The 5 Profit Pillars Every Chiropractor Should Know

Hi everyone, welcome to Chirocast where we explore what it really takes to run a

modern, thriving chiropractic practice. I am Dr. Stephanie Brown and I'm Danielle Javas. Today we're digging into

profitability, what's working, what's not, and what you can do about it. So today we are joined by Dr. Nota

Hashimoto. Dr. Nota is a chiropractor and co-founder of Trackstat.

uh he works with practices across the country to identify what he calls the five profit pillars. These are not vague

theories. This is no fluff realworld look at how to sell with confidence, improve retention, cut unnecessary

costs, and get paid faster. So, why don't we start not if you want to just

jump in and share with us a little bit about yourself, your chiropractic journey, and we'll let you take it away.

All right. Um yeah, thanks for having me. And then yeah, I I started off the

journey um maybe like a lot of other people, I started off as a patient um as

actually going to school to be a dentist. So growing up in a household

with Asian influence, uh you have a choice of being a doctor, lawyer, engineer. Um I volunteer in the hospital

in high school. Didn't want to do that. I didn't like wiping people's butts and stuff like that. And then my brother was

already going into engineering. Didn't want to be a lawyer. And then some of uh family friends were dentists. And then

some of my mom's cousins were dentists. So I said, you know, I want to be a

dentist. And um it just I just really wanted to have a business. Like since I

was 8 years old, I wanted to have a business. It seems kind of odd, but we grew up in I'd say upper lower class,

lower middle class somewhere in there and like there was like just someone that I met and they had a business and

they seemed like they had choices and we just didn't really have choices. So like um I was going to school actually got a

predental scholarship out of high school doing predental in college and then got

in a car accident. um got in a head-on accident actually got two disc bulges and then I did PT for about 6 months

took medications. I was very alopathic back then and uh doctors said that well

you need to go see an orthopedic surgeon when it wasn't improving. That's when I kind of freaked out a little bit. Uh I

didn't know what was going to happen knowing what I know now. I know nothing was going to happen but like when they say you're going to send to a surgeon,

you start to panic. So then my mom panicked and then we called a family friend and he was seeing this

specialist. We didn't know uh what it was and then talked to him and then he

actually made an appointment and um I was so naive cuz I had like neck pain

and back pain. I couldn't understand why he'd send me to a chiropractor cuz I thought they only worked on low backs.

Uh that's how much I knew about chiropractic. And then yeah within two

three visits probably by the end of the first week I was 50% better. Within 2 months my acne cleared up that I was

seeing a dermatologist for 5 years. And all the chiropractor did is like hey um

you know those Coca-Cas and those Doritos and those Wendy Jr. bacon cheeseburgers probably aren't good for

your skin. So eat a lot of those. I'm not going to lie. Yeah. Like he just asked me about it and

then I was like well my dermatologist said it had nothing to do with my diet. And then um he's like, "Well, are you

self-conscious talking to girls?" It's like, "Touche." And he was like, "Gave me a diet," which was paleo way back

when uh before paleo was paleo. And then um that cleared up and then I was set

and I asked if I could shadow him after um I think I was like working in the

summer at that time. So I shadowed him and it was just a totally different experience of volunteering in my

dentist's office. Like the dentist bitched about insurance, he bitched about the staff, he bitched about patients, he just bitched about

everything. And if I would have shadowed maybe a different dentist, I feel different. But he just complained. He's

like, "Don't go into dentistry. This is the worst profession." And he just like, "This is cracking."

And then I go into the chiropractor's office. It's like packed. He's like high-fiving patients, seeing babies,

seeing grandparents, seeing everyone. People are crying. People are bringing in homebaked goods. Uh, that didn't

happen in the dentist's office. People were bringing in things that they made. Um, I remember when I told them I was

50% better. The office was packed. There was nowhere to sit. People are standing in the waiting room. And even though

he's super backed up, it's like I told them that I was like, I've been doing physical therapy for 6 months and now I'm like I feel like 50% better. It's

like it was I just I was blown away by the just two adjustments I had before.

This is the third visit. I'm telling him this and then he just stopped what he's doing, had me go to the waiting room,

share that story. Everyone stood up, they clapped, they celebrated, he made a big deal about it and it just it was he

was just very passionate about what he was doing. And then um I told my parents

I wanted to be a chiropractor. They tried to convince me not to do it. My best friend's parents tried to convince

me not to do it. And it was like just the the path, the right path. And it

just I think a lot of people that get into this, especially that excel, like I'd say a lot of my friends, they

started out as patients. And I know a lot of people where people tried to talk them out of it, right? It's like, hey,

you should go do this other thing. And it just I didn't want to. And then um

met my wife in school, started a practice. Um grew that fairly quickly.

like we I worked for a mentor for a year. Um paid off both of our student loans within two years of practicing on

our own. Um and then yeah, we did a million, did a multiple million, did a

few million, and uh we kind of had quite a bit of different things in practice.

So like we did the insurance, then we did the cash only, then we added in like supplements and services, and then we

added in like PT, PI, and added in medical stripped out services. And I

pretty much started out as a shiny object chaser, and then realized that I had too many shiny objects. And then I

started simplifying and focusing profitability cuz um yeah the at one

point like we were making quite a bit of revenue but our overhead was out of control

and then um you know it was just like you know what we have to add more profit. when it was like me and my wife

in practice, um we were really profitable and then obviously you have kids and you hire people to fill in and

uh we were still profitable but that profit was like ekking away. So then we just started implementing these five

profit pillars in practice and maximizing the profitability. So that's

story on how I got here and then yeah. Well, how did you get from practice to what you're doing now?

Uh well uh one of the things that we're doing this is a total tangent from the

presentation but so like one of the things that we did is we did these educational seminars. So I was like I

got pretty early on on Google Adwords but really early on like day one on Facebook ads and we just blew up with

that and then I had a couple friends helping me with that. We were doing these seminars and just killing it. And

then we I had people I was in masterminds. They say, "Hey, can you do this for us?" I was like, "No, no, no."

