Master Your Year-End: Planning Tips for a Thriving Practice

Hi, and welcome to ChiroCast. My name is Danielle Javines, and I have Dr. Stephanie Brown with us today to talk about one of the more important topics in the world of business, which is practice health, practice goals, and end of year planning.

Yeah, super important. I think especially as chiropractors, we go to school to learn how to be doctors, and like lots of other professions that get trained, not necessarily taught how to run a business. And so a lot of us are kind of trying to figure this out as we go.

So hopefully today I'll help give some people just some direction maybe on things they haven't thought of before.

All right. So let's get started. What should we be focusing on going into the new year?

So as a chiropractor, I think we have to break it down into categories because you have your practice, your practice health, you've got your business planning, and then personal and professional. Would you agree?

That definitely covers all the bases. There's a lot of them.

There are. And I don't think we're going to be able to cover the entire scope of all the things that you should be focusing on going into the new year, but we'll cover high level as much as we can and hopefully set everybody up going into the new year. So let's start with practice health goals.

Practice audits, year in review. What are some things that folks should be paying attention to as the year is wrapping up?

So I think it's really important to look at statistics, right? And so where, like how many patient visits did you see? Like everyone, that's like an easy thing for people to think of for sure.

But I think the value in that is like looking where you are so that you can figure out where you want to go. And then if you keep track of it and like you have an Excel spreadsheet or something like that, that way you can look like you're over year and you don't have to suddenly five years from now wonder how much you've grown. So if you've already been in practice, then start doing it now, maybe look back retroactively.

But it's really nice, I think, to be able to identify those trends. So to be able to, I think, have some effective goals and come up with goals, it's really important to know where you've been. And that way you can just kind of see what worked already, what might not have worked as you look through those different types of statistics.

Yeah. I think it's important to not function under the pretense that as long as there's money in the bank account, we're doing fine. I think there's so much more that goes into it than revenue.

And I mean, I know there's folks that say as long as it doesn't decline, we're fine, not good business practice at all.

I think it's really smart to be intentional about it.

Yes, for sure. Okay. So what about compliance in the office?

Hipaa, PCI, what should we be looking for there?

So just a note on the PCI compliance. Everyone hates this, I think. It comes up, for people who may not be familiar or remember, PCI compliance is like with your credit card processor basically, or it is.

It's typically something I believe that you have to attest to or complete annually, so once a year. And if you don't complete it, you usually, I believe, you're going to get fined.

And I think it's like a monthly fee for not being PCI compliant or not demonstrating that you were PCI compliant.

And it'll just recur monthly until you get compliant. My processor, they actually have a program in place, so I just complete the program that they have. But I have to remember to do it.

So, super important thing, part of what we're going to talk about here is having a calendar that you can, like, you know, you're going to look at the month of January and be like, where are my things that must get done this month that have to do with, like, the business stuff? So that would be one of them. So mine's going to be every June.

I've got to make sure that I get that done so that I don't get hit with that fee. I mean, that's an industry standard thing basically at this point. But so, it's just nice to plan ahead on that one.

Know when it's coming up so that you can plan on making sure you've got whatever you need to get done, done, and that way you don't get fined. So from a compliance standpoint, I think that's an easy one to just make sure you plan ahead for so that you know when to do it. Hipaa is another way, so, you know, just having a resource where you know you can turn to say, like, has anything changed that I need to know about?

So Hipaa is not necessarily just, you know, written in stone and never have to think about it again. It's always good to see if you're compliant and if anything's changed. And it might not even be that Hipaa changed, but as the way that we all practice and run our practices evolves, Hipaa has to be applied to that.

So if you just recently started communicating electronically with patients, that might be something you want to check and make sure like that you're doing it in a Hipaa compliant manner. And if it was something you were just super excited about in like September and just added into your practice and you didn't think about that yet, then it's just a good time to do like a Hipaa audit almost, to just look at all the components of your practice to make sure that you're compliant. And like I said, have a resource handy that you know you can turn to, that's going to be able to help give you that correct information.

Probably not social media, just putting that out there.

Yeah, I know it's something that people, I mean, depending on who you are, they take it lightly, they don't consider it something that has to be paid attention to. They're going to avoid any charges that could come along with not being compliant, but when that day comes, it's a nightmare. So it's always good to stay prepared, stay up top with what's happening.

