EPISODE 466: The Barriers for Patients

Hey, chiropractors. We're ready for another Modern Chiropractic Mastery Show with Dr. Kevin Christie, where we discuss the latest in marketing strategies, contact marketing, direct response marketing, and business development with some of the leading experts in the industry. 

Speaker: [00:00:00] Welcome to another episode of Modern Chiropractic Mastery. This is your host, Dr. Kevin Christie, and today I'm gonna bring you a solo episode and I'm gonna talk about some of the different barriers that you may be putting up in your clinic. Uh, sometimes intentionally and sometimes not, or sometimes. You are willing to, uh, have the exchange of what that may be, but there are certain things that are barriers for patients.

And we had once, uh, done a whole, uh, coaching lesson, I think we did on the Mastermind as well, where we talked about the friction-free, free patient experience and everything from new patients to existing patients to inactive patients. Uh, what would it look like theoretically to have a friction-free patient experience?

You know, there's things like having online scheduling, having the phones answered quickly, and getting back to them. Being able to schedule new, new patients within 48 [00:01:00] hours. You know, making sure your social media is monitored for direct messages. Online paperwork. We kind of ran through this whole thing, right?

Just, you know, short wait times, uh, treatment plan handouts and chiro up reports. We, you know, having payments stored on file. There's a lot of things that could really help smooth out that process. 'cause frankly, in healthcare, uh, it's, it's very, very friction full as, as we can imagine. Uh, but then when, you know, you design your practice and some of your systems and processes and how you do things, um, some of them can be, can be barriers.

And that's, uh, not uncommon. It's not uncommon. But again, we're gonna roll through these and some of them. You're gonna be okay with, and, you know, there's an exchange to that and I, we've done this in our clinic and I'll, I'll outline, uh, some of that, right? Um, but some of the barriers, I'll just kind of go down a list and, and, [00:02:00] and, and briefly chat about it.

Obviously, if you're out of network with insurances, that's gonna be a barrier for a lot of people, right? So if you're in network with every insurance, there possibly is. You've removed that barrier and you are more than likely the most affordable option they have. And so you've, for the most part, taking a lot of the finances out of it, right?

You're, you're in network with all the insurances because frankly, when you're out of network, you might get, you know, 10 people that want to be new patients, and sometimes you don't even know. That they don't become a patient of yours because of this, but you might, let's say you have 10 call and you know, they, they inquire about being, you know, a contracted provider with their insurance.

And you're not, and you know, maybe seven of them become new patients, or six of them do. And so you've lost three or four because of that. Whereas [00:03:00] if you were in net worth insurance, they would've more than likely scheduled. Those are the ones that call, uh, there's quite a few that might find you online.

Uh, you know, Google or a friend refers and the first thing they do is look to see if you're in network worth insurance and you're not. So they don't even bother calling. So those are kind of the silent ones you lose. Right. So, and, and, and I'm not. Saying it's right or wrong, my clinic is, is outta network.

Uh, and, and I knew that I used to be a network. I went outta network. I knew that was gonna be a barrier for some, and I've lived it and, and we've been okay with it. Um, but it is a barrier. Uh, and I think we all know that that's one of the bigger barriers. Okay. Another, you know, barrier is, and we recently did this, but for a long time we were outta network with insurances, but we billed the out-of-network insurance for the patient.

Um, and we no longer do that. I think it was a couple years ago we stopped doing that. And so we, we, we don't bill the out-of-network insurance now, we'll give them a super bill if they request and they can submit it, [00:04:00] but we took that layer out. Okay. That one didn't really seem to bother anybody there.

Right. Uh, but that is, that is another barrier obviously. Um, your clinic hours, right? Are your clinic hours designed more for you than for what your patients are? Right? If you, you might work in a particular area where if you had, you know, 7:00 AM start hours, a few days a week, that would be filled early and you'd see more people, but you're not a morning person and so you start at, I don't know, 9:00 AM it's fine, right?