And eventually I was like, "All right, well, screw it. We're going to say yes." So, we spun up a marketing business. We

took it to a million in the first year, took it to just over two in two years,

and then we were having a good third year, and then COVID happened, and it turns out putting old people in a

restaurant a couple hundred times a month was not a good business model in the middle of COVID. And then we ended

up hiring an engineer for that business cuz like Zapier is what we were using to

connect things. and uh make was I was integraat but they weren't really designed for all that throughput of

data. It was like constantly breaking. So then that's when we ended up hiring an engineer. I tried hiring an engineer

before but I didn't know anything. And then I actually had one of my friends uh

help me hire him. And basically his advice was he he he'd helped me hire

him. He said, "I could help you build some of this stuff, but it's going to break and I'm not going to be available

to help you for maybe a month or two months or three months. So, I'll help you hire someone and make sure that they

had the technical prowess." And he just said, "And hire them and pay him salary

because if you pay them by the project, they're going to leave and go do something else." So, that was his advice to me. And that was our CTO now, David.

So, he's been with us since then. And so when we're doing this marketing business in between we um had this software not

to sell just for our own practice cuz we just we were one of the things that we do is we just track our patients. We

want to know if someone came in as a new one like did they show did they start

where did they come from? If they dropped out did they drop off on their own or did we discharge them? And then

everyone that started a treatment plan, we had finish a treatment plan. And then we did a VIP, like an autodebit

membership. It was decent. It was not like a big part of our revenue, but it was still like 20 grand on the first of

the month, which, you know, was kind of nice and there were easy visits. And then um so like we had all this stuff

and nothing talked to each other. We had like a software called Infusionoft at the time. We had like seven Google

Sheets. Um we had a texting platform. We had another stats platform. Nothing

talked to each other. Well, we had a texting thing on top of that. And yeah,

so like David and me, we just like worked and built a couple of things. And then, you know, I go to like a

mastermind meeting and people like, "Oh man, I was like, that's awesome. Can you hook me up?" And then like I figured

we're on to something when I have like someone like it was like I was a drug dealer, right? Like I get like a friend

of a friend call me up and he's like, "Hey, uh, my friend Corey said you got

this thing. You can hook me up." He's like, "I can hook you up." And it's like, "Go on their computer, install this software." And they're like,

I had a couple dozen practices using a software that would even have a name. We called it the tracker thingy. Uh and

then cuz it track it was a tracker thingy of stats and patience and

productivity and you know like I wanted to turn into business but I had no time

like we had a practice with like we had just under 50 people working for us like

we had a call center in the Philippines. We had a marketing company and then we

had a practice that was doing 36 384 on a good year. So it was uh and I had just

no plates to like grab. And then um yeah, then when CO happened happened,

but like the year kind of like before that like my dad got sick and then it

turns out like at the end of everything like it's not about like a watch, a car,

a house or anything. It was like meaning, purpose. What am I here for?

And my dad was the most certain person on the planet. Like I'm holding up a red

water bottle. Like he hated Google. And he's like like I show him he's like, "No, no, that's red." He's like, "No, it's purple." Right? Like he just he was

the most certain person on the planet. And to watch him like I remember it was

like September uh 2019 and we talked for like two hours when I was a layover at

the airport and he was just questioning his very existence and purpose and

I just remember coming home from that trip and I told my wife like, I don't care what we have to do. Like this thing

that other people tell us we should do. I want to do it. And we started talking about what that would look like. I just

said like I don't want to wait till I'm 76 and dying of cancer to figure out this is what I want to do. Like I want

to I think this is the best profession on the planet. You get to help people

get better without drugs and surgery. And there's so many good chiropractors out there that are awesome clinicians

but just not that great at business. Uh and that's not a dig at them. It's just, you know, a lot of people get in there

because they want to help people and and no one Well, maybe there are some that do, but I don't think most people

that decide to be a chiropractor are thinking, you know, I I'm want to do this because I'm an amazing business

person and I'm going to be really good at the back office stuff.

Yeah. So, like we wanted to kind of like build something that they do it and then you know we talked about it and I'll

admit like at the beginning of co like I freaked the f out like for like 3 days

and then um cuz I watch like one revenue go down, expenses are still up and at

the time like I'm very vitalistic um but like there was still that gnawing a little bit of doubt was like maybe it

will kill me if I get it right. So like and then I didn't know if my malpractice was going to cover us as someone came in

and we're operating. So it was like and then you know like after about a week like 5 days I told myself to quit being

a little and kind of move on. Like I've been talking and praying like when are we going to get the time? How are we

going to do this? And you know whether you believe in universe God or whatever you just like drop right in our laps and

just time here it is here it is and you've been talking and praying about it. So, like,

you know, quit shooting. Shout out to your dentist. Do it. Yeah. And then I know that was a longer thing,

but that's just kind of how we got here. So, no, I loved it. That's exactly what I wanted to know.

Yeah. And I think it's a good segue. I mean, you talked a lot about the pillars that we're going to go into, but I think

you laid a really good foundation because you didn't start off making millions of dollars on day one. it was

trial and error and going through these pillars. Um, so I think if you're

looking for practical ways to boost revenue and reduce overhead, you're going to want to hear Dr. Nota. So let's

get started and dive into your five pillars. Yeah. Um, well, it's pretty easy. I'll

just go over them and I'll explain them, but like sell for more, sell more often,

reduce your operating costs, reduce your accounts receivable, and finish your projects. So, and then

a lot of times like if you sold your business to someone else and like let's

just say you sold to a big private equity group, one of the first things they're going to do is raise the fees,

right? And like that is like one of the fastest ways to get there. And if you

look at a lot of people's cash prices, it's a price that they've had for 20 or

30 years sometimes. Mhm. Right. And the cost of everything's gone up. So I'd say figuring out how to raise

your fees is going to be a big thing. Um, and I just feel like not every

state, but most states like insurance is like it's like a sinking ship. So like

supplementing those with like some cash services and you know like I like metrics obviously

like we started something that does that and I think what's measured grows and if you just started measuring how much you

collect per visit over time you're going to eventually get there

but you want to get there faster like there's a lot of different things you could do and you know like one of the

things would be is like working on that whole sales core choreography of like

getting people to say yes um ethically and you could do that ethically and

there's if you don't have a coach that helps you with that there's a lot of companies out there that do that like I

think um you know like close for cyros is a popular one blueprint's a popular one

the business academy is a popular one um they all follow a similar framework like

