineer and he wants all that then you let him have a little bit more than the next guy but on the

average client don't overwhelm him just tell him you can help him and lay out that spend most conversation on what

you're going to do for them and I explain every visit to you here's what your normal visit's going to look like

it's three to five minutes is all we believe in the power that made the body can heal the body I’m going to remove interference your body's going to do the

rest and we're not going to overtreat you we're going to often the less we could do the better and so we explain

that very clear to them this is how you check in then we're going to do these re-exams and this is what that looks

like then we're going to have these reports we sit down with you then as you get better you're going to do more and

you're going to come in less and we're going to do this together there's a certain for you part

you can't do for yourself but there's a certain part we can't do for you and so this teamwork makes a dreamwork approach

is what's going to get you through the first four months at the end of that four months we're going to do a really really detailed exam again we're going

to compare you to day one so I guess my question to you is if you chose to do

nothing about this today and again this is day two and day 37 these key

transition appointments if you chose to discontinue care or if you chose not to start care what based on our

conversation and what you just learned today what do you think's going to happen to your underlying spinal

condition and by the way one answer to that yeah what would you say like it's

what do what do you hear when you were practicing a lot what were you hearing yeah they just they'll say it's not

going to get better or it's going to get worse yeah how many Cyros ask that question

and then the next question after that if you say well gosh it would get worse then I'm going to go well is that what

you want and they're going to go no and I go okay well I think we should start right away I’m not a procrastinator I

think it's time to get going it's been long enough so I'm going to have Sandy

come back she's going to explain the ins and outs of our care plan how the finance works how the schedule works we

need your I I need your commitment because I'm 100% in I need your mindset

I need your schedule and we don't work for free so she'll talk to you about that but we provide a great value and

it's we could charge way more than we do but you know I don't say that necessarily but I'm just saying it in

general it's my mindset yeah yeah let's touch on that I I know as you were talking you talked about mapping out the

care plan and it made me start thinking about you are there DCs that

unintentionally create care plans that maybe are too complicated or they're unclear to the patient you know could

cause roadblocks for that patient or the financial aspect um so how do what do

you do what do you avoid when you're presenting a care plan yeah and I think gosh you know how well you do day 37

care plan when they're don't the first four in my practice how well we do our annuals oh man day two and those key

appointments how well you do those how you do them socratically how you get buy in how and then those key appointment

conversations of if I'm only with you for five minutes you know it might be a little

bit about man the Raiders made a bad draft pick or whatever you know I agree

then I immediately go to talk and tell I talk about their spine I talk about different symptoms that might create hey

you're subluxated here at T6 has your stomach been bothering you lately that kind of stuff so I work through

explaining chiropractic every patient I don't care if you've been with me for 30 years your C2's off today you've been

having trouble with your sign you know every visit every day high volume for years I've done that and I always end it

with coaching every visit a leadership moment instead of like expecting your girls to have all the plates in the air

up there because I'll look on Chiro Touch it's so easy on the cloud click on their name boom there's all their

appointments should click on futures and past if I see less than four futures I'm not happy as a boss like our

next training or it's a patient problem and the front desk goes "This guy's so hard to he's so nice to you up there but

up here he's like I'll call you." You know so then now that I know that I provide an extra level of leadership how

often do you do chiropractors triangular conversations in front of your staff and the client at the same time so key it it

no spilt crumbs because if I'm in talking to Danielle about you doc about

what you need in front of you hey I want her to come in three times a week we're going to do a re-exam on the 12th we'll

do a tableside on the 13th let's set those up for now or that's going to be the first you know and then the then

we'll go to twice a week if you respond how I expect you to go you know then at visit 30 we're going to do re-exam every

12 visits and then on visit 36 we're going to shoot some new pics so it's really important that you follow through

on the active care because that's going to dramatically impact your um your corrective results on your X-ray and so

anyway you know all these nuances in there we get so LZI fair just on the given visits like cap it with leadership

walk to the front you can sense a flight risk right they're doing way better yeah

they're getting ready to go on vacation and sometimes they don't fly away on their own they just happens right they

feel better you did a great job you know so you go to the front hey we're transitioning into a critical and

dangerous stage of of care Danielle because you're feeling so much better and I'm worried about you overdoing it

because I know how your personality is so I want you to remember where you were a month ago okay so don't that's the

first thing is critical and dangerous because you're going to overdo it don't overdo it listen remember where you were