I know you said Hipaa changes, I mean, it can change all the time, it's fluid. What used to exist years ago when electronics weren't as mainstream as they are now, the standards had to evolve. So I imagine it will continue to change and staying on top of it is key.

Yeah, absolutely.

Okay, so what about staying on trend for businesses, new revenue streams?

Yeah, so as people go through their numbers, patient visits, how much money did I bring in? You know, you might be looking at how to make more money. I mean, that's always a good idea.

Or looking at the different ways that you already are making money and seeing if there's anything to optimize or switch up or change or what have you. So, I mean, that's something you can do at any point of the year. But, you know, often something I think people will look at in the new year when they're looking at how the current year finished and closed out.

So for example, like our last podcast episode here on ChiroCast was about biohacking. So biohacking, you know, trendy things that could maybe be something that you look at incorporating into how you practice, whether it's literally something you offer in your office or just intelligently making recommendations to patients. So they still see you as like an authority on what is current in, you know, the health care world.

Yeah, I feel like it's no different than fashion trends, social media trends. There are health care trends. I know some people refer to things as fads, but getting on top of them, staying in time with them can help your business might not be something you offer forever.

But, you know, there's no harm in trying, seeing if it works. And like you talked about before, what worked this year, what didn't work, trying new things and maybe making money off of it can't hurt.

Yeah, like this is totally unrelated but partially related. So just in the last couple of weeks, I keep everything on social media has to do with grounding and beef tallow or just tallow. I don't even know if I'm saying it right or what it is.

I think it's like something you cook with or whatever. Anyways, but like that's how quickly things can change. So I'm not saying anyone incorporate tallow into their practice, maybe grounding, whatever.

But so yes, I think it's good to have on a calendar like some kind of plan where you do like, especially if you're not big on social media, it's a great place to just see what people are talking about. It make a point of planning when you're going to go sign into, you know, whatever site you like to use and have an account for to just see what people are talking about. But yeah, I mean, that might spur ideas for new revenue streams and help you figure out where you're going there.

Agreed. So when it comes to practice health goals, another item when it comes to your practice audit is emergency planning. And I know we did cover this on, I want to say episode 50.

So we're not going to go into all of the different areas of emergency planning, but that is something to take into consideration when you're planning the following year.

Yeah, if you don't already have something in place, like you need to put that on the books for when you're going to plan it and give yourself a deadline too.

It could be that during the year you learned what pieces were missing when you experienced a hurricane that hit you in an area that you never thought a hurricane would hit you. So having that emergency planning plan is key.

I think this can be overwhelming for people. And so if it's not going to be an end of year thing where you sit down and look at all these things at once, that's okay. Go ahead and split it up across the year.

So, you know, quarter one, you're going to make sure you have your emergency planning thing figured out. Quarter two, you're going to examine like different revenue streams and change up your table talk or, you know, plan what you discuss with patients when you're on your visits or whatever. So just some of these things that we go through, I don't think it's intended that you would sit down and figure all of them out like in one sitting.

So I think that's key because it can be very overwhelming. And so you should come up with a comprehensive list. And then figure out when you're going to figure these things out if you don't have it figured out already.

Yeah.

So the calendar, the calendar is clutch.

Yeah. And speaking of list, we actually have a checklist for everybody for end of year planning. And I don't know what you want to call it.

Setting, setting yourself up for success checklist.

Sure.

Yeah. It will be posted on the website. So stay tuned for that.

OK. So next piece would be business planning goals. There's a lot to cover in this one.

So let's start with staff. Things to consider when you're planning for the following year when it comes to staff.

So something I had to do recently was evaluate. And this is for my day job. What we might need for staffing needs next year.

Am I going to need to hire somebody? Am I planning to grow my team or my tasks that need to be completed for our work that needs to be done? Am I going to grow that or create a situation where I'm going to need a new employee?

So the time to figure out if you need a new employee is not when you need them. Certainly, if someone quits or leaves, that's going to be reactive in most cases. But I think for hiring, it really makes it less stressful if you can be proactive on hiring.

And to be honest, if you've got someone in your practice who you're not sure if they're going to be the best fit to continue staying on your staff, I just think the second that you get that feeling, you maybe need to follow that gut feeling. You need to make sure you're documenting things to be compliant with whatever the laws are in your state if you end up needing to make a change and let someone go. But you shouldn't start looking for a new person to replace them like after that person leaves.

Ideally, you would find someone before or you would at least have a pool of people that you can like actively pull from, you know, if and when that happens. So hiring, planning hiring is something that can be planned. It doesn't have to be reactive.