I'll teach like a line some people teach closer and Then um align is like the

closer framework, but it's like the first part with a is like just attract with authority. And then I've uh

obviously a big fan of marketing. And I think like if you get like a very templated website that you had no input

in creating and you're running very generic ads and you're complaining about the fish that keep jumping onto your

hook and getting into your boat, you got to change your bait, change where you fish, you got to change something about

it and you can't really continue complaining about it. Mhm. Uh, one thing

I did about like fees, I just looked at like how much money I made in a time

frame divided by patient visits and, you know, how many dollars per visit was

that? But then I took that number of patient visits and I multiplied it by like this number or that number, like

just different iterations. And like that is like the smallest exercise I think that you can do to say, "Oh, like I'm

really leaving a lot on the table here." because then you suddenly see like a small raise to your fee equates like x

number of more dollars across maybe that year or that time frame or whatever. So I think that some people are hesitant to

raise fees because I mean everyone wants to make more money. But if you can show

yourself like what that might result in, I think that that's a good place to start. And also, I will freely admit to

this, like I have literally had patients in the past told me that I needed to be charging more. If your patients are

literally telling you to raise your fees, then you're way late. Should have done it already. And, you know, you

really shouldn't hesitate because they already are valuing your service. I think that's a big deal. Like, they have to value it, but as long as you're

providing that value, like you you can raise your fees. Like, there's no problem here.

Question. Yeah. Oh, yeah. Question. Cuz I'm not a chiropractor, but I was like, if I'm a chiropractor

and I'm coming out of school, I'm opening up my first practice. How do I assign value to what I've not done yet?

Like, is there a strategy to coming right out the gate and setting the bar really high or do you start off smaller

and give yourself room to have those incremental price increases over time? I'll tell you what, I worked for one of

my mentors and I didn't have value on it cuz like when you're coming out of school, you have this poverty mindset

and he just did a little exercise for me like you know he just like okay went over how much I paid for school, how

much time I gave up and then he's like okay let's just say you were making $40,000 a year and you didn't have to go

to school. You had a small raise. He went over like how much extra revenue and like that gap. He's like, "Quit

trying to give this away for like 25 or 30 bucks a visit, right? Like you you're

worth more than that." And like he just had me quit discounting, quit doing

this, quit doing that. I know it was salary, but like um I just that was an

exercise that he did with me and it took a little bit, but like eventually within

like three, four, five months, I started getting that conviction. Um, and then just saying I'm worth it.

Yeah. And on that note too, when you're a new practice, I think it's easy when maybe you're depending on how you

marketed and how you've launched, if you're open and you got some free time

in between patients once in a while. If you're with a patient and you're, you know, you know, you don't have anyone

right after that, I think people, it's easy to fall into a habit where you spend more time with that person. But

then what's going to happen when you do get busy and you're not spending as much time with that person or those people, they're going to notice that change and

they're going to say like, "Oh, well, you spend 30 minutes with me and now it's only 15." So, I mean, in that

circumstance, if you're just opening a practice or getting going on your own, I feel like you need to practice on day one as best you can the same way that

you would practice if you were really busy because not only you you want to exude and and project that, you know,

confidence like we're talking about and that busyiness, if we can call it that. But when things change and you are busy,

patients are going to pick up on that and that's when they leave. I mean, I've had people tell me that, too. Like, my other chiropractor used to do this and

now they don't anymore. Um, you know, back when I started that was tied somewhat to um there were docs in our

area did a lot of modalities because they could charge more to insurance for them. Well, insurance pulled the

reimbursement for it. So, suddenly now no one's getting stim, no one's getting heat, like no one's getting ultrasound.

And they perceive that change in value because they're not getting that extra service anymore. but they pulled it because the docs they're not getting

paid for it anymore and so and then they complained about it to me. So, um yeah,

I mean I would just say like practice the way you're going to practice if you were super busy and just be careful with time and how you're presenting those

services because if patients perceive a huge change down the line, that might be when they start to actually change their

own mind about coming to see you. Yeah. And you also have more energy too like um

you know like I cluster book like I remember when we had one when I had one patient I open up the doors I rented a

room I had one patient and then I got the other I got the spouse in there and I scheduled them at the same time then I

ended up getting another patient but they couldn't come in the morning so then I saw them in the afternoon and I remember like I had like

uh like I think five total patients or something crazy like that back in the time people like doc you're busy but I

just booked them all at the same time. I had like three people come at the exact same time and I had two people come at the same time and then I worked on like

my business in between. Like I built my first website on I bought a book HTML

for Dummies and I did it like it there's things that are out now that are way easier to build your own site and stuff

like that, but I did it like the hard way coding it on HTML and stuff like that. And it's uh that's the stupid

stuff I worked on in the middle of the day and I just ran around and had all this energy. I even went door todoor in

communities. Uh that was uh but willing willing to do anything. And then um

yeah, like getting into like I'd say one of the things I see a lot of people do is they don't they don't really think

about their marketing, right? uh like they'll say that okay well um I have an

ad for like uh say like a bunch of kids and my website's showing a bunch of like

older people and then I'm really going after people in their mid-30s and 40s.

So like just being kind of like congruent with your messaging all the way through. So for me, I just started with the end in mind. And originally I

wanted to work on a bunch of young people, but then I realized that these baby boomers had expendable income and

they take a lot more time and money to fix. So then I just went I was going to

focus on the baby boomers. So I was like 55 and older and that's what I focused

on and I just went all in. So all of our advertising was about that. the pictures, uh you think about the age,

the sex, even the race and like the messaging, uh your marketing, internal

marketing, everything was like geared around that. So, you're getting kind of like a better kind of like you have better bait and you're getting in the

right kind of fish into your boat. And then if you work on your sales process,

um that's it's just really really critical. And like when I first started,

I had a consultant. He gave me a script and I believed in my heart of hearts that this script was magical and I was

just closing everyone. And really what it was is they were just buying my conviction and my confidence cuz like I

was like just closing freaking everyone and then um another thing that I learned

later on from another consultant and like this is kind of like when my head exploded like I was in a coaching group

and everyone's bragging about closing like 90 something% of the people. He's like, "Well, your prices are too low

then." I was like, I was like, "Oh." Right. So, it's like uh, you know, learning about price elasticity. So, if

you're closing 95% of the people, then your prices are too low. And an easy way to figure out what your ideal case fee

is, you take your closing percentage and you multiply that by your price. And you keep working up your price until that

dollar number of the two is not higher than the other one. Well, that's solid. Were you not keeping