secondly is you're going to be more likely to miss an appointment here and there and that's going to set you back

just because you're feeling amazing doesn't mean you resolve the underlying condition the iceberg's still there we

just helped you get it below water so you're not really as disabled as you were two months ago are you with me on

this always end with a Are you with me it's disarming close to your patient you're close to them already are we on

the same page do you have questions for me are you getting ready to stop care I

said that to a guy the other day yeah have you ever Well I'm not I promise I’m like don't man

that's funny but the wellness plans are great ours we Okay let's just use an

example once a week so we have uh three menu options because we also do health

coaching in our practice if you're a practice out there and you're like gosh I want to coach them up so much more per

visit but then I got to charge more and I might price myself out of the

market or I can't spend more time with them so we created these health coaching

visits for those that need that extra level of guidance so we do our top tier

plan we have a hyperaric chamber too and we have long axis traction so you get four adjustments a month you get two

long access kind of preventative traction sessions a month you get one hour of health coaching with me a month

on Zoom or on a HIPPA compliant one actually um u

doxy.mme does I wonder do you guys have one built into the cloud I meant to ask that but we could talk about that later

but anyway then the the other thing we offer is we also offer um well that was

it yeah oh and just kind of the rules of engagement are they have to be on auto debit and they have to be mapped out for

their exams the whole year we map it out 12 months at a time six months minimum because we have a stat in our practice

that will haunt you as a practitioner and that is you should be 80% future

scheduled visits one month out so if I look a month from Monday our team checked out 200 on Monday so that's

kind of our average so in a month from Monday we better have 160 on the books

already and I looked this morning we have 130 and we have a staff training tomorrow so guess what's going to come up top of the list is hey mapping

because it just gets you get busy and you look and go "Oh I didn't map this person out." And that's how people slip

through the cracks they're feeling better you have to chase an appointment reminder by text and a week go by two

weeks go by yeah yeah and if they're on auto debit it's not like they're doing the let me stop at the desk every time I

leave kind of thing so yeah that's something like if you're going to have a practice like this you have to have

those systems in place to make sure that your staff or whoever's job it's going to be is watching to make sure that

you're not like if someone's approaching the end of their future scheduled appointments like at what point are you guys noticing that and then scheduling

more or whatever the next step auto debit continues whether you're into Well

that's the other thing we have a built-in system that we've created to watch for those credit balances because

next thing you know you John moved away and you have a $400 credit that you got

to write a check to John and too many chiropractors are taking prepayments and

they're using that to pay their overhead and their life and they're not putting in in escrow account what we do in our

practice we never accept more than one month of payment at once it just keeps the credit ledger list

manageable for those that slip you know some people just vanish right like where'd they go they were doing great

and they just high flake factor and you did the best job you could and they said all the things you that they should have

said and it just seemed like it was off to a great start then find out later they were just so amazed at the results

and they just stopped and that's just how they roll roll with their life you know and you just happen to collide with

them and and you did your best but now they're on auto debit and they got a $400 credit and they want that and your

team's like "Well you could keep that as a credit you know and start coming back in and but it doesn't always work." And then sometimes the doctor's got to call

and yeah did I let you down what's going on those awkward calls but I have some Cyros they get like two 3,000 at once

and so are they taking 1,800 of that and putting that in an escrow account and not touching it and only drawing upon

that when the visits are rendered system you can set up that's how you do it because then that's

required in some states too and a lot of people don't even think about what their state laws are or bother checking into

it so that's a really good point yeah so for us we try to keep that list low but

we'll give people uh discounts if we we we disincentivize people from paying as

they go so we always have some sort of package or plan for them mhm but yeah

and by the way for them to get health coaching hyperbaric treatment all those modalities in my office as oneoffs

they're saving dramatically but they're not saving on the chiropractic side we don't discount our chiropractic care but

we have two level two price levels um adult and senior citizen and we throw a

lot of people families like if you're coming in your husband we just put them on the senior rate to make your family work better but um we don't in

