Mark Sanna, DC, ACRB Level II, FICC

A primary reason for hiring staff is to increase the ability of the practice to deliver more services more efficiently. The staff’s role is to make the job of the doctor easier. The most successful practice teams are the most effective at delegating all services and tasks that do not require physician-level staff to support staff members. Those staff members must hold themselves and their fellow practice team members to the highest level of accountability. Delegation with accountability means that essential tasks are performed and the practice operates at the highest level of efficiency and profitability.

Knowing who to delegate a task to is often as important as knowing what to delegate. On a practice team, there are members who generate profit based on their billable hours, such as doctors and other licensed professionals. Other team members play more of a support role in generating profit. For example, radiographs can be developed by multiple team members, but it is not the best use of a doctor’s or associate’s time. Be sure that everyone on your team is aware of who has billable hours and whose role is support.

Many chiropractors don’t realize that hiring staff can be the greatest way to increase their practice profitability.  Understaffing your practice can be penny-wise and pound foolish. Lots of things can be done to help streamline patient flow in a practice if you have sufficient staff, particularly in the active care department. In many states, active care is reimbursed greater than chiropractic care and yet there’s no support staff assisting patients with active care rehab exercises.

Hire Properly

In his best-selling book, Good to Great, author Jim Collins reminds us that it all starts by getting the right people on the bus, the wrong people off the bus, and the right people in the right seats. Everything starts with the right people. There are qualities that cannot be trained and they include a positive attitude, personality, and a strong work ethic. Hire in the absence of these key qualities and you may find yourself constantly trying to fix someone who is not fixable. People like to be around positive people and if a team member carries a bad attitude, if they look like they’re harried or busy or that they’re off-put because a patient is engaging them, it’s going to hurt the long-term profitability of the practice.  On the other hand, you’ll know that you have the right team member when patients look forward to being with them. They make your practice fun and engaging and create an atmosphere of energy and excitement. The right team members improve patient referrals and retention simply by their way of being. They make your practice a place that patients want to come to.

Foster a Practice Culture that Promotes Profitability

Create a practice culture that encourages acknowledgement—catching each other doing things right.  Praising in public and reprimanding in private is really important.  Trust and respect can be gained over time but it can be lost in an instant. Reprimanding a team member publicly rather than taking that person aside privately and correcting a behavior can rupture that practice leader/team member relationship. This is something that is very difficult to repair once it has been broken. Take time in each weekly team meeting to allow a different team member to share a “win” that happened in their area of the practice. It gives that person the opportunity to shine in front of their teammates and also underscores the integral role each member plays in the practice.

Be sure your staff knows “why we do what we do” as a practice team. Share your vision and share your practice mission with your team on a regular basis because they forget it in the day-to-day of carrying out their tasks. It’s not just a J-O-B.  Take time in your daily team huddles and monthly team meetings to remind your team how important the work that each of them does is to your practice and patients. Have your team members experience your new patient examination and attend a report of findings. After that, it’s a rare event that they don’t undertake chiropractic care and, if they don’t, you may have a serious issue with that person as a team member.  The best team members are under regular chiropractic care and can share their personal experience with patients who may be discovering chiropractic for the first time.

Great Patient Care Includes Your Team

Your practice team must know the important role they play in the healing process. They are an important part of patient care. Share the science behind the healing process and how you set goals for care beyond pain relief. This helps your team members understand how you perform case management in your practice. When your team has a sense of purpose, they understand that what they do is much more than a job. Your team members should have an understanding of the phases of the healing process and why it is important for patients to follow the doctor’s recommendations and treatment plan.

Encourage your staff to talk to patients about their improvements so others can hear, be encouraged and learn what other conditions the office treats. When your team understands the healing process, they can help support patients when they have questions or doubts when the pain has gone away and they’re questioning why they still need to come in.  A caring and nurturing environment is often missing in medical practices, where patients are often treated as no more than a number. When your entire team is focused on patient care and compliance, you will produce better results—the foundation of profitability.

Patient Flow & Profitability

In a busy practice, the reception room should be empty.  A full reception room is a key indicator that there is a bottleneck in patient flow. This is very different than the reception room of the past that could have 10 to 15 chairs ringing the room and people sitting there reading magazines.  There should be no magazine reading in your practice.  All staff members, and in particular front desk staff members, must be acutely aware of patient flow in the practice. They must look for bottlenecks and speed bumps to ensure that the wait time and service time for patients is at its most efficient level.

If the chiropractor becomes backed up, patients under regular care, without an exacerbation or new injury, can receive passive or active modalities prior to or after receiving their chiropractic adjustment. Reexaminations also can create a speed bump in the schedule if not adequately planned for. Pre-scheduled times for new patient examinations and reports of findings helps ensure that these procedures do not bring patient care to a grinding halt. Efficient patient flow improves patient compliance and retention—two key areas for practice profitability. It is challenging to generate profit if you are not generating great outcomes from care.