And I think oftentimes it is.

Yeah, I mean, I think that could also fit under your practice audit, planning for performance reviews. When are those going to be conducted? When are they due so that you can evaluate who hit their marks over the last year, who might not have, and figuring out if you're going to rehab them or if it's time to start looking for replacements?

Yeah, just to toss something in there for performance reviews. I think it's really important to make sure that you include the good things. So even if an employee has an area that they can work on, like an opportunity to improve or whatever, that's great.

But I think it's a really good time to make sure that you're giving kudos to people too, because that's important.

Yeah, for bonuses too, I would say. End of year bonuses, nobody's going to shy away from those. So you have to have a plan for that and have a structure for those bonuses as well.

Absolutely.

Yeah. Another hot take is time off, not only for you as the doc, but for all of your employees and shutting the office down. Because you definitely don't want to not plan for shutting the office down and then, you know, scrambling when the time comes.

Yeah, or having upset employees that you're gone for a week and so they don't get paid for a week because you didn't plan ahead to make sure they had work to do so they could still come in and get paid. Or you did that on purpose because you want to try to save money because you're not bringing in money that week. But like, you know, it's cool if you can get your staff to want to coincide their time off needs with yours, that's perfect.

But that's just not always practical and not always the case. So, I mean, I think that's one thing to work on to is employee retention. So not only giving kudos, but also like how can you make their life better, happier, and easier?

And that might include like letting them work still or having a modified schedule when you are gone or the office isn't open. There's probably plenty of tasks that can get done. You know, if they are responsible for cleaning, they could do a deep clean in the office.

They can catch up on X, Y, and Z. So maybe you make sure that they have like a set list of tasks to accomplish while the office is closed. And that way, you know, you're not paying them to pretend that they're doing some things or you know, maybe they could have gotten it done in two hours and not 20.

But yeah, saving tasks or planning ahead to have something for them to do if they're not going to coordinate time off at the same time. I think that's a huge employee retention, you know, idea because then they're still being paid and valued even though you are going to be off, if that makes sense.

Yeah, it makes a difference when your employees love what they do and they're happy where they are and they know they're going to be taken care of. The longevity is organic. They're not going to want to leave.

Exactly.

It speaks volumes. And speaking of vacations, strategic planning for those, especially when you know when you've got your peak patient times, you definitely don't want to shut the office down for two weeks, coinciding with maybe school closures because everyone's on vacation the same time you're going to be on vacation and there could be influxes there or could be dead periods.

Yeah, definitely. So that goes back to looking at your office stats. You may have a sense of the fact that, for example, when I practice full time, the time period between

Thanksgiving and Christmas, like always felt like it was the busiest without question.

But that begs the question, like, was it really, or was it just my feeling? Because I had so many other things going on outside the office at the same time. So look at your statistics to determine, like, when are your busy times?

And then, you know, I think as chiropractors that own our own businesses and anyone that owns our own business, if you have the ability to build your dream and practice exactly the way that you want, then I think you should do it. And if that means that you close for the second half of December, then that's what you do if you absolutely need to and want to and have to. So, but again, if you should make that decision informed knowing historically that was your busiest time of year, or maybe you look at the numbers, you find out it's not, and then you feel better about doing that.

So there's a lot of practices that will close between Christmas and New Year's, and there's a lot that don't. So, you know, that was always a really busy time for me, because so many other like schools are closed and things like that, and more people are home and they want to come get adjusted. And so we were always very busy then.

But if I had a family, that might be something that I just, you know, I'm gonna take one for the team here and not be working that week because I need to be home. So you've got to balance your personal needs and commitments with the business. But I think you can best do that when you can really see what's going on in your business and then plan ahead for it.

Yeah. And I would say that it also depends on where you are in the business ownership lifecycle. If you are a brand new business owner, you're just getting started.

It might not make sense that you've got four two week vacations built into the year. You're building your practice. You probably don't have seven associates in the practice that can step in while you're away.

So I think being realistic with your time off, your vacations while you're building, or maybe even if you're an established business owner, you have to be realistic about it.

Because I know some folks have the mentality, it's like, I'm a business owner. I'm going to take seven vacations a year and go off and do whatever.

But the business offers a little bit.

Yes, then you have the opposite of that. The people who say, well, I'm a business owner. I can't leave the business.