California we do some insurance billing and to be compliant with the insurance

laws every cash rate you have needs to have a billing code attached to it so

for instance 98941 whatever you charge for that that could be tied to your cash

rate you can't you can only discount them a set amount and you have to do it

for each of them if you do insurance billing so don't be out of compliance with that for sure um so two big

pitfalls people get into is huge auto debit balance of money coming in or taking too big a prepaids up month

upfront and then um missing out on helping people with just insurance details things like that

let's talk let's talk about that I I don't I think some people think they put wellness in a separate box from

insurance patients but there are lots of offices out there where your patients they want to use their insurance and

they want to become a wellness patient how do you navigate that year-over-year when insurance resets well technically

most insurances are for crisis care so they're going to give you limited visit offering um obviously Medicare

you're not supposed to do maintenance care but most Medicare people have chronic symptomatology so it's not really an issue but you know um but as

far as just regular insurance what we do in the report of findings on day two is we hopefully know all that by then

sometimes you don't unfortunately and we don't we're not a big biller we're out of network with most but we'll do like

Veterans Administration Medicare um again some PPOs out of state are great

uh we do personal injury med pay things like that but um even within all within all that on a on a cash patient or maybe

it's a hybrid of maybe you get 10 visits a year and you have a $30 co-pay but I

laid out a program for you that's you know maybe the first year it's you know let's just call it um 52 visits the

first year so we just will explain it to you on paper like hey you know you got 20 at or 10 at a $30 co-pay and then

you've got these 42 at our cash rate and you just lay that out for them up front so they know um you know sometimes you

the problem with insurance is sometimes you don't know the nuances until you get the explanation of benefits back right

you know because every carrier is going to have an allowed amount and no like PI is a good example no two PI med pay

payment schedules are the same you know every carrier seems to have their own reduction schedule allowed amount so um

so I think within that it's hard to sometimes get these care plans just right but at least give them an idea up

front like hey you need more than your insurance is going to cover now if they came in in December and it kind of sets

up nice for them to get 20 if it's a calendar year program then all a sudden they get 20 visits in the next two

months so sometimes they get lucky and that covers the more intensive part of

their relationship with you versus um and then you know going forward for that

individual you could kind of have them on a wellness schedule or a maintenance schedule which would be 26 visits a year

and let's say their insurance covered 20 so now they're going yeah over year now that I paid my dues and I'm on this

level of care um I'm only having to come out of pocket for six a year kind of thing so I think it's good to kind of be

able to if you have a hybrid practice where you're not pure cash or pure in uh pure insurance that's kind of how we've

done it and it works pretty well sometimes you get math is off and EOBS are off and you get patient owes money

or you owe money just got to explain that to them up front you know expectations and agreements things like

that I think they appreciate the effort too when you show them on paper like this is what we think we can tell from

your insurance this is what we think is going to happen and I think that they all because nobody trusts their health insurance company anyways they

understand when it comes back on paper if it was different like you still did the best you could um but Danielle to

address your question if someone has health insurance and they're like I want to use this but I have no complaint I’m

coming in for wellness care or whatever I mean I have done this in the past and I have them all like if I'm in network

with that insurance company I I have printed out their actual like chiropractic policy and I will show it

to the patient because it will say like we only cover this this is what that

means uh we define maintenance as X and we don't cover maintenance like in the insurance company's own words as soon as

I show people that like that helps it click a little bit better we'll have that conversation like you know when

they come in they have a cute thing going on or whatever that's what your insurance is going to help you for but once they see that you've you know

gotten better to their definition then they you know they're out at that point and here's where they are explaining

that to you and so I have literally done that I have them all saved I used to have them printed out on paper when I

practice full-time and I would and it they it would blow people's minds too especially the way the Medicare one is

worded it's wild because it's like god I wish I had it in front of me but it just says something like you know we don't

pay for care that seeks to improve health and stuff like that and it's like the way they have it written it's like

exactly what the patient wants and Medicare is like nope we don't do that so I have found that that helps people

understand um over time and um you could just Google some of these things sometimes and it's publicly available

like on the website of different companies and whatnot so you don't always have to be in network or you know

be logged in or whatever sometimes you can Google these things and you can just find them yeah that I mean I think

that's awesome because I know there's got to be you know hundreds of thousands of patients that are you know

oh my plan covers chiropractic well what does that mean they're not looking into it all in their mind no it covers

chiropractic no it covers an acute issue and once that acute issue has resolved

they're out insurance is out and you're on your own so I think you know explaining that upfront that's

incredible um but that also ties into my question of uh the financial aspect um

because I imagine there are patients out there they see the value they understand the value but there's budget constraints

how do you how do we navigate that can I just share a story really quick

always go to Starbucks no I'm just kidding I hope this patient isn't watching um I had a patient once came in

to see me and um I was in the office by myself so there was no one else around I had no backup and regular established

patient I was in network with her insurance um but she said to me like "Hey Dr Stephanie I mean she had like a