Were you not retaining those? So, you were closing them, but you weren't keeping them, I'm guessing. No, no, no. I was closing too many of

them because So, like my prices weren't high enough. So, he just says, "Raise your fees." So, pretty much I So, like

if my closing rate got to 80%, then I'd raise my fees again. And then I tried to

keep it from 2/3 to like four out of five, like three quarters somewhere in there. And if I was consistently hitting

8590, then the fees go up again and then you know the number goes down but like

what you're collecting gets higher and you know like I think you're allowed to

make money in business, right? I don't think it's a bad thing and you don't have to spend more time and it's it's

just really about outcomes and we delivered great outcomes like we were the top rated person. We were probably

one of two chiropractors that got referrals from the medical community in our area. I sold my practice to an

orthopedic surgeon, right? Because you referred we referred back and forth so much. So like,

you know, like you could have both, right? Well, how often were you So, how often

were you running that data and doing your calculations and then changing your prices? Was this over a year, six

months? Like, how often were you boosting your pricing up? Uh, not that

often. Like I got it up pretty quickly. Like we were charging like 150 a visit.

Like and I think for someone coming in three times a week that's that was a

good point. And we were charging that like 20 thou by 2010ish.

So like I felt like for us that was like a good point. And then if they prepaid they get them for like 125. And that

that worked for us. like I could have charged more, but it seemed to be kind

of a good mix. And then as I hired associates, I found that they weren't as

good at creating that value. So, I just stuck with that price for a while. But,

you know, there's a lot of people out there charging like 40 bucks a visit. So, I think 150 is pretty good.

Yeah. And you you I know you honed in on marketing and you talked about overhead

and how you can reduce overhead but you know not make yourself busier or stretch yourself too thin. What does that look

like? Um well like the path there or like what do

you mean? Well, like so I know like I guess I'm coming from a place of we we

want to help new docs that are starting out students and think about it from their perspective. When you're when

you're opening your first practice, I know overhead is probably the only thing on most of their minds aside from

getting their hands on patients. So how can you start your practice and you know

get going with marketing and all of these things but keep your overhead in mind?

you know, I'd say worry about it, but don't worry about it. Like, um it's not like I don't think about that. And that

would be the advantage of um practicing with my wife. So, she I feel like when I focus on like those things that gets me

into a scarcity mindset and then something my mentor always told me is you can't save yourself into a profit.

Uh a lot of people try to like cut cut. But, um I'd say if you're new in

practice, like the first critical skill that I think you got to work on is communication. And sales is just really

communication. And you know, you could learn these different tactics from all these different people, but at a certain

point, you got to get reps. And for those of you that aren't doing spinal screenings, I'd say that is the best way

to get a lot of reps talking to people. And like I did screenings every week um

when I worked for my mentor. And then when I was in Cairo school, I was doing screenings for another mentor. like I'd

go do a spinal screening on a Saturday for them for zero dollars, but in

exchange he'd mentor me and stuff like that. And it just you practice talking to people about chiropractic and it's

just you could read about all this theoretical stuff. You could read these scripts, but at a certain point you just

got to go in there and get like a bunch of reps. Mhm. So, like new and practice, I'd say you

got to do this stuff till like, you know, like I could show up to your house, poke you with a stick at 2 in the

morning, roll you out of bed, and you could just start going. Everyone can have their their friends or

significant others test them by doing that. Perfect. Yeah. I was practicing scripts I learned

from a consultant on my honeymoon with my wife. She still teases me about it. I was like reading this at the beach and

like recording myself. I'd record all my consults. Like I remember I hired my first coach and then he gave me all

these things like do a map, record these consults, record these roofs and I sent it to him in like 24 hours and he called

me up. He's like what's wrong with you? I was like what do you mean? He's like I

asked for this stuff and he sent it. He's like yeah. I was like I'm not paying you to be my friend. It's like I've been working on getting this stuff

for a year from some of my clients. So, it's just you just got to do it. You got to fail fast. And like the worst thing

that happens is usually nowhere close to what you think it's going to be.

So, um I'd say raise your fees. If you take a ton of insurance, figure out how

to add in some cash services. If you don't have a decompression table, I'd say that is the easiest stinking thing

to like offer cuz like almost 100% of people's patients have either neck or

back pain. And there's probably at least one out of five of them that do that. And we had a few of those tables and

they were just running all the time. But like it's something that's absolutely critical.

And when you raise your fees, don't make a big deal of it. I just raise them. and

like, you know, we just raised the fees and Mrs. Anderson comes in, he's like, "Hey, Mrs. Anderson, do you get the

email about that?" Oh, I did it. No worries. Um, this visit we're still going to honor the previous rate. Um,

next visit's going to be X. However, if you want more visits, you could purchase

up to 24 visits at this rate. Um, and they prepay for like 24 visits at the

old rate and boom, now you got a bunch of like cash closes right there. or if there were maintenance people, we'd say,

"Hey, if you want this rate, you could join our AutoDebit membership and then still get that rate." So then they're

coming in twice a month or once a month on Autodebit. And that's just how we handled it. But a lot of people, they

make this big deal. They make an announcement and no one even reads it. And people like, I'm pretty sure you

guys have sent out texts and emails and they haven't read it. Even if they did, they forgot about it. So yeah,

making a big deal about it is the worst thing you could do. Yeah. What about to

um like future scheduling and retention from that standpoint? Um do you find

patients like to schedule out, don't want to schedule out? Um I think our job is to kind of be the

shepherd or like the sherpa on the journey, right? The patient's the hero.