Uh, you could be at an area where people won't need appointments till 7:00 PM but you don't want to get home too late. And again, totally fine. But have you developed clinic hours that are more conducive to patients, or are your clinic hours putting up barriers and how much of that can you sustain? You know, some people do Saturday morning hours.

That's opens up a whole. World of visits for in a particular month, right? You get people [00:05:00] that might see 10 people on a Saturday, and you do that four times a month. That's 40, uh, appointments. And how many of those would've come in on Friday if you didn't have Saturday? Like, there's gonna be a certain amount that would've, uh, come in anyway, but a certain amount that wouldn't.

And you gotta figure that out. But clinic hours can be a barrier. Okay? Um. You know, we talked about being outta network or in-network and, and so your cash rates, you know, some people, the cash rates are too high, and that's a barrier. I'm all for not being commoditized. I'm all for, for, as you know, charging what you, uh, are worth.

But there's a lot that goes into being able to have high cash rates and enough people seeing the value and being willing to pay that in your schedule, being. Close to full for the week. Uh, there's this kind of thing going on where, uh, a lot of rehab chiros are, are charging a [00:06:00] lot of money, uh, per hour, like four or $500 an hour, which.

You know, there's a, I, I love when people can do that. I've, I've had James Spencer on my podcast some years ago. He's someone that built up to that, but he's someone that's built up quite an expertise to get there. Sometimes people are put in the cart before the horse and the cash rates are not indicative of what the public perception is of their.

Particular skillset. And so yeah, they might, the patients they are getting are paying a lot, but they only see 12 people in a week. And it's not enough money, uh, to build a, a clinic and a team there. And so you have to, uh, you know, you have to evaluate that. Are, are your cash rates too high for the time being?

Do you need to build up your expertise over some time? Do you have to be in high demand? Like do you have to become. James Spencer or Greg Rose or uh, you know, Brett Winchester, something like that where, yeah, people will pay it 'cause they see the value, but, uh, I, I love higher cash rates, but it can be a barrier for some [00:07:00] patients, right.

Now your patient's schedule availability, like I treat patients twice a week. Um, that's a little bit of a barrier. There's no doubt about it. And so it's not necessarily our clinic hours are a barrier, it's just my particular patient's schedule availability. Or are you so busy that a patient calls and you can't see 'em for two weeks, or you're trying to reschedule a patient, you know, they come in on Monday and you gotta get 'em in another time this week, and your patient, you're already filled up.

And so there's a barrier, or you just have so much, have so few availabilities on your schedule that the patient's like, yeah, I would, I'd come in one more time this week for my care, but you only have Thursday at 5:00 PM available, and I can't do that. And so now they're missing appointments, right? And so your availability can be a barrier as well.

I think oftentimes the 30 and 60 minute appointments is a barrier. Time is a barrier. Uh, there's a, again, this perception that time equals results [00:08:00] and in some cases it does, some types of patients it does. Uh, you, if you spend too little time, it, it packs it for sure. But if you pulled. A hundred people and, and if the results were the same, would they rather come in for 20 minutes or 30 minutes or 60 minutes?

The vast majority would like to come in for 20 to 30 minutes. Now, I think we've equated people being okay with 60 minute appointments with physical therapy, but a lot of those physical therapy patients are post-surgical, and that's an event in their life that they know they have to take serious for.

Eight weeks or whatever, right? Three months and they'll be done. They, you know, had ACL reconstruction, but a lot of people don't want to spend 60 minutes twice a week at a chiropractor's office. There's some that do for sure. It's a select audience. Um, but time can be a barrier. So keep that in mind. Time too much time can be a barrier.

Uh, [00:09:00] compliance. I have a saying that compliance is the thief of joy. And having your office be compliant in everything, we have to be compliant in HIPAA and all the things and, and billing and, and all that can be challenging, right? Um, avoiding dual fee schedules and, but being able to. Bill Cash patient this, but the insurance that, um, you know, we've recently implemented Chiro Health USA for that reason.