$20 co-pay." And she was like "Can I catch up next time?" And I was like "That's fine I don't care." I knew she

was coming in people will forget their wallets and this is before I did any like auto debit and stuff so it you know

it's not a big deal by and large but like on her way out after her appointment she I was like "Oh what are

you doing the rest of today?" And she's like "Oh I'm going like she was literally going to get her nails done

with her." Like this was an adult woman bringing like her elderly mom to like go get their nails done and like she like

"Okay so you value paying to get your nails done but you don't value me the

office or the service that you're getting here?" And like in those moments like I was like "Oh that patient who

does she think she is?" which is kind of true but more so I was like "Okay what am I doing wrong?" But it's like how are

your nails more important than paying to get adjusted um and so it aligns you

know to what Ra said a lot of what they're doing I think it forces people to look at their own values and their

own value system and determine what's really important to them and I have experienced this over time like you know

if somebody really values or wants to pay for something like they will find a way um we had another family one time

that you could tell and there were other things going on where they were not of high financial means at all

whatsoever and um my employer at the time struck a legal good deal with them

so we were like within the guard rails of what we're allowed to do in our state and whatnot um but I mean they used to

bring in like fresh fruits and vegetables from their garden just to try to like they it was like that exchange

of energy and like assets kind of like they felt like I mean and they were amazing tomatoes but like they would

they would just bring stuff in for us like that um and they so appreciated

the care that they were getting but then you have somebody who would rather pay to go get her nails done like which patient which patient do you want you

know yeah pouring your energy into yeah that's right sorry there was a lot of No I love it

that's it's that's uh something people need to hear yeah but Ron do you guys deal with like those financial um

objections or like and like how do you handle it but I do want to say I feel like it's way easier like plan to

explain to somebody when you are only asking them to pay monthly like you're not asking them to drop down two grand

for the entire year all at once and I feel like that makes it harder um I

feel like smaller are it's just more digestible for a lot for most people probably you have to create that

you have to create the value you have to maintain the value you have to um keep

your mindset on the pulse of how that patient's presenting to you their body language um everybody you know

receives education differently so the style at which you got to educate patient on table one is far different

than the guy on table two so being able to understand the nuances of of human

behavior my team is trained now to give me a heads up on new patients like hey

this lady more fits this personality profile so when I come in guns ablazing

on a type A person I got to tone that back down mhm and change you know try to

match the patient's tone best you can there's a nuance there and the longer you do chiropractic the more you kind of

learn the other thing too I think for me is a lot of people forget to go back to

the life effect of what the condition that brought them to you in the first place how is it affecting them we always

say four agreements you have to have four agreements with the client one is we have to agree on what your problem is

like if you're minimizing your problem I have no interest in being your chiropractor you're I can't do anything

for you secondly if you know is that a maximizer are they somebody who milks it or

whatever you just kind of know but are we in agreement of the problem is not the symptom it's the list of things that

you're not able to do in your life that are meaningful to you and so that's where we spend a lot of our time as a

team is find out their why everybody's got a list of wise right um some rated

higher than others like god I love to travel but I can't do it I can't sit in a plane or I can't do this my shoulder

with a luggage you know fill in the blank and so figuring out their why it's gardening it's sports it's passion

projects of knitting and painting or whatever we all have every client that comes in has something they love and so

get out of your own ego and really get to know what they love and never forget what they love and every visit you talk

a little bit about what they love I never stop talking about what they love whether it be an acute patient in month

two that's doing way better I’m like "Woo you might be pitching and putting in two weeks you know that kind of stuff

it's real stuff." Or "Hey it's springtime it's time you know I know you want to turn that garden so be careful

make sure you ice and you drink your you know sea salt water and make sure you get your electrolytes and you're going

to be out in the sun." You know man I'm telling you people are so impressed by

that and you're not doing it to impress them but I'm impressed by that when I'm

in a healthcare office I love that attention and it's not phony it's genuine it's rooted in care and empathy

um you know it's rooted in what brought them to you in the first place their goals their life effect most people's

goals are I want to play golf by June or I want to I want to be able to dance at my daughter's wedding you know it's