Many successful practices have instituted the role of “Patient Advocate”. This can be a team member fully dedicated to the role, or one or more team members who float between their main positions when the need demands. The role of the Patient Advocate is to coordinate patient flow. Just like a host or hostess controls the seating of guests in a fine restaurant, your Patient Advocate can be sure to keep the patient flow moving freely.

Assistants that help to deliver passive or active therapy are often overlooked in terms of their value in fostering patient relationships and creating high perceived value in the eyes of patients. While they may feel a low level of influence over patient care, they are the team members who often spend the most time with patients during their visits. Be sure that your therapy assistants are aware of each patient’s goals for care so that they are engaged in the healing process. Ask them to share their success of the week with the patients they are working with so that they can motivate them and foster referrals.

Many chiropractors have added the position of “Scribe” to their practice teams. The Scribe accompanies the chiropractor during routine office visits, exams and re-exams, and enters the notes into the electronic record as they are dictated by the provider. Documentation can be one of the greatest time vampires in a chiropractor’s day. This procedure helps the doctor keep up with documentation requirements and provides a higher quality of work-life balance. The doctor doesn’t have to spend their valuable patient care time or equally valuable personal time charting notes.

Accounts Receivable Management

Proactively calling after delinquent patient and third-party accounts is an essential role in accounts receivable management. Waiting for explanations of benefits (EOBs) to manage accounts is like hoping to win the lottery without buying a ticket. Allowing patient accounts to age greater than 90 days decreases their value by up to 50%. Certain accounts can be pre-funded or factored to improve practice cash flow and profitability. There’s an unwritten rule that a patient who has a delinquent account simply will not allow themselves to get well.  Keep insurance authorizations on track, perform timely billing (daily or weekly) and follow-up with EOBs and denied services. Daily management of your accounts receivable keeps this important financial lifeline from becoming interrupted without warning. Make sure that there’s a system in place to run pre- and post-error reports to make sure you’re catching any bills that may be locked in your system unbilled due to uncorrected errors.

Practice Marketing

Marketing a chiropractic practice is a team sport. It should be “all hands on deck” when seeking opportunities to collect positive patient testimonials and reviews. Positive reviews are key in terms of optimizing the searchability of your practice website. When a patient has a positive experience, it is the perfect time to film a short HIPAA-compliant video perfect for posting on social media. When a patient sings your praises, it is also the best time to ask for the referral of their friends and family members.

Wellness seminars, new patient orientations, health fairs and screenings are not the exclusive domain of the doctor. They can be very effectively performed by the right practice team members. This magnifies the reach of your practice in terms of engaging with potential new patients in a way that could not be accomplished if these marketing procedures are only performed by the doctor. Many practice teams have outgoing members who would love the opportunity to represent their practice to their community.

Product Sales

Practice team members are often in the ideal position to recommend ancillary products and services such as pillows, supports, and nutritional products to patients. Practice team members should always be listening for opportunities to provide patients with needed products and services. Team members should know that, without their recommendation, patients might purchase these items elsewhere, without the guarantee of quality that comes from purchasing them through a licensed healthcare provider. Staff should use the products your practice provides so they can speak knowledgeably about them.  Many successful practices provide their team members with a new pair of orthotics each year as a way of saying thank you and stimulating sales. The staff can tell patients, “I love my orthotics.  They’re in my shoes right now!” Be sure that your team members are aware of all of the products your practice provides.

Many chiropractors are great about selling products, like nutritional supplements, the first month and they’re terrible at selling the second. Create a “memory tickler” system, so that you know when a patient’s supply of supplements or a particular product runs out. Put a member of your practice team in charge of monitoring the tickler system and incentivize them with a bonus system based upon sales. Most practice management software makes this process very easy to implement.

Seminars and Learning Opportunities

Having a practice culture of continuous learning is essential to practice productivity and profitability. When you increase the knowledge base and skill set of your practice team members, it increases their loyalty to your practice and their ability to generate profit. Regularly hold in-service training sessions with your practice team members and bring them to educational seminars. This exposes them to new ideas and allows them to interact with other practice teams to generate new ideas for increasing practice profitability. A staff that remains within the four walls of your office can quickly become mired in the belief system that their way is the only way. Being exposed to other successful practices helps your team keep up-to-date on what is working best in other practices similar to yours.

Dr. Mark Sanna is a member of the Chiropractic Summit and a board member of the Foundation for Chiropractic Progress. He is the president and CEO of Breakthrough Coaching ( 1-800-723-8423).