Have You Been Skinny Dipping?

"It’s the economy, stupid" was the catch phrase used by Bill Clinton’s political campaign preventing George H. W. Bush from enjoying a second term. A similar economic theme was used by Ronald Regan (“Are you better off today than you were four years ago?”) to unseat Jimmie Carter. I’m guessing the economy is likely to play a role in next year’s presidential election also.

Which begs the question. Have the recent economic developments caused your practice to take a downturn?

I had almost completed my four-hour speaking gig at the Missouri State Chiropractors Association Saturday night when the subject of the economy came up. Apparently, some in the room were of the belief that the economic downturn was responsible for the challenges they were facing in practice. That, combined with an earlier whining from a chiropractor who felt victimized by Medicare, prompted a rant that I’ll attempt to present more constructively and with greater self-control.

Spoiler alert: if you’re allergic to the truth, or prefer to be a self-righteous victim, please don’t read any further.

If virtually every chiropractor was dipping into his or her savings to stay afloat, I might be more sympathetic. But the fact is, some chiropractors are having their best year ever. This alone causes one to question the conventional wisdom that a general economic downturn automatically means that chiropractic practices will take a nosedive as well.

Warren Buffett famously observed after the economic dip that followed 9/11, “You only find out who is swimming naked when the tide goes out.” In other words, a robust economy allows even marginal businesses to survive. But when times get more difficult, the flaws, shortcomings and lack of a sustainable practice model are revealed. That may be what we’re seeing today among some chiropractors who find their practices exposed as the tide recedes.

They’re simply reaping what they sowed, such as neglecting their patient education duties, being too dependent on insurance reimbursement, or using shame, guilt and annual care plans to get patients to continue care they didn’t want, drying up referrals and reactivations in the process.

Rule number one: when you find yourself in a hole, stop digging!

While you can’t do anything about the past, you can dramatically change the future. Here are seven suggestions. They won’t turn things around overnight, but if done consistently, they can get you back on track. I promise.

1. Increase your marketing overtures. Please don’t make the classic small business mistake of cutting back on your marketing when things get tough! That will practically doom your prospects. If you don’t have a website, get one. If you already have one, add some energy to it—more pictures and more compelling information of interest to new patients. Grow from within by resuming the patient newsletters, reactivation postcards, birthday greetings, and New Year’s resolution reminders you used to send. Hold some patient lectures. Conduct some patient focus groups. Be proactive!

2. Find your tribe. Abandon the notion that you can appeal to anyone in a 5-10 mile radius of your practice who has a spine and is warmer than room temperature. Differentiate yourself. What types of cases do you especially enjoy helping? Find the people who have given up on traditional methods. Befriend the health food store owner, the midwives, acupuncturists, yoga instructors, Pilate studio owners, etc. Which practitioners are currently serving the constituency you’d like to serve? I promise that there are people in your vicinity who need your help and for whom money is no object. Trying to be everything to everybody is impossible.

3. Improve insurance reimbursement. Many believe that insurance money is all gone. Not true. Are carriers pickier these days? Of course. If you want to get every penny you deserve, you’ll probably need to improve your documentation. Use outcome measurements to show functional improvements and put an end to medical necessity denials. You’re probably leaving money on the table from down coding. Get every penny you deserve. Up your game.

4. Focus on stress and nerves. You could probably list three or four things that would improve your patient education. Implement them! Stop communicating with patients as you do insurance companies. Instead of bones and biomechanics, explain subluxation as a stress response. Explain their improvement as the result of reviving their ability to self heal, mediated by the integrity of their nervous system. Pay now or pay later. In other words, either invest in world-class patient education now, or you’ll pay later with a relentless appetite for more new patients. Enthusiastically and creatively tell the chiropractic story. No selling required. Just tell the simple, gorgeous truth.

5. Stop watching the news. Many of the chiropractors who find things slowing down can tell me what the stock market did yesterday and the latest drama showing up in the headlines. If you’re not ready for a total media fast, at least go on a strict diet! I’ve covered this previously, but suffice it to say that the news 1) advances a spirit of fear (unhelpful) and, 2) thrives on bad news (to attract eyeballs that can be sold to advertisers) that you can’t do anything about. Thus, the media turns consumers into powerless victims. Don’t fall for it. You’re not a victim. You know the truth. Unplug!

6. Redouble your staff training efforts. Not only is your support team the true gatekeeper of your practice, they also serve as your eyes and ears. Do you know how well your front desk CA is fielding questions on the phone? Can he or she recognize referral opportunities? Does every member of your team understand chiropractic principles, its nervous system focus, and potential whole-body effects? Until the holes in your appointment schedule are filled, use every available moment to conduct chiropractic staff training. Use staff meetings to role-play possible telephone scenarios. This is the “practice” of practice.

7. Focus on self-development. Your practice will grow only as you do. Look for opportunities to stretch and force yourself out of your comfort zone. Have the difficult conversation you’ve been putting off. Acquire public speaking skills. Tour some practices that are helping more people than you are. Ask for help. Ask more questions. Journal. Put words to your feelings, worries and challenges and notice solutions appear. Humble yourself and show up more curious and less judgmental. List, and then question your assumptions about patients and practice.

When I was growing up in Olympia, Washington in the 1960s, there was a saying that “When Boeing sneezes, Seattle catches cold.” Same thing here. All of us at Patient Media are deeply committed to your success. We only thrive when you do. How may we help?

Originally posted December 4, 2012