I can't take vacation or I shouldn't take vacation. Or because you don't plan ahead strategically, or maybe you don't know how, you're not comfortable leaving so then you don't. And then you get burned out.

And that's going to be just as bad and toxic for your practice as if you are closed all the time because you're traveling the world. So I think it's really important to be realistic with yourself and just understand as human beings, like we need a break, especially when things are busy. There's a lot saying chiropractic.

A lot of people say you cannot be in growth and protection at the same time. So if you are going a million miles an hour all the time and you never get to just pause, take a step back, relax, enjoy something that's not your office, when you do that, I think it not only helps you recharge your batteries, but it also helps kind of reset your perspective on things. And it can help you grow as a business owner and a chiropractor, I think, just because you take time off.

So never leaving your practice and never taking time off at the end, like is eventually going to cause a massive significant problem. And I see this get talked about on social media on a pretty regular basis over the last year. People who have been practicing five, seven, ten years, that all of a sudden feel like they can't stand it anymore and they think they want to get out or they don't know what to do.

And I think there's definitely occasions where it's at least partially because they never took time off. And they created a situation where they essentially became trapped in their practice because they don't have an associate, or they don't have any backup, or they don't give themselves permission to take time off and get out of there. And this happens too.

They let the inmates run the asylum. So part of practicing, it's like customer service. But if your hours are over at 6 p.m., it's okay to say that you're done and staying in the office every night till 8, 8, 30, just because you have people that need to be seen.
I mean, it's not good for you. It's not. So don't get burned out.

No, that's not, I mean, no matter what profession you're in, not taking time for yourself, it's not healthy. Your body needs the rest, the relaxation. And it's not that you have to step away for weeks at a time, a couple of days here and there.
I mean, it's important. And having goals and making plans for these things can help. Stay on top of what you should be doing, what you can do more of.

Because I think it's important. Set a goal for when can I realistically bring another associate in or bring one in to help and work towards those goals. It might not be right away, but having a plan in place can help you.

Yeah, definitely. Really important.

Cool. Flipping over, still with the staff and business planning, how important would you say having an HR mechanism is within the business and planning for those things?

Really important. Again, this is something we don't think about as chiropractors. You just want to chiropract at college, open your own business, you hire your first person, and it's like, oh, God, I need to get these different workers' comp insurance or whatever, all these things.

But then if you're not also like, again, I know this comes down to firing people and we don't want to fire people because everyone's amazing and perfect and so it never impacts your practice poorly. But when it does happen, it depends what state you're in, if you can just fire someone or do you have to have a reason? What does that need to look like?

How is it documented? And then if you do let someone go and they're definitely going to put a claim in to collect unemployment, like end of story, just assume it's happening. And I hear from people all the time and I have friends that own businesses that are not chiropractors different and it just drives them nuts whenever they get that notice in the mail and they don't think that person deserves unemployment for whatever the reason was.

But if it's not documented the way it is required to be documented in your state, like you're going to lose and they're getting unemployment and then that can affect you however it might affect you. So I guess that's a bad thing and I have a tendency to do that when I'm analyzing. Like just think of all of the worst case scenarios, assume they're going to happen and then put plans in place to make sure that they don't or that you're at least prepared.

So in this instance, like you need to have an employee manual that outlines what that employee's expectations are. And then if they don't meet them, what are the consequences? We've already mentioned this, but employee reviews.

I mean, you should be doing reviews because that forces you to put pen to paper and have documented how they've been performing already. So you're going to be doing that no matter what. I mean, it's kind of lame sounding, but you should have a process to write people up.

If that's what's required, it all needs to be documented again in a way that is required by your state. And I'm not just talking like, is it physically written on a pen and paper?

Does there need to be a witness?

What time frame might it have to be reviewed with that employee? Do they need to get a copy of whatever is being documented? All of those kinds of things are going to vary from state to state possibly.

And it's super important that you know that stuff ahead of time so that you just have a plan in place. So an employee manual, you could get on the Internet, find an employee manual and just customize it to your office. I mean, if you have no resources, it's an idea.

Maybe better to work with like your Chamber of Commerce locally or like your state board or somebody like that, a state association. But also if you have payroll, like your payroll company might be a really good resource too. I know a lot of payroll companies offer that as a service, which is cool because they'll help you make that employee manual, but then they also keep it updated annually as the laws in your state change, which is also very important because you're not compliant if the law changed and you have no idea.