And if co taught us anything is that people are a lot more compliant than

you'd think. Um, it just people like to follow and we

just block scheduled people. It's one thing I learned from the consultant. At the beginning, I didn't think it was a

big deal. We have like a couple thousand chiropractors in our system now and there is a night and day difference from

people that block schedule. I don't care if you schedule out five or six visits at a time or 30. Um, so for practices

that schedule, here's an interesting fact. So like I looked at last year I

looked at like 750 chiropractors or something like that and if you schedule

by the visit the average rate where they'll lose half of their patients was

between visits three four five to maximum six. And then for people that

block scheduled their visits, it was double that minimum, but most of them

were triple, quadruple, quintuple. Like they were hitting that number at 12, 15,

20. So like it just absolutely crazy. So

like we just And then when you measure out like how many visits are scheduled out on the

next 30 days, it's really the provers's job to do that. It's not the front desk. the front desk job is to kind of execute

on the scheduling, but the it the provider has to make a big deal about it. But like we did three metrics like

the weekly visit, we had a team bonus. Everyone was bonused on that. And then um future schedule, that would be a

provider bonus. How many visits they have scheduled out over the next 30 days. And then we look at future scheduling rate, right? We look at last

week, say we had 100 visits and then 80 of them scheduled a next visit. That would be an 80% future scheduling rate.

And 75 or higher is the number that you want to be and then with stats like I

see people they obsess about certain numbers and at the end of the day they're really about trends and like oh

clients it's like I got 98%. It's like well your fees are too low right or they're doing referrals or you're not

getting enough new patients. So, I think 75, 80 is a good number. For people that are 90, 95, 96, which we have clients

that do that, and there's nothing wrong with that, but like they're not advertising. They do a lot of insurance.

Um, and that's kind of like their model, and that's what they want to do. But I think 75 80% is a realistic number for

anyone to kind of hit. Obviously, if you're not advertising the it's easier to be higher. And then if you're doing

cash versus insurance, right? Because a lot of people drop out. But like I again like I like what's measured grows. And

then essentially you just have you want to get all your interested people in. You want to get those people that are in

started on care and finishing a plan. And then you want the ones that finish a plan to go into some kind of maintenance. And

that's all we focused on. And that was like the beginning of track was like just Excel sheets. We had a new patient

tracker. We put every single new patient on there and then we had every single person on a treatment plan on this Excel

sheet and our numbers went way up. I got taught this by a consultant and it just

it was an absolute game changer. It's so stupid simple. And we just put every single person that was on treatment plan

and like made sure that they were coming in at least like once a week or like and then made sure that they finished. And

then like our numbers went way up because what would happen is our numbers would go up. We got a ton of new

patients, someone's sick, someone goes on vacation, there's turnover and then the system gets stressed and then we go

down a little bit. Then I start like, you know, like getting on all these

people to do their activities, then the numbers go up. And then once we started doing that, we're just much more stable.

And I imagine you've automated a lot of those processes nowadays, which I think

these days, you have to have some degree of automation to make, you know, care

plan adherence or retention efforts and marketing work for you. Otherwise, it's

m I mean, it's no different than you managing all of those spreadsheets manually and hoping that nothing falls

through the cracks. AI automation software, that's great. It's like a combination of that with

humans is what you need cuz like the the doctor still just needs to say that it's

like, "Hey, Danielle, um you know, like based on what you have, this is what we

need to do." And it's important to be consistent, right? Like you can't go to the gym sporadically once every two or

three weeks and expect to get in shape. If you're learning a new golf swing, you can't work on it sporadically and expect

to get better. Same goes here with chiropractic. It's a therapy. We're retraining your body. So it's like to

make sure you get the times that you want. It's like we're going to make sure we schedule out all of your visits and

if things change, you could always reschedu it. And so you make a big deal that you talk tell the patient it's

really about getting the best outcomes. And it's true. It's not like we're making that up. And then the front desks, they just have that presumptive

close. It's like, hey, let's get you scheduled for all those preferred times. Now you have people that work in hospitals and pilots and people that

only get their shifts every two weeks. And those are harder. We still work at those, but like pretty much everyone

were like at least scheduling them out for a month. I have some clients that schedule out for a year. Like great. Uh

for us, we just for us, we just focused on like getting the next four weeks out.

I'm like a great example of the type of patient where so two weeks ago I was at

my chiropractor and I was kind of just chitchatting with the front desk before I'm leaving and we did not schedule my

next appointment. So last week went by. It was Friday and I was like hm I didn't

have my appointment this week and then I was like I wonder why. And it's because we didn't schedule anything out. It's

like a as I'm leaving, if you catch me on the way out, great. If not, uh the

way my brain works is it's out of sight, out of mind, and two weeks, 3 weeks go by and I'm like, hm, I haven't been in

there in a minute. It's Yeah, people do that. Like I did it with my dentist. I remember years ago

like I was back when I was seeing patients. I was, you know, staff text me, patients are showing up early. I was like, I got to get out there. I ran. I

was like, I'll call. They called me nine months later. I normally get my teeth cleaned every four months. and they say,

"Hey, Dr. Hashimoto, um, we need to schedule for that appointment." It's like, "Well, I was just there." He's like, "You were here nine months ago."

It's like, and I knew that I want to keep my teeth, right? I knew that it was important

like, uh, what I have some good friends that are dentists. I remember asking him, I was like, "What should I do?" He's like, "Just get your teeth cleaned

three times a year instead of two times a year." And that's a simple thing you could do on top of like, and I just knew

and I forgot. And people I remember I read this study. I can't remember what it I think it was like uh Tel Aviv or

something like that with a university and essentially I think the premise of the study is um people would get

shocked, right? It was different than that Mgrid study um but like they get shocked and they were

more likely to finish it because they were told they were finish it but they were also told that they could stop

anytime they want. It was the playoff of that Mgrim one with like the someone in

charge. I can't remember what it was. And like people people will finish what they started even if they know that it's

not good for them. Now, I'm not saying chiropractic is bad for them, but like that's it just makes a huge freaking

difference. And like for those of you that are not scheduling out at least two weeks at a time, like I highly, highly,

highly encourage it. Like it just I didn't totally believe it before. I was

just taught that and that was the only thing I knew like the people that mentored me that's what they did and

but like being on this end of it seeing all the data from all these practices and it it's just night and day it's

unbelievable. Well, not only scheduling out but reminders making sure that the patient

is I mean we're in a technological world. I'm not writing it on my calendar on my dry erase calendar in the kitchen.

