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October, 2011

You Can Make Excuses or You Can Make Money

By Mark Mandell, DC, MBA

If you are running your practice the same way you did five years ago, then you are already traveling on the unfortunate path to going out of business.

Businesses evolve or perish. Blockbuster is dying as video rentals morph into the digital age. Borders bookstores failed to successfully adapt to Internet book sales and went belly up.

Polaroid instant cameras were out-hustled by digital cameras and view screens. And in today's new health care market, chiropractic practices have to respond to the changing economics, not just to thrive but also to survive.

Why the Three-Way Practice Model Fails

When my grandfather practiced chiropractic 75 years ago, cash was the only game in town. Forty years later, my father followed in my grandfather's chiropractic footsteps, but prospered in the insurance heydays of the '80s and then the personal-injury model of the '90s.

As a third-generation chiropractor, I practiced amid managed care at the turn of the 21st century. Currently, I see many practices crash by trying to navigate all three types of practice – cash, PI, and managed care – into a single practice. Here's why chiropractors fail in that three-way model and why whole-body care is the next big stage for chiropractic.

Many patients want to utilize their health insurance coverage to pay for their chiropractic care, so chiropractors join the patients' insurance networks. The average annual value of those patients with today's co-pays and third-party reimbursements is $50 per visit for 12 visits, for a total of $600. Then chiropractors try to convert those insurance patients into cash-paying customers and wonder why it doesn't work.

It fails because insurance patients mostly want to get out of pain and use their health insurance to get themselves well. They paid into that system and want that system to take care of them. Conversion of these folks requires an immense effort that, albeit a worthy one, may not garner cost-effective results.

In a similar fashion, trying to convert the stereotypical personal-injury patient into a cash patient is highly challenging.

Although they may have a higher average annual value as a patient, because of the higher per visit fees and higher average number of visits, these folks tend to want to get out of pain and for the health care system to pay for it. For them, the end of coverage means the end of care.

Do Your Patients Want the Services You Provide or Something Else?

The struggle chiropractors have with trying to convert these patients from relying on insurance to paying cash for treatments is that chiropractors are focused on trying to sell services first instead of what these patients really want. These same insurance and personal-injury patients who refuse to pay cash for their chiropractic care will then go and purchase pain-relief products from the drugstore, the Internet, their favorite home shopping channel, department-store and other catalogs, and anywhere else that offers a promise of relief.

The advice patients are getting from these retailers is a pure sales pitch, and yet they willingly pay hundreds of dollars for the latest gadget – from a heating pad to a pillow or salve.

Have you run into one of your patients in a big-box retailer purchasing such a product? How much of a chump did you feel like? I ran into one of my patients buying cases of supplements at a nutrition store and realized that I had failed by never talking with her about the value of nutrition.

The easiest first step in converting patients from insurance to cash is getting them to pay cash to you for home-care products. Since patients are already coming to you for their health, you owe them the best advice, including appropriate product recommendations:

  • Will a brace stabilize their low back?
  • Will TENS/EMS help?
  • Will a hot or cold pack ease their pain at night? Can elastic therapeutic tape work for them?
  • What multivitamin would you recommend?
  • Would an anti-fatigue mat alleviate their stress when standing?
  • Which pillow would best fit their neck?
  • Which exercise ball and home exercises are best for them?

Don't Withhold the Information They Want

If you are withholding this kind of information from your patients, you're not accomplishing anything except hurting yourself and your practice, because they will seek the information elsewhere – and take their spending dollars with them. Offering patients specific recommendations on ancillary products that can improve their condition is not becoming a salesperson; it is a duty a doctor owes every patient.

You can then choose to let the patient fend for themselves and purchase the product elsewhere, or offer the convenience of selling them the product and making sure they are properly trained to use it.

Familiarity: The Key to Timely Conversion

The sooner a patient is more familiar with paying cash to you for products, the easier it is to convert them into paying for their wellness care beyond the insurance coverage period.

From back braces to TENS units to pillows and anti-fatigue mats, many chiropractors have realized thousands in monthly profits just by making specific product recommendations and then offering them to patients.

Once a patient is used to paying for products outside of insurance coverage, it is simpler to explain that wellness or maintenance care is not covered. At that point, patients are more accepting and understanding of the cash model because they have already been participating in it.

Major medical and personal-injury insurance are essentially pain-relief and symptom-focused institutions. Good health, however, goes far beyond the mere absence of pain and symptoms, and, of course, chiropractic care is a major component of a patient's good health.

Stop the Excuses, Reap the Rewards

You have some simple choices to make that can dramatically impact your practice future. You can continue to make excuses for not making product recommendations to your patients. You can continue to make excuses for not being a whole-body health care advisor. You can even continue to make excuses for failing to transition your patients into wellness or maintenance care.

You can do any or all of that, but instead of making excuses, I recommend that you make money and make your patients healthier at the same time by offering healthy product choices and leading patients down the path of ongoing, regular chiropractic care.

Take the first step toward evolving your practice and your patients and you will reap the benefits.


Mark Mandell, DC, MBA is a third-generation chiropractor and the president of The Vitality Depot, a chiropractic supply company. In addition to his DC degree, he has an MBA in management and a BS in consumer economics Dr. Mandell can be reached at 866-941-8867 or by e-mail at for more information.

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