Yeah, I don't think it's not chiropractic specific, but I did used to work for an employer that employee manuals didn't exist. There were no guidelines. You basically showed up, you worked and you got a paycheck.

There was nothing in black and white and I didn't learn until years later that that is not the way to go. That business no longer exists. Having a plan for these things is going to make everybody's lives easier.

I mean, at the very least, use some type of legal something to either overlook it or there's tools, like you said, like LegalZoom, we're not sponsored by the way, but I've seen those, Rocket Lawyer. There's, you know, you put your information in and it creates one for you based off of the state that you're in, so.

Yeah. Or like if you do want to do the footwork to do research and like make your own, have an attorney in your state review it who is an expert in employment law, labor law, whatever it is, have an attorney review it annually. And at that first time, if that's something you want to put the effort into first creating on your own and hope that you don't have to pay them a lot of money per hour to edit it, I guess.

Right? Otherwise, you'll go back to the disaster planning and have to plan for somebody suing you.

Yeah, doing it yourself is not always the greatest idea. You know, those of us at Tech On House projects, we find this out ourselves sometimes, but it's not different in your chiropractic office necessarily. Like there is really good times for professionals and this might be one of them.

Yeah, for sure. OK, so moving on to marketing within your practice, when it comes to website refreshing, development, maybe changing things up, color scheme, something seems small, like a color scheme within your practice. Having a plan for those things, would you say is that important, necessary?

I think it's important to evaluate if it is necessary.

I feel like, again, we don't get a lot of training in marketing, right? So having somebody who knows what they're doing is probably a good idea to talk to them. I've learned over time, just in general, you'll end up with a logo, right?

Which is good. And maybe there's a point at which you reevaluate that logo and maybe you want to change it. This goes back to the name of your office and stuff.

So I don't think changing your office name is something people do like all the time, because that's a lot of work. But yeah, updating a logo and colors is good. But I would really caution people against just getting these ideas in their head and then just doing it themselves on a regular basis.

So like branding, colors, shapes, logos, like that's part of your branding and recognition. And from a marketing standpoint, you want to be recognized. So if you come up with a new color scheme once a year, just because you think it's fun and cute, you might actually be harming your marketing recognition because people might be used to seeing your stuff in like blue with a triangle or something like that.

And then next year it's green. Like that might be just enough to throw them off. So I think it's good to revisit those things and figure out, do I need to update something?

But I don't think it's something that needs to be updated like all the time. It's kind of like the Constitution, right? So we wrote a Constitution way back in the day.

And I should know this number since I brought up this example, but I don't know it. So how many amendments are there to the Constitution? It's like 30-ish or 35?

27?

28?

I'm making this up completely. But there's only so many amendments to the Constitution, right? It's not like we don't look at the Constitution every year and change it.

And it's a huge deal if we did need to make an amendment. So that's what I'm saying. I think you should evaluate these things, but stuff that has to do with your branding, it shouldn't necessarily be changed all the time.

And if you are going to change it, you really should talk to somebody with training and like marketing knowledge so that when you do make that decision, you're making the right one because it's a big deal.

Yeah. And even having the recognition, having a website, having these resources that link you to whatever you're offering. If you don't have a website, I mean, it's 2024, almost 2025.

You've got to have a website.

I don't have a website. I'm sorry.

Okay. Well, get a website.

I don't want to be found. I'm actually hiding, so it's fine. I have a SpeakEasy Chiropractic office.

You have to know the secret knock.

I like that. See, now you're going to have to change the name because that's catchy.

I know that would be really funny. Yeah. No, no, but for regular chiropractors, I don't know how you survive without a website.

There's no such thing as phone books anymore. We don't get them anymore. I don't think anyone gets phone books.

When I started practice, we did have a phone book, but there's no phone books. The Internet is the phone book if you want to think of it like that. I struggle to understand how when that's your main deal, your source of income job, how do you not have a website?

You got to have one. And it needs to be effective. So again, talking to people that know how to build websites and know what drives traffic to them I think is important.

Yeah, for sure. I mean, it's the digital age. And if, I mean, people don't want to pick up the phone.

They don't want to pick up the phone to schedule an appointment. They want to use their phone to find a doctor, schedule their appointment and do all of the check-in online. They want to do everything on their phone.

And so having resources that fit that mold is also going to help you succeed in this digital age.

Yeah, definitely.

That leads us right into getting new patients in the door, planning for that. What does that look like in your practice? Is it, are you going to offer online booking?