'cause we, even though we're cash base, we do have auto and we have, uh, Medicare and we just wanna make sure we're compliant. So we use Chiro Armor for our compliance training and, and, uh, and making sure we're compliant. And then we implemented Chusa. For that. Uh, but getting people to sign up for Chusa, you know, we, there's a lot of com communication that goes around that and, you know, and you gotta make sure it doesn't become a barrier, but having your clinic fully compliant can be a barrier for some, right.[00:10:00]

Uh, and that is a reality. But, uh, so far, so good on implementing. Which has been cool and it's allowed us to feel good about how we're billing our personal injury and our cash and doing everything compliant. And overall, patients have been very, um, accepting of that. Right. Next is not having online scheduling that is a barrier for some people.

I don't think it's a, a huge one, but it is a barrier. I got, I'm halfway there. I got a lot of barriers. So there's a lot of barriers here. And again, the point of this is not to say you shouldn't be doing some of these, or you shouldn't have some of these, just letting you know that they can be a barrier and.

What my recommendation is, I'll kind of give a little halftime here, a little halftime pep rally or halftime speech is to overcome some of these barriers, you need to layer on really good communication. You as the doctor and your team has to have [00:11:00] really good communication with patients, right? If you're adding over insurances, there has to be good communication on why it's still.

Valuable for that patient to come in and pay cash rates if you're, you know, trying to sell cash packages. 'cause you're a cash practice. You have to have good communication around that. If you're implementing Chiro USA, you have to have good communication around that. Right. If you have high cash rates, you better have good communication with the patient and report findings and treatment planning and visit the visit and, and all that type of stuff.

You, you can overcome some of these with a world class experience for the patient and that world class experience is gonna be your clinical chops. You gotta have that, which is again, I think was part of the struggle with some of the early dcs trying to do certain things. Like huge cash rates and stuff like that is 'cause they don't frankly have the, they're not a lot of times great enough clinically to warrant that yet to get [00:12:00] there.

You'll get there, but it's just not yet. Um, so you have to have that world class experience. You clinical chops, you gotta, you gotta be good. You gotta be great, alright. Your communication with the patient has to be really good. Your communication, uh, with the team and the team, communication with the patient has to be really good.

Okay. So you gotta have a nice office and you gotta have all those things to be able to, to warrant some of this. You have to be in demand. 'cause they have options. When you put up a lot of barriers, there's other options. If, if you're in high demand or your clinic is, people will accept the barriers because they know the values there.

Okay? Uh, another barrier is limited social media and Google presence. Okay? If people can't find you, that is a barrier. Uh, if patients are being sold packages or payment plans, which I'm for reasonable packages, you know, um, nothing crazy. We sell very reasonable treatment packages and payment [00:13:00] plans. You, you, you know that you need to have communication around that.

But some, some chiropractors where it's almost like you have to buy a package or a payment plan. That can be a, a barrier, uh, requiring credit card or deposit on file for new patients. I have some clinics that do this and they actually do well with it, and it works well for them. They're in high demand, they've got great clinics.

They're weeding out the no show. Nothing worse than a patient that doesn't show up or late cancels. So, but that is a barrier. There's gonna be some people that aren't gonna do it, but that is, um, to offset that. Late cancellation fee, um, that can frustrate some people, but it can also weed out the flakes, which I totally get.

But again, just keep in mind that if you do that, it'll be a barrier for some people. But it can def, you know, if you do this right, if you work through [00:14:00] this and you build up your expertise and you, and you become high demand and you do a great job and you have a remarkable experience. You can start adding some of these things and you can really curate the patient base you want, that you like, you like 90% of your patients, so like a lot of chiropractors hate half their patient base.

You get frustrated. But if you do a great job, you can, you can do this and you can really cultivate the patient base you want and use some of these barriers to do that. Right. Um, poor communication capabilities with your office, right? Patients. Can't ever get ahold of you and leave messages and they don't get called back.

They, there's not a, a way, you know, like maybe there's no two way texting capabilities. There's no online scheduling. Um, maybe the e you, you offer your email address, your clinic email address on your website or whatever, and, but you don't answer the emails. Um, maybe you do a lot of Instagram stuff, but no one's monitoring your direct [00:15:00] messages and people are messaging you through there for appointments.