If it's not getting texted to me 24 hours prior to I will probably forget

about it. So I think using those types of tools like they go hand in hand. Schedule out but then also have some type of tool

that's going to remind your patient and give them the ability to text you back and make changes if needed. Um I think

that makes a world of difference. Yeah. No, it's huge. And like the ones that have canceled and missed that don't have a future following up with them

doing regular recalls like we go through and do a regular recall and then like

most people I read this one marketing study and I think the number one reason

why people quit going to a business is because they forgot, right? It's not because of price or

service or whatever. It's just because they forgot. So like we'd always try to do that and some people they don't block

schedule. So, we used to do a birthday recall every month. So we pull up all the people that have a birthday this month that have been out for four months

to like two and a half, three years that paid over like say $500 and then we

invite them in for and I'm not a compliance but like we offered a wellness visit. Uh but we did cash so it

was like okay and we did a free wellness visit and as we're doing the exam and stuff like that we did the free wellness

visit we find out why they quit coming in. Most of the time they forgot or insurance changed or they got busy and

we'd offer them our membership and we'd reactivate several people a month just from that birthday recall. We'd call uh

50 to maximum 100 people a month and then we just go through and the nice thing about this is you'll sweep your

entire patient base over a 12-month period. But yeah, it's just you got to do recall

activity and then um you know during the visit like Dr. Stephanie knows this, like try not to talk about the weather.

Try to talk about things that kind of like move it forward, right? So, we'd have like different tablet talk

conversations about like movement, active versus passive. I'd talk about

celebrating progress and then always future pacing, like talking about next week we're going to work on this, next

week we're going to work on this exercise. And then some people get bored. So, like we just do different adjustments for the same thing just

because it was different. Because like if you go see one of your old friends, you don't say, "Hey, what's old and

exactly the same?" You say, "What's new?" Right. Yeah. I never thought of it that way,

but like So, and people I mean, I think we've all experienced this. Patient will come in. I mean, I always ask like, "Have you

seen a chiropractor before?" And I try to find out maybe why they're not going there anymore. Um, if they want to share, but often I'll hear like, "Oh,

well, they just it just they just kept doing the same thing." And so I wonder

myself though like do I fall into that pattern? Am I do my patients feel like I'm always doing the same thing? Because

to a certain extent I might be but I love that like there's more than one way to do an adjustment in most cases or

many cases. And so just yeah like changing it up so they distraction table

right we had one of those we had drop so we're going to do this or we're going to do a supine thoracic and prone thoracic.

We're going to and then I did gansson. So I did a bunch of seated cervicals, but as I got more associates, I had a

number of them that couldn't do them. So I got away from those. But like we did different adjustments, you know, face up

cervical, face down cervical, and we just mixed it up just cuz. And then we'd have like just different table talk

conversations, right? Whether you're evidence-based, subluxation, vitalistic, you could just write up and you could go

to chatbt for ideas. And they're just little conversations. It's like on the third visit, this is after everyone

signed up, they would have a laminated uh recipe card. It's like, "What happens when you quit taking antibiotics?" And I

just walk in the stall and say, "Oh, hey, Dr. Stephanie. How's it going?" He's like, "Oh, do you figure out the answer to that question?" They're like,

"Uh, what?" I was like, "Well, have you ever taken antibiotics?" It's like, "Well, it's like, do you know someone?"

And then we talk about it and we say, he's like, "Well, if you quit taking them early, right, it could come back."

back. And then I say he's like, "Well, if it comes back, can you treat it with the same kind?" And then sometimes, yes, but sometimes it has to be stronger. So

I say, you know, in the first visit, we shared kind of like all the things you came in for, what you're trying to go for. Second visit, we kind of went over

the X-rays and the plan, and we talked about it. We scheduled all these visits, and then we talked about you wanting to

go golfing three times a week and making that trip with your kids and grandkids to Italy this summer. And we talked

about what you have to do to get there. And so what do you think happens as you

start feeling better and less pain and we start doing less work? Do you think we're going to get to that goal in time?

It's like, well, probably not. It's like exactly. So, you know, and I just even

though they prepaid, they schedule their visits, I sold them again on the third

visit. And it's just doing that kind of stuff. And then when you get to retention, like

it's not the last visit. Yes, we talk about it near the end of their plan, but it was all those little things. And

you know, like yes, sometimes you talk about like briefly about sports and then I was like, hey, you see that injury?

I always stayed out of politics, but like that was just me. No, you can't go there. Well, it just my favorite thing is like,

don't get me started. Doesn't it's like no matter what they say, you would just say don't get me started.

Polar opposite like don't even get me started. It's like let's have you lay down. It's like it's like like how's that doing uh with your golf swing and

stuff like that. But it's that one is a great advice. I'm going to start using that in my dayto-day with my kids.

Everyone started and this just came to mind. I I had been going formally to see

a chiropractor and they did they they scheduled me out for almost a year which I mean I don't care. I don't mind. Um I

knew ahead of time when I had to go so I could plan for it and it was fine. But I got to the end of that year and like

It's like they forgot. I I don't know. No one there was no re-exam. There was

no let's schedule your next appointment. Like I guess they didn't want me to come anymore. So So I never went back. But

like I mean don't don't do that. So if you are scheduling out that far, you've got to have a system where you're

staying on top of this person is approaching the end of their visits. Like what are you doing with them next?

Like that patient has to know. Um and you can't forget about them. Uh, I feel

like if you do that, it's hard to it's hard to come back from that. I really I really do.

And if their card's on file, you're probably going to keep charging them, even if they're not coming in and you're

going to owe them a lot of money. Yeah. Like we talked about it like on the third to last visit, but we talked about different things, right? You know,

we just said like, "Hey, you're going to get better. You got to make your visits. You got to do your home exercises. We got to break your bad habits." And then,

you know, like as we're moving along, it's like, "Hey, are you still staring down at your phone?" "Yeah, I saw you in

the waiting room doing that today." It's like, so it's like you're going to continue doing dumb stuff. Yeah,

they're watching that. You watch the patients. I watch people walking through the parking lot sometimes if I happen to be

like out in the waiting room. New fear unlocked. We had a one-way glass. So like where my

office was, I had a one-way thing. I could see into the waiting room. Oh, that's terrible. So like I could see

kind of like what they're doing is I'm doing like soap notes and stuff like that and yeah them in a lie.