Yes or no. And online booking doesn't have to mean they're going online, they're finding a date and time and boom, they're on your schedule. It could mean that they're requesting an appointment.

And having these tools within your EHR or however you use your scheduling platform is going to be important so that you're not having to manually track everything on sticky notes.

Yeah. So here's something I struggled with. I tend to be introverted.

I am not the person that's going to cold call up the local school or employer or other doctor's office or like whatever and ask if I can come in and do a presentation. Or any of those things where you have to stand up in front of people and talk. I mean, I think those are incredible ways to reach people, get your name out there, start to become known.

So there's nothing wrong with them, but it's not my strong suit. Now, there's a lot of people that will tell you, oh, you have to get out of your comfort zone. I don't want to.

I'm not going to lie to you. I want to identify my strengths and play to them as much as possible. That doesn't mean ever in my whole life, I'm never going to get out of my comfort zone and go do something I don't want to do.

But if you need somewhere to start and you don't want to go out and do like spinal screenings at the local 5K or like whatever it is, start small, figure out what you are comfortable doing and just start doing those things. Because especially when it comes to public speaking, like if you are doing those things in your office, say for example, so maybe you are going to give a talk, but it's in your office and you invite your current patients, but you tell them you can bring a friend or whatever. People are going to show up to those things potentially to listen to you talk and that's going to help make you feel more comfortable.

So maybe you will go out and do some of those other things. But maybe you get busy enough where you don't ever have to go do those other things because you figured out what you were good at and you really maximize that stuff. But if you're going to do some of those things, you need to have a way to measure what that return on investment is.

So tracking the performance and identify those things you're doing to get new patients. I'm putting them in air quotes, get air quotes. Maybe you do presentations in your office and they don't gather a lot of new patients.

You might identify at the same time, though, that your retention increased and got better. So maybe it kept your existing patients coming in to see you more because they realized how smart you are and they want to keep you on their health care team. So that's the value in tracking that performance and some of your statistics across time and having that info at your fingertips.

But, yeah, I mean, you may find out that that's not working at all, but maybe to get new patients, changing what you talk about during table time has generated a lot of new patients. So maybe you put more energy towards getting even better at that or something. But you're not going to know if you're not tracking that performance and looking at your statistics.

And then I think just be reasonable about what you want to start doing and play to your strengths as much as you can.

It's like math. There is more than one way to get to a solution. There isn't a one size fits all.

And I mean, geographically, some things are going to work better in some areas versus others. I mean, if you're in a very rural town where maybe you're the only chiropractic office, your marketing and referral strategy could be very different than somebody in New York like you, Dr. Steph.

Like say you're in Florida with like you're just inside of a huge retirement community. That's awesome. And maybe you decide, I want to expand, bring in a pediatric doc, and all these patients are going to refer their family members to us.

That may or may not be practical or feasible. So you might want to evaluate things like that. So it might depend on your location and your patient population, like all of those factors for sure.

Yeah, and plan for it. Set those plans in motion. Write it down.

What are you going to do? What are you going to try this year that you didn't try last year? And again, track it.

See how well it goes. You don't have to try everything all at once. Pull the trigger and hope for the best.

But planning for it and setting goals is going to help you in the long run.

Yeah, definitely.

All right. Patient care. So when it comes to going into the new year, whether revisiting your forms, whether they're digital or you're still using paper, you have to look at it.

You have to consider what's coming, what's new, what you're going to offer, what maybe you didn't do last year that you should have been doing and how you're going to implement that this coming year. Let's talk about forms. Why is it important to have versions on your forms year over year?

We did it just to keep track. I mean, we would have a new one. I mean, okay, so we would sit down.

Usually, what would happen is in December, we would be like, oh my God, we got to get the update form ready for the new year. Holy cow. We're running around like mad people because it's between Thanksgiving and Christmas, busiest time of year.

Oh God, we got to get this ready. And so we look at our form. We might change something on it, but I think it's important to have the date.

I mean, you're going to ask the patient to date it for the day they fill it out, but like just standardize. You should have a date on it somewhere so that you know like when you revised it last and what year version it's for. Yeah, I don't know.

We just did it always. But what we shouldn't have done was wait until we needed it in a week, right? Because then we were also all on paper.

So we would like run to the store and have to make like a thousand copies of this thing. And then we made the patients fill out all this other paperwork that went with it. And

I mean, we would have a giant stack of papers in the month.

