PATIENT RETENTION & THE 3 STEP REPORT OF FINDING

Compliments of Sam Reader

  1. G. Reader & Associates, Inc.

Isn’t it interesting that patient retention during the Camelot years of Insurance (unlimited visits, $7.00 co-pay, $250 deductible) was as high as 35-40.

Patient retention is defined by how many visits a patient will participate in before dropping out of care.  It is easy to calculate.  Divide your annual visits by new patients.  Example:

            3500 (visits) divided by 120 (new patients) = 29 (retention – average visits per patient.

The latest poles show patient retention between 15-17.  What changed?  It appears the patient today is getting much less Chiropractic medicine (if you will) then the Chiropractic patient 20 years ago.  Is it possible the techniques have become more refined and effective – requiring less visits?  I feel the obvious reason lies within the drop in insurance benefits and the human tendency  (as doctors) to sell the patient the path of least resistance – pain.

I’ve known several doctors to refute their low patient retention by saying, “Why should I be penalized for getting my patient fixed so quickly.”

I suppose it is how you define “fix” or reconstructive care.  Here is a quote from an article written by Burl Pettibon, D.C. and Walter V. Pierce, D.C. under Clinical Comments;  The Journal of Chiropractic Case Reports, January 1993. “If symptomatic relief is the clinical goal of the doctor of Chiropractic, he has done his job and the patient should be discharged after 10 to 12 adjustments.  One the other hand, if the clinical goal is to further correct, stabilize and increase spinal function (rehabilitate the spine so that it can be expected to maintain its correction and function in addition to eliminating pain), it is clear that the goal has not been reached.  To correct the spine an additional 20% and to allow it to be stabilized and rehabilitated requires an additional 20 to 40 adjustments with rehabilitative procedures.  If 90% to 100% correction is required due to paravertebral soft tissue instability, an additional number of adjustments and procedures may be required.  It should be noted that to gain an additional 20% spinal correction, beyond pain control, requires a minimum of 2 to 4 times the number of adjustments as the pain control treatment only.”

My goal is not to argue philosophy and technique on how many visits constitute reconstructive and/or fix care; rather, do you have a clear idea of what reconstructive and/or fix care is for your patient as defined in the report of finding?  Do you provide an opportunity for your patient to choose reconstructive care over pain relief?  Is the patient’s best interest at hand?  Is it easier to down-sell the patient on pain relief and/or patch care to avoid confrontation, dissension and possible rejection?

There are many aspects to building patient retention, but non quite so vital or pivotal as the report of finding.

Here is an easy, penetrating 3-step approach followed by an example of an R.O.F. summarized on one sheet of paper for the patient to take home.

The 3 step R.O.F. is broken down into thirds.

  1. Disclosure: Disclosure will take 80% of the total R.O.F.  Disclosure is where the doctor directs probing questions to the patient in trying to get the patient to open up about his/her symptoms, conditions and motive in life.

Many patients have shared with us that, “If the doctor can’t find the problem – it’s not a problem.”

There is much to read into this statement.  It’s as if the patient is saying, “I dare you to find the problem.”

Many years ago, I referred my mother-in-law to a client of mine.  Prior to her visit with this doctor, she forbid me to tell him what her problem was.  I said, “You have to be kidding – what’s the point?”  She responded with, “If he is a good doctor he will find it on his own.”

I have seen too many times where a doctor will walk into the R.O.F., flip on the view box and start talking away.  This is not good!  Disclosure develops a relationship of trust between patient and doctor.  During disclosure, the patient is doing most of the talking while the doctor does most of the listening.  It has been said that the world’s top salesmen are not talkers, just good listeners.  Patients will open up and disclose if the proper probing questions are directed. I mentioned earlier that disclosure identifies the patients motive in life.  This is critical if we are going to take the patient above and beyond the treatment of pain only.

What makes this patient tick?  Is this a stock broker, homemaker, truck driver, or teenage athlete?  I guarantee a stockbroker’s motive are totally different than a truck driver’s.  A teenage athlete’s motive is different than a stockbroker.

It is in disclosure we find these motives.

A couple of years ago, I had asked my daughter how she felt she played in her soccer tournament.  She said, “I wish I would have seen a chiropractor before the game”.  I asked if she was in pain.  She said, “No!  I don’t have any pain, I just wasn’t on”.  Much can be read into her statement about why she goes to a Chiropractor.  What do I know about stockbrokers?  Highly stressful, competitive, long days, early morning to late nights – motivated by money.  What can I provide as a Chiropractor to help this person stay on top of his/her game and make more money?  Do I sell this person pain relief or the primary benefits of Chiropractic such as stamina, endurance and energy.