simple stuff right it's not like I'm going to do the Boston Marathon you know there's those people too but you know

getting to know their why and never forgetting their why and their passions and and helping them get to some of

those passions again and celebrating with them when they get there throw a party give them a book give them a gift

card give them a phone call man it's amazing how amazing a phone call is or even a text nowadays of "Hey it was so

good to see you today I’m so proud of you from where you were a year ago and I

just wanted you to know you know that our office thinks really highly of you and we're very proud of the journey

you've been on and you've been a real example to your children boom how hard was that I do that stuff every day I

personally recall certain people that I'm like "Where's Bev?" We'll come to find out bev slipped into hospice care

darn it but I'm glad I called because her son was like "Thank you so much for calling she was asking about you yesterday." I'm like "Oh poor Bev." You

know 92 though she had a great run in chiropractic was a big part of her success story I have pictures of her on

my wall on my slideshows and when I met her she was in a walker and she didn't bring it out until like a year ago she

was off that walker for 12 years man we actually put it on our wall and I've mounted it in my wall so it's not needed

anymore yeah but um you know how deep are you getting in and how organized you

got to be organized and you got to have meetings with your team and you got to you know get all these plans in order

and present your paperwork clean and nice and not haphazard and you know like

our stuff on that note what um what do you give the patients whether it's like

care plan or patient education type stuff like do they physically get stuff that they leave the office with ever

absolutely we will um we will give them a print out of their core score which is on our subluxation station the three

tests they get a summary page of our care plan recommendations

they get a nice little robust package of dos and don'ts and just things we want

them to consider about nutrition and sitting just everything A through Z kind of back care that we produce so it's

nice little flyer and then they get the care plan they just signed up for they have their little folder has our logo on

it and um you know it's got all their stuff in it it's so cool it's cute when

some of these people bring them back in you know on their re-exam because they're so organized and I always applaud them when they do oh good you

brought your folder I love it you know because you know 80% of people probably goes in file but whatever yeah I I'm

that patient like when I get to walk out with a folder full of tangible papers that I can write on I can highlight I

can document my heart is happy um that's awesome versus you know being fed all of

this information verbally and then trying to retain that myself um it's

difficult but that's just me I’m sure there are people out there that can retain information um

made me think of this you made me think of this Danielle because this is a nugget for you guys is I have the spouse

present at all key visits no matter what like on day two

we're not doing day two until we get it set up with the husband or it's a FaceTime call right why because I want

him to know what you're going through and I want her to know how to help you it's two different conversations with

the wife versus the husband right so it's really important that you have your wife there I really want her to understand what's going on so she can be

more of help at home with you and understand I don't want you have to go home and try to translate all this to her and then um sometimes the type A

women will be like I don't want him in my appointment he's going to annoy me and no I got my own checkbook I don't

need I don't need his help so you just you still try because you air on the side of I want them to know what you're

going through I want them to see your findings I don't want you'd have to go home and try to explain this and it's so

important you know how many times I've done a report of findings with a lady in particular and men too but more women

okay okay well I got to go home and talk to John about it d and now John's going "Wait he wants how much money?" And

what's a subluxation a submarine what are you talking about and spinal disease and what um you know versus if So

there's two different husbands right the one at home has the checkbook whatever that or the debit card and then the one

that comes to the appointment is the night and shining armor he has the arm around her wow babe this is serious you

really need this the guy at home's like "What?" And so my my my juniorist

associate has struggled with this one and he's finally mastered it because he kept forgetting to walk up and say and

our staff's trained to do it too but for some reason they forget this principle and we'll get these roofs when the

spouse isn't there not I'm usually like we're training on that tomorrow wartime training but um it's so important that

you have that they have support workshops bring support with you health is better our family policy is basically

we have found that families that are under wellness care together are way

healthier individually going through this as a group than they would ever be if they

did it isolated by themselves hands down so we start early on family policy you

got to get the whole family checked we got to get your kids checked your husband needs care we got to get you guys in the same rhythm and um it works

really well and it's true it's needed so oh question on that okay so that just

brought up when you have family plans like that I imagine it's easier for the family to adhere to wellness plans

when it includes everybody but what about the kids that are on a different

phase of care like I know maybe the adults on three times a week versus you know a two time like how do you navigate

is everybody on the same care plan where they're coming that's a great question um but for us you know with kids it's