It's pretty cool. But like um I had that and yeah it's you know I just had that

conversation with them. It's like you're going to keep doing these things in your golf swing. So I was like you know it's like just like you do maintenance on

your car, maintenance on your teeth, maintaining anything that you want to keep, you probably want to continue with

these results, right? It's like yeah. So, we have uh you know, maintaining things a lot easier for us. It's a lot

cheaper. That's why we have a membership. I just go over what our membership is and then give them the sheet that

explains it. They think about it next visit, you know, answer any questions and, you know, not everyone's signed up

on them, but it's like 104, 103 for sure that would go on it. Some of the people

they'd say, I would rather just buy a block of visits. I don't want to go on like any kind of a recurring one. And,

you know, we were fine with that one, too. Mhm. But you're doing that ahead of time. You're not waiting for the last

visit. You're not saying oops and contacting people after they're already

gone. Like it's just part of the process. Yeah. And then we did a huddle right on the huddle of the day. We could see

anyone that had milestones, people that are going to ask for video testimonials, people that were going to ask for reviews. We'd have it like, you know,

like they'd have a certain appointment type if they didn't have any future visits, you know, if they owed money. And like it was a quick standup. We did

that in five to seven minutes, right? So, the huddle should be quick and we did a standing meeting on purpose

because if you sit, people take their time and that just helped us allowed us to

serve more people in a shorter period of time. Yeah, I love it.

Um, you mentioned something earlier I wanted to bounce back to and it was you mentioned finishing projects. So,

what do you mean by that? Well, it's kind of like inventory that sits on a shelf, right? Until it's sold,

it doesn't benefit or serve anyone. So, a lot of people will start projects and

never finish them. Um like there's uh there's a book

essentially they go over like um OKRs, objective and key results. Like it's like they said like Google's secret

weapon. Um but like essentially you have and then some business plan coaches will call it rocks, right? you have your big

thing that you're going to work on and here are like the five things that need to be true for this thing to be accomplished and

I did that in practice and then as things come up during the week during the month we call those issues right and

then like we just write them down we wouldn't try to solve them all immediately and then if there are smaller issues we'd solve them in a

weekly meeting and then if they're bigger issues maybe it goes to a monthly and then if they're really big issues

where we're really changing things we do them quarterly and it's actually pretty

similar in software. Software is a little bit more well a lot more agile than that but like yeah like I just have

all the list of we'll call them to-dos or issues whatever you want to call um

you know it could be like better clarity on a pricing sheet it could be better clarity on like explaining insurance

versus cash and deductible or like better scripts for front desk. So, like

we just write down all these things and then, you know, like I'd have certain days where I'm busy with patients. I

call them shovel days, right? Like I'm just like shoveling away and my goal is to finish my shift, finish my day with

no soap notes and maybe getting one or two things done. And then I'd have kind of like my busy productive days and like

Dan Sullivan, business coach, he talks about buffer days and focus days and free days. And then like I'd actually

schedule out time to work on these projects. I'd schedule everything. And it's like a lot of

people think they could be more productive and more profitable by having more patient hours. Um, we actually like

I worked on my business Tuesday morning until lunch. Uh,

Thursdays I'd have off and I just work on the business primarily. And then, you

know, like we do training and stuff like that. And those that don't train can't complain, right?

Yeah. finishing projects big one and then yeah I talked about um didn't really reducing

operating costs and AR like with operating costs like you know like

Danielle talked about it like you know using AI automation or integrations when possible

um and I know like chairoach like now you could take or I don't know if that's

officially released yet where you have the AI summarizing the intake forms and then putting that into the subjective

So that's like really it's like and if people are using AI with that kind of

stuff like that's a no-brainer. AI is going to be great for writing emails, editing emails. Um you know like we have

a thing where it's like chasing down uh that's coming out in a month where it's going to chase down leads, qualify them,

book them, schedule them for an appointment, handle like phone calls. But like AI can't do everything. But

like those kind of things, it's absolutely amazing. And if you're just hand typing in soap notes, like you're

going to get left in the dust. Yeah. And on that note too, I think that's important is like to adopt like

newer strategies and especially some of these AI things. It does to a certain extent require you to um like as a

provider to change some of your behavior. Um like the AI intake is a great situation. I actually, this is

going to sound terrible, but I love sitting down after I see a patient because I have time to do that now. It was harder in practice, but a new

patient going through their paperwork, going through my notes, really organizing that first soap note like

with all the history, all the things. It was just very like task oriented thing to me and I just loved it. And oh yeah,

don't forget this and whatever. You just make it like the greatest note ever in the world. And so I have the AI intake

summary now. And it's it was tricky at first because you have to like be okay with letting like you kind of let

control of that a little bit. you're you're handing that over to someone else and like letting them do it. I mean, it's the AI thing, but um but that's

behavior modification. Like I have to get used to, okay, I'm not sitting here and just doing that by myself anymore.

Maybe I'm going to proofread the summary, which you should because you have to make sure it's correct and whatnot. Um but getting used to being

okay with letting it do that was something that I had to get used to. Um the same thing now with the AI scribe. I

mean, it's like the best thing since sliced bread. I don't know how people are practicing without it. Um, but I

will say like I need to modify what I'm doing during my visits to fully take advantage of it, but if I would just

change what I'm doing during the time that I'm already spending with that patient, then I would have to spend

almost no time at all on looking at my lo my notes later because they will be totally complete and already done for

me. And so, yeah, I just had to throw that out there because it reminded me of that like AI is amazing, but you got to

you have to like let it into your life and like adapt from the standpoint that like you're going to have to change your

behavior to maximize what it can do for you. And it feels weird at first, I think. At least it did to me. But, um, I

mean, it's going to give you time back. And time is money. So yeah, I'm kind of jelly that it's uh it

wasn't around when I was practicing. But like yeah, some people get lazy.