Um, so those are all. All examples of barriers of poor communication capabilities with your office, right? Um, bad location. Parking. No parking. That can be a barrier for some, uh, some places of business. If I know that parking's impossible or it's hard to get to, I, I don't even go, uh, check that out. Long wait times.

Right. Do people have to wait in your waiting room for for too long? That's a barrier for a lot of people. It's not too bad for chiropractors in general, but it's a, it is a barrier. Do you offer very limited treatment options, right? You only offer, uh, maybe one or two things. That's gonna be a barrier for some, right?

Um, but it could also be great. Like if you're just world class palpation and adjusting, that's what you offer and you do it in an evidence-based way, you'll probably be fine. You'd be really fine. But there's gonna be some patients that are looking for more and that's fine. Maybe you have [00:16:00] referral system for, uh.

If they're looking for rehab, you send 'em to a, a good rehab, chiro or pt. Uh, if they're looking for dry needling, you send 'em to dry needling. If they're looking for shockwave, you send 'em, you have people around your, in your town that you're referred to, right. Um, unwelcome, I'm sorry, unwelcoming, dirty, outdated, and uncomfortable waiting treatment rooms.

Right. Just not a good. Environment. That's a barrier. Okay? Maybe it's an unfriendly, rushed or unprofessional front desk or support staff. That is a barrier. You want to get that fixed, lengthy, or intimidating. New patient paperwork and initial exam without clear explanations. Something that we keep on looking at.

We got a lot. We have online paperwork and we got a fair amount of it. It's again, when you become compliant, um, it adds, it adds things for them to sign. Uh, so we audit that every so often. Um, maybe recommended high [00:17:00] visit frequency, um, could feel overwhelming or salesy, right? Um, or obviously long duration.

That's where, you know, if you're trying to do six month care plans, it takes such a high level of sales. To do that because you're overcoming massive barriers to that and you have to sell, right? Like the higher the barriers in certain cases, whether it's money or duration of care, uh, it's gonna take, uh, more sales to do that, right.

So those are my list of barriers that you wanna look at when you're teasing out what your patient experiences and what your system and processes are. You know, uh, they're, you know, think about like the joint right one. I would say that. If I had to sum up the business model for the joint is they've removed every barrier possible.

Right. And even though they're not in network insurances, they're [00:18:00] so cheap that they're, they're actually cheaper than most people copay. So they're like, we're not gonna do the insurance model, but we're gonna make it cheaper than insurance. And so they've, they've literally removed every barrier, right?

They, they may, I've talked to people with the joint. They only pick certain locations where they'll open up a joint. There's gotta be a certain amount of traffic. It's gotta be easy to get to plenty of parking, nice space. They, you can walk in and get adjusted. It's super cheap. It's, I mean, it's just, they easiest thing in the world.

Not saying it's good, but you can tell their business model was to put, to knock down all the barriers. And, um, and walking in and being able to get it adjusted whenever you want. That's a big barrier for some people. Right. Um, so just understand that. And when you lay out some of these things that we talked about today, um, is it a barrier that your clinic can overcome?

Do you have too many barriers in this stage of your clinic growth? Right. Uh, a lot of times [00:19:00] practices add barriers as they go. And that works out well. That's what we essentially have done. We're 16 years into this particular practice. I've been practicing for 21, and it was a slow addition of barriers and overcoming one and adding the next overcoming one and adding the next, sometimes adding one and say, you know what?

It's a little bit too big of a barrier. Let's remove that. And, uh, and see how it goes for you. So I hope that was helpful. Um, one of the things we try to do with our clients is make sure they have a great patient experience, friction free as much as possible, and if they're gonna add barriers or do we need to remove barriers, we help work through some of the strategy around that.

So I hope this is helpful. Do an audit of yourself. Again, a lot of these I said, I'm not saying don't do. Just understand that it can be a barrier to some patients or a lot of patients, and you gotta know what you're getting into.