going to be a far less frequent they respond so well to chiropractic they

resolve so much quicker than the average person and so there's that um with

babies we'll do weekly checks for the first two to three weeks then every

other for two to three and then monthly for two to three usually with kids because they're so active and they're

all developing humps in their back now so we're in a whole new generation so we got to watch this generation even closer

than the last I think as far as neuro neurological development especially if you pair that with all the other stuff

their poor little bodies got to deal with the um we won't go into other reasons but there's a lot right all the

forever chemicals in our society that are kids are exposed to but then the blue light and the technology and the EMFs and where do where do you stop

right stress but anyway I think we need to check kids more if you're not checking kids man you got to you got to

get deep in your philosophy and figure out why would you check a kid and if if

your why is big enough then get after it and quit being intimidated by the

conversation I feel like chiropractors are intimidated by the pediatric conversation because they lack their own

conviction and their own belief in chiropractic which I think sometimes is forged over time um some people get it

right away because their story is so profound but um it takes a while for chiropractors to get their philosophy

dialed in takes coaching it takes encounters with other chiropractors um you know I I don't know

I just feel sorry for some of these chiropractors that post online how bad things are going and I just want to hug

them and and teach them and mentor them well I think more often than Oh sorry go

no you go I was going to say more often than not these days you're going to have

parent like the kids are going to be there with their parents anyway they're tagging along to these appointments why

not get them on the schedule it can't hurt it It really can't and I I mean I

imagine there are offices out there that they do shy away from seeing the pediatric patients but those are

patients that they're right there they're readily available and they need the care just as the adults do we check

our newborns as a courtesy for the first um year of their life if if their mommy

was under care during their pregnancy and and prior so we just kind of tell them during pregnancy when little one's

here we're just going to check because we're going to keep checking you um but we definitely want to check baby on a regular and we teach them little home

exercises and it's super fun we just posted a video on social about that and um it's just so fun and people we get a

lot of questions about wow you work on kids why would a kid need people have it in their head that chiropractors help back pain and so I think that's why they

would ask the question like why kids but back to your question about wellness care so a typical family for me would be

hey husband's weekly he's a home builder wife is twice a month and then the kids

the two kids come in once a month and we have them on an auto debit accordingly and um we actually have we have our

normal adult price we have our senior price and then I have one-third price that I have done historically I have a

huge family so I do it for um my family members that all my cousins and whatnot

that want to come in I can't treat it right for free because you got a free practice great but you got no room for

people that want to pay you because you're filling up your schedule with free all your family coming in so I made

there in the game yeah yeah so you know that's a good example of a

family plan so they're basically getting eight visits a month as a family it's probably costing them you know less than

$400 a month probably 300 a month Ish and the dad's getting the care he needs to stay in the game as a builder the mom's

getting the care she needs to stay functional as a stay-at-home working part-time stay-at-home mom and then the

kids are developing so fast and you know kids fall 4,000 times before they turn seven so we're checking for patterns

checking for their feet their back their spine their sutures it's there's some basic pediatric protocol programs out

there you don't have to go full Webster and full peds diplomat program you can go do some really good seminars on how

to get comfortable with babies so I was just going to bring that up too like cuz for me that was one of my barriers I

didn't feel like I knew how to adjust kids um and I took our pediatric courses in school and they just don't you know

it's not like there's kids in there to adjust and stuff and they just I didn't feel like it was very thorough so I did go do the courses with the ICPA I did

get fully certified that's cuz I wanted to um but for anybody listening like if

you want to start seeing kids I would first of all I would beg you to learn how first because it's not they're not

just many adults um but I mean even with the ICPA like you can read through the website and you could find the courses

that are specific to adjusting for example and I'm sure there's other organizations and courses um but so like

there's opportunities to go learn so that you are comfortable with kids if

that is one of your perceived barriers if somebody wants to start doing that but is nervous cuz they you know

especially I find and I think I felt this way too I mean I still don't have kids but I was also intimidated by taking care of babies cuz like I don't

know how to hold one or pick them up you know like how do you even how do you know right yeah so going

to get some extra training really helped me back in the day um that was like 10 or 12 years ago now um but those are

great opportunities to add um you know tools to your toolbox and maybe open

that door so that people are comfortable taking care of infants and other kids that's awesome yeah

I think I mean it can only expand your wellness plan capabilities the more

folks that feel included and that they can be part of it the adherence is built in it's natural