Like I have like one of my um clients, he took it away from one of his providers cuz he was lazy cuz he didn't

re proofread the AI. He still use your brain. He was just letting the AI do its thing. And it's just like he was reading

the notes and they do a lot of personal injury so you can't have it. And the AI is not going to get lefts and

rights correct and stuff like that. He just like so he took it away from that provider. He's like, "You no longer have

AI. You have to go back to the old school way of doing it because he lost his privileges."

And then so he has to do it the old way because he was just lazy. And you still have to know what good looks like. Like

I'd say I'm quite strong at like copywriting. So like I could be very efficient at writing like sales emails.

Um you know like we use it on our engineering team but like it's not perfect. You still have to know what

good stuff is. Like we're just about done migrating databases. In just a

simple task of translating from this one language to that, it screwed up a ton of stuff. So they still had to like

handcode a bunch of stuff. So like AI is powerful, but like it's always

trying to appease you. So like it's like giving you like sometimes they'll give me an answer and I was like that's not

right. It's like oh yeah, you got me. It's actually this. It's like like you still have to do that cuz like if you're

playing around with your own AI like it knows kind of like the stuff that you want like you've trained it and then you

call it out like sometimes I'll call out like chat GPT or Perplexity and like I'll use both of them quite a bit and

co-pilot and yeah they're just like oh yeah no that's not correct. It's a tool. Like you still

have to you have to know the foundation and in using the tool. It's like you

wouldn't go airrate your yard with a nail gun. Is it going to work? Maybe. Is

it going to cause issues? Probably. A really funny example. And I actually have one too. I had to remove my

bathroom floor. I mean, did I have to? I probably could have hired somebody, but I literally there were like these little

square tiles and I'm like, "Oh, I can get these out." I literally went in there with like this little chisel and a hammer. Like this is going to be a

breeze. No, I actually cuz my friend needs to do this. I found the picture the other day. I had chiseled out like

these two tiny little squares right next to each other and it took like 20 minutes. So, um that was a no. I went

the next day and I rented like a actual I think they're called demolition hammers. Like it was ridiculous. But

that made very short work of it. So like yeah, you need the right tool and you have to use it properly. um to maximize

things. So, don't don't try to chisel out your bathroom floor. Yeah. And then, you know, like uh

there's like a video editing software like there's a ton of them out there, but like Opus Clips is pretty easy to

use. And honestly, like and then running like meta ads is like getting so stinking easy. Like if I was in practice

now, I'd probably be running my own ads and editing videos and running them like

side by side all the freaking time because it's getting really really easy.

And then um yeah, I guess the last thing forgot to mention this is just if you're running insurance like running your AR

reports and then just breaking it down 30 60 90 120 and then just breaking out

by pair. But like when we started doing that and then like collecting an estimated amount even before they got

the service like that made a difference like because we did insurance initially and we do the service and then you find

out it's not covered. So like we'd always make sure we have a card on file and then doing that and I know Kathy

Mills Chang which you guys have on like always teaches that and that was huge for us too.

Yeah. I was talking or we had an office earlier today or yesterday that um I

don't know front desk was saying something about like well when we have a deductible we don't know or we're we're

not allowed to collect upfront what the fee is going to be and I would just say to that office I mean you need to double

check that because at least where I practice I mean we we're given the amounts we're allowed to collect upfront

and that patient is paying me when they're here for that dollar amount. Um,

we're not billing people after. I mean, we will if there's a difference or they get a credit if there's a difference, but the way we practice and the way I

did full-time, we we pretty much always knew what it was going to be and that was due at the time of service. And the

patients knew that though. You just you just have to communicate to them like this is how things work here. But yeah,

if you're uh if you're just billing things out and waiting for it to come back to find out what you're going to

get and not collecting, that's I would not be doing that if I didn't have

Yeah. Plus, like it takes several times to collect it, right? Like I felt like

it took seven, six, uh, eight or whatever times to collect

it and then we're like mailing out stuff like all those attempts versus like yes, you collected it up front. You have a

card on file and you just charge them the difference. It's huge, right? You're wasting time on printing stuff, mailing

stuff, postage, and then chasing chasing chasing money. Yeah. It just really

sucked. And yeah, we got out of that. And then like another thing I see

practices mess up is someone calls on the phone and they're trying to explain deductibles, insurance, and co-pays.

They get confused and say, "Oh, let me check my schedule." And what they're really politely saying is, "I have no

idea what the heck you're talking about. I'm going to call someone else." Yeah. Like, you know, training your front desk

on the phones and like getting them into the office. Obviously, you're not lying to them. If you don't take any

insurance, um don't say you take insurance and say you're going to verify their benefits. So, like

yeah, you know, those are there's just so many things that you could do to make your business better and it can seem

overwhelming, but like you know, like I just say pick a couple of things like every quarter we go through like these

five pillars and just say any areas in our quarterly meeting that we could optimize our business. Yeah, love it.

Um, that was super powerful. I think I probably learned um the most from you

that we've I learned at least from any other guest. No offense any other guests. Uh, but no, this was awesome.

Uh, thanks for coming by. So yeah, whether it's raising fees, improving retention, automating busy work, um it's

really clear, you know, I think what we covered today would be super helpful for for any practice. And really, you know,

everyone says this, it might sound cliche, but work smarter, not harder, but it's so true. Um, you know, if you

can work smarter, not harder, it's going to leave you more time to work on other things or just go do something enjoyable. Spend time with friends,

family, whatever it might be. Um, and work on growing. So here's another one, too. you can't be in growth and

protection at the same time. So, um I feel like a lot of practices are operating in protection or they're in

like that kind of like sympathetic state and um just a little bit of planning and

and looking at some of these items we covered today I think would make um a big difference for those people. So,

thanks for coming by today. Thanks for having me. Yeah, agreed. Big thanks to Dr. Notashimoto

for walking us through each strategy. There's a lot here to reflect on and even more to apply to your practice. And

if you want to learn more about his work, head to trackstat.org or find him

on social. Yeah. And if today's episode gave you ideas, inspiration, or really resonated

with you, we would love for you to subscribe and share it with a colleague. Thanks for tuning in to Chairocast.

We'll catch you next time. Thank you for joining us on this episode of Chairocast. Insights for modern

chiropractors brought to you by Chairo, hosted by Dr. Stephanie Brown and Danielle Havas, 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. [Music]