Like our staff, this goes back to staff satisfaction, hated the month of January because not only did some people's insurance change and maybe have to check new benefits and stuff like that, but we gave them this ridiculous amount of paperwork to process. It was just insane. I mean, think back, it's like walking out of the UPS store with this giant stack of copies.

And we would have to go back and make more in February. But it was just our office policy, your first visit of the year, you had to fill this thing out. So even if you came in in June, you still had to fill it out if it was your first visit for the year, if you weren't a new patient.

But so it's a ridiculous amount of paper. It's really cool if you can do something like that digitally. So with my, because I have ChiroTouch Cloud, I have in forms.

I do still, I've already evaluated the form and it's ready to go, but I'm done with it. And I can just send it out digitally, like click, click, click. And then, like, I don't have staff because I do everything myself.

But for people who are sole proprietors, if you are doing things by yourself, it's going to make it easier on you too. And that way you don't have to like read the form, transfer the information into your system. And then we would make the staff like initial it, so we know who processed it and prove that we had read it.

And then scan it in and save it and put it into, like you don't have to do any of that if you just had a program that does it digitally for you, because then it would just be there.

Yeah. Take away is digital forms.

Yeah. I mean, again, I don't know how people don't have these things, so it's amazing. But back to what I was saying before, we should have had our update form ready to roll.

I think best time would be by like October 31st or maybe by November 15th, just before you hit that busy holiday season. And that way it would just would have been done and ready. And we could have casually taken our time to go make copies instead of going.

I literally, there were years I went on New Year's Eve. Like we're going to need this in two days. I got to get it done because I want tomorrow off.

You know what I mean? Like so planning ahead and getting something like that done beforehand. Like we're talking months in advance.

And I think we had it on our list somewhere too, like planning holiday events in the office or holiday themed things just to engage with your patients. So we're coming up on the holiday season right now. And you know, maybe you can pull something together this month to celebrate like end of year holidays, but you probably should have thought about that like in September at the latest.

So back to your calendar that everyone's going to have now. You know, if you want to have a fourth of July themed thing in your office, that's great. Figure it out in March or April.

And that way it's just already planned, thought of, figured out. And no one's wondering, oh, what are we doing for fourth of July? Because you already figured it out.

But yeah, like holiday themed or like calendar themed things that are going to coincide with certain things at certain times of year. You should be planning them months in advance. It just takes the stress off and then you're ready.

And there's no trying to figure something out at the last minute.

And budgeting. You have to budget for those things. You can't wait until the week of and have to go out and go to Costco Sam's Club and buy thousands of dollars worth of whatever you're going to have in the office.

Sparklers. Getting out sparklers or something.

Yeah. You've got to plan. If you take away one thing from this episode is plan.

Plan for everything. Have a plan for everything. In this case, overthinking is needed.

You've got to overthink everything.

Yeah. Like I said before, it sucks, but you have to be a negative Nellie and try to think how everything could go wrong. Or in this case, just think of every possible thing in the world, which is why we're doing this to try to help.

Then it'll just be easier to know what you're doing.

Yeah, for sure. Okay. This is a hot topic, revenue.

Going into the new year, I'm not a chiropractor, but I've worked with many that we get to January, February, and they're like, oh, we've increased our fees. They've already billed out lots of claims, and it becomes somewhat of a mess. Planning for your fee schedule increases, or if you're in all cash office, looking at your stats and deciding, are you going to increase this year?

Do you have to? Planning for those things is going to be paramount before the new year starts.

Yeah. I think it's important, too, to think about what time of year that you're going to institute that price increase. So I'm trying to think here.

I don't. So it might still be important to keep that in mind if you are doing insurance just because depending on how high someone's copays or deductibles are, if it is going to increase that patient's out-of-pocket cost, or just putting that out there that you might want to check with your insurance contracts to see if there's some time frame in which you're supposed to notify patients if their out-of-pocket cost is going to increase. So if your fee isn't going to make a bunch of things up here, if your fee is $40 and the allowed amount is 50, but you are a good doc that just evaluates your fees independently and your price was 40, but now you are going to go up to 45, patient still has a $60 copay, allowed amount is 50, so you are allowed to collect that $45 from that insurance patient.

But is there a time frame in which you needed to notify that person that their out-of-pocket cost was going to increase? That's what I was trying to say. So it's good to check with your insurance contracts if you are in network to find out if there is some kind of time frame notice that you need to give.