I love it that's You know what I actually had one other question for you Dr Ron you mentioned getting to know

your patients it's more intimate how do you stay on top of the nuances with your

patient where you know you have an elderly patient and maybe you know her you know her dog's name what how do you

stay on top of that visit after visit with understanding each individual patient well gosh great leadway into

utilizing your um practice software right you know for me the note section

um we have an openline practice so we share clients so it's critical for that but like what adjustment techniques have

worked and what are some nuances about this kid and we always list the

um you know I used to call it the blame box but it was they always sometimes people try to blame the chiropractor my

back's still sore then you go to their blame box and you see that one of their hobbies is they like um yard work well

did you do yard work this weekend he's like well yeah I pick weeds for like six hours did you ice after did you stretch

at all how was your hydration you know so you get the blame off of you back to them but um you know just having good

notes in your system of what adjustments you've done in the past um you know we

have a an educational system called the Dirty Dozen which are 12 life principles we want every new patient to know within

their first month of care and then we hammer them in in after that so we kind of had this talk track anyway but I

think it's important that people spend more time in their day one um interviewing the patient and getting to

know their story and getting to know all the nuances of their story you know for

us that's a big long conversation it takes 30 minutes to do it well and then

we transition and and by the way I have a new patient concier trained up to do that part and it's so beautiful because

I come back in right pre-extray and introduce myself and I get five minutes

maybe with you to do the X-ray and to talk but I let my new patient concierge

triangular communicate to me what's going on I go give me a reader's digest

well you know she's got this headache and it's coming at night and it's affecting her ear and you know it seems

to be related to her neck and it started with you know a year ago she had a car crash and she didn't feel bad then but

she was thinking maybe that did it and you know so you get that person talking about you in front of me it's beautiful

that just saved me 45 minutes of my life that was like seven adjustments eight

adjustments for me you know um and so a lot of these practices that don't have

associates maybe you can't afford one yet but maybe the first step is to train up a new patient concierge one of your

team members who's got a good mind for it and you know maybe on their personality assessment test they showed

a high aptitude for understanding science terminology things like that and more leftrain and can you know be a good

interviewer and so certain makeup good listener somebody who's empathetic but also smart about science it's hard to

find those people but they're out there and we found a couple good ones that we trained up we have three team members trained up for two offices so now those

one-off re-exams and all that stuff they can do a lot of the heavy lifting for me but it's done well it's not hurried we

have it all preset up in Chiro in our notes it's a new patient intake uh setup

so my team can walk through it I can easily look at it we talk about trauma history family history we want to know

everything about you and I put all that in my my dashboard so going forward

Danielle if I don't know you from Adam but you've been seeing Dr Christa and all of a sudden now you're on my table

and I'm looking in going man I see you had a C5C6 disc fusion surgery you know

I'm glad I saw that and um you know Dr Chris has been doing more drop technique

and arthro stem and more just um kind of micro stretching on the upper neck and you've been responding really well to

that style of adjustment or you know you've been doing better with flexion distraction and drop and not diversified

on the pelvis okay good to know you know so we always have it just helps because

we have an openline practice and so people are on my table every day that I've never met before and I like it spun

but it and then we have our x-rays all converted to PDF down on the dashboard anything I need about Danielle is right

there and I look at that you know I go through that case history i'll have looked at your X-rays already um even in

the digital version in the back because the carrot touch ones are JPEGs whereas in the back I can do different angles

and markings so you know I don't know if that answered your question but I think if you're more organized one doctor I

mean I was you guys I was doing 300 patient visits a week for five years by

myself and I was charging over $50 a visit and this is in like 2007 cash and

I'm not tooting my horn I’m just saying if you have the right systems and the right process procedure and you have the

right you build the right team the right orc chart and you give all your team

members job descriptions and scorecards so you could measure their performance and give them key performance indicators

so that they know their job and then when you meet with them on on a review you this is what you're being looked at

on and um you can build this remarkable practice I hired a coach to do all this

I never went at this alone I don't know why people do that I think they're afraid to invest that money but if

you're if you're paying a,000 a month for a coach all you're expecting that coach to really do is to pay for that is

to give you one new patient a month and I'm telling you a coach will give you 20 new patients a month if you had me

coaching you I could get you 20 more new patients a month but not only that you would have incredible net momentum