Money is probably not a primary motivator for a teenage athlete.  Again the question might be, what can I do as a Chiropractor to help this young person become a top soccer player?  The questions and answers that come from disclosure provides the nuances in repositioning the patient from pain only to Chiropractic as a way of life.

  1. Correlation: Simply put, we correlate our musculo-skeletal findings to end-organ dysfunction.  In other words, is there a cause and effect relationship between the spine and nervous system and each of the organs in our body as shown in the nerve charts we pass out and the autonomic nervous system display on the wall.

The fundamental principals of Chiropractic and what makes it work is time tested and beautifully simple.  Never underestimate your patient’s ability to understand and accept this simple concept and the care you are recommending.

  1. The Close: “Mrs. Brown, we have two choices here.  We can provide for temporary relief and get you out of pain, which will take anywhere from 6 to 12 visits, or we have reconstructive care.  Reconstructive care in your situation, Mrs. Brown, might be  28 to 32 visits.” (Visits will vary depending on your definition of reconstructive care.)

“My recommendation for you is ___________.”  Fill in the blank.  What are you recommending?

“Mrs. Brown, here is why I’m recommending _________ care.  I feel you may be at risk for the following problems, such as _________, _________, _________.”

Identify and list the injury or health risk.

“Mrs. Brown, I want you to know whatever you choose, I’m behind you 100%.  What would you like to do?”

Wait for an answer.  No assumptive closing!

If the patient uses money as an issue to avoid care, try using this statement.

“Mrs. Brown, suppose you just won the lottery and money was not an issue.  Which care program would you choose?  (They usually say reconstructive care)  “That’s great Mrs. Brown.   I just needed to know where your heart really lies.  If this is something you want, I have never turned down a patient.  I have never allowed money to be the obstacle to keep a patient from getting the care they desire.  We can work it out.  So Mrs. Brown, what would you like to do; pain relief or reconstructive care?”

Wait for an answer.

Enclosed is a one page summary incorporating each of these steps.  The summary provides clarity to the patient as well as ammo your patient will need when confronted by their spouses (your greatest obstacle) as to what’s wrong, how long, and how much?

JAMES D. SMITH D.C.

Report of Findings & Treatment Program

PATIENT’S NAME:  Teal Jones                                                                      DATE: 8/8/01

FINDINGS (What is wrong)

Constant mild to moderate neck and shoulder pain (for over one year) from a curvature in you low back, straight to slightly reversed cervical curve and numerous vertebra in you spine being out of alignment (C1, T1 ,L1 ,L3 ,L5) causing pressure, irritation and inflammation to the nerves and nervous system.

These misaligned vertebra have also caused the joints in your spine to become jammed.  The supporting muscles have become tense, tight and spasm (to protect the nerve from more vertebral pressure).  The surrounding soft tissues have become swollen and inflamed (from being stretched on one side and compressed on the other).

This has been there for sometime due to the degenerative changes in your spine, early signs of bone spurs and unequal spacing between the vertebra. (degenerative osteoarthritis).

Pain (which will increase) is the result.

INJURY AND HEALTH RISK (Why these recommendations)

~ The longer the misaligned vertebra is allowed to put pressure on the nerves the greater the risk for permanent nerve damage and chronic pain.

~ The longer the nerve pressure and the greater the nerve damage, the more muscular, organ and glandular systems imbalances, increasing the risk for sickness and/or disease. (ex. kidney problems, mitral valve prolapse)

~ Progressive degenerative joint and disc disease (arthritis)

DOCTOR’S RECOMMENDATION (What to do now)

28 – 32 treatments within the next 90 days

1 – 9 treatments are to reduce the pressure on the nerve, thus decreasing the pain and inflammation.

The remaining treatments are needed to guide the vertebra back into its normal (or near normal) position.  As we are repositioning the vertebra, we are also retraining and strengthening the muscles and ligaments that hold and support the bone so it does not snap back to its old position re-aggravating an already irritated, inflamed nerve compounding the disease process.

ADDITIONAL PERSONAL GOALS (What do you want to do that you can’t do now)  Play with my grandkids and hike with my husband and stay active during my golden years.