because net momentum is a hidden metric in chiropractic and it's this you got

your goal I want to get to 300 a week or whatever that goal is right and you're having a hard time getting there so you

reverse engineer it like how many new patients do I need a month so it's new patients minus how many people become

inactive a month which is what we've talked about in this call is how to limit that number by mapping them out

getting them on plans educating them you're still going to have a slippage rate people move away people pass away

um you're going to have inactives so new patients minus inactives new patient conversions I should say minus inactives

equals your net momentum and so if you want a net mo of 10 or more you're going to grow if you're going to grow 10 new

clients per month your total active patient list gets higher so you can begin to look at what your goals are and

be able to reverse engineer your goal and say "Oh to get to that $500,000 revenue mark I need 30 new patients a

month to account for the 10 inactives a month that are moving away drop

off and then all of a sudden you got a beautiful practice growing." Are you

mentioned write things down and have goals that can be measured coaching receive I was gonna say you I was going

to say you mentioned coaching are you opening the table for our listeners to find Dr Ron and seek out your guidance

absolutely yeah I I would do a complimentary discovery call with anybody if it's through this chiro touch

thing just to sit and talk to I love talking to chiropractors and it could be a 15-minute discovery call just to find

out where they're at maybe it's a question about the software maybe it's about what we talked about today but I

just feel like we're not getting this coaching in school and a lot of doctors get out and they don't feel they can afford it and then I'm sitting there

saying "You can't not afford it how do I spend money I don't have?" You know and

so it's scary it's a slippery slope well we we'll include we'll include a link

after this episode um we'll include a link so that our listeners from this episode can connect with you absolutely

I would love that yeah absolutely I love helping chiropractors I I I learned that long ago if I can help chiropractors be

more successful I'll have a greater impact on humanity than I would by myself in my little office here yep the

the more the more positive impact I think we can have on each other the more people in this country are going to wake

up every day saying you know I need to have a chiropractor as part of my um you know part of my own team because I think

that's really as a profession where we're lacking you know people wake up every day and they know they have to go to the dentist twice a year or whatever

it is or they have to go see their medical doctor once a year or whatever but people not everybody wake up and say

"I need to see my chiropractor." And that has to change so hey in Elora Hills that's not the case exactly you guys

have done Let um Yeah you're right and we we have an operating mantra and I

know you believe this doc and Daniel I know you do as well and that is that people are we always say that people

that are under regular chiropractic care are healthier and safer than those that are not and so that's been our operating

premise that's our drives us that's our vision is to reach more people not to make more money money always

trails true success and putting value in other people's life in a service

industry if you know and if you look at your Google reviews and you look at your impact locally I mean another thing is

go speak chiropractors never get out of their four walls and go talk to people I

still on a monthly basis have at least one lunch and learn in the corporation for years some are the same ones over

and over again and uh I'll come and speak to them about health and wellness and of course chiropractic

all right well uh we hope today's conversation gave you practical ideas to

rethink how you present and support your wellness plans um before we jump into closing segment

how for those of our listeners that are listening only how can people contact you Dr Ron

okay so I guess you can put my email in there somewhere or they can reach my office and ask for me my office number

is 916-9337022 and mention that you met Dr

Ron on a podcast and would love to pick his brain and my team will drop

everything they're doing and come find me they will they will connect us they are all about the mission my team is

very missional like me awesome love it all right well a big big

big thank you Dr Ron for joining us today I really love the insights that you have some of the stories you shared

um it's always really really helpful for chiropractors to hear what other chiropractors are doing and what their

their practice lives are like so thank you so much for opening that door up and um letting us peek in I love it you guys

are great hosts it was really fun love it thank you and for our listeners if you've got a question a challenge or

even a win that you want to share send it our way at

chairocastouch.com and we might we just might feature it in a future episode awesome uh and if you like what you

heard today don't forget to like follow and subscribe on your favorite platform the Chirocast Podcast and that'll help

other chiropractors find us that much more as well which as we've just stated would mean a stronger community for all

of us yep thanks again for listening to Chirocast we'll see you next time thank you for joining us on this episode of

Chirocast insights for modern chiropractors brought to you by Chiro hosted by Dr Stephanie Brown and

Danielle Javas produced by Debbie Brooks editing from Matthew Dodge and title

animation by Eric Madden our theme song House 5 is from Scott W brooks if you

enjoyed today's show don't forget to like link and subscribe we appreciate your support and we'll catch you next time

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