Like you might not be able to wake up on Monday and decide I'm increasing my prices Wednesday. I think it's good to let people know ahead of time, but that's just me.

Oh, yeah, for sure.

Also, just to throw this out there, I think we think of the New Year as a good time to figure stuff like this out. And institute those increases. But like example, I just got a notice two months ago, one month ago from my local one of my biggest payer that they're increasing our fee schedule.

I almost fell over and died because it's been like nine years since they've increased it. It went up for our most commonly billed service about 80 cents. Go us.

But regardless, it's a raise. But anyways, it goes into effect like December 11th. So even they don't time.

It's not like it's January 1st. They're not timing it with January 1st. So evaluating your business and trying to figure out a good time to let people know that it's happening and then when it actually does happen, those should be well thought out and planned out in my opinion.

Yeah. Speaking from a patient's perspective, I don't want to find out the day of that you're increasing your fees. I'm not in the mindset that I'm going to have to come out of pocket, whether it's five to $10 more.

I think good practice would be at least give everybody a 30 days notice that you're going to increase your fees.

Oh, yeah. They should know.

Yeah, for sure.

I would be pissed. Honestly, I'd probably be fine with the increase if I knew ahead of time, but if I find out when I'm there and if I think it's too much, that would be bad.

Yo, what's even worse is you don't find out that day, you get a statement in the mail. You get a statement that's like, oh, by the way, you owe us $400. It's not going to be a good day.

It's not a good look on the practice if they take it to social media or a very unhappy patient shows up at your door and is ready for confrontation. Staff won't be happy. That goes back to staff satisfaction and trying to mitigate things ahead of time.

Planning those things accordingly and letting people know is important.

Yeah, totally agree. It just heads off problems.

Yeah, for sure.

It helps you plan properly your projections.

Yeah, for sure. How you're going to inform your patients is important as well. Whether you, again, goes back to digital.

If you don't have a digital platform to notify your patients, whether it's text, email, have a sign somewhere in the office so that somebody knows what's changing and when.

And I think too, most people freaking love their chiropractors. I mean, maybe I have a skewed view of that, but I think most of them are going to understand and just say, okay, thanks for letting me know. And we went through it.

We've raised prices at one point, and we also left an insurance panel one year. And I'll tell you, the year that we left the One Insurance Company, we made more money that year. Oh, and there were people that didn't, that stopped coming in because we didn't take their insurance anymore as a network.

But it just made more room in the schedule for people who valued the care that we were providing for the price it was at. It just made more room for those people. And I guess we were able to fill in those spaces with existing and other new patients that didn't mind.

And like I said, I mean, we ended up making more money that year. So that was super interesting side story. But whether you should take insurance or not and being in and out of network or what have you, that's a personal decision.

But that's the fear that the patients are going to leave. So I guess it depends what company you're leaving and how many patients you have, like what percent of your practice is that or whatnot. But I would say ours was pretty big when we dropped that one.

And if anything, it was better.

Yeah. And like you said before, I mean, unless you're tracking it and measuring, you wouldn't have known. You would have no idea.

Yeah.

I had a spreadsheet and I am obsessed with numbers.

So yeah. But you planned. I mean, you had it.

You had the numbers and you made more money. It was win-win.

Yeah, definitely. Which brings up bonus. Can we talk about bonuses next?

Yes.

Yes.

This is a hot topic, maybe. Like should you bonus your staff? I guess that's up to you too.

But what I would suggest is evaluating whether you do one annual bonus or is it split up across the year? I think it's cool if it's split up across the year, but that's just me.

I mean, I think incentivizing or letting people know that there are milestones along the way, bonus opportunities throughout the year increases morale.

Yeah, for sure. And just psychologically, it also helps them feel appreciated. I mean, not to say they won't appreciate a larger version of a bonus, whatever form that takes at the end of a year or whenever you do that annually, but I think it helps psychologically to get a reward every so often of some type.

Yeah. And you have to plan for how you're going to bonus. You can't just change it up as you go.

You've got to have the expectations, how you're going to do it, how much money needs to be made in order to make these things happen, and then planning for those bonuses that come up.

Yeah. And I don't know. I think that brings up a really interesting topic.

Would you still bonus your employees if the business didn't perform the way you wanted it to? If you fell short of your goal, are you still going to bonus your employees and how? And so is there bonus tied to the performance of the practice?

And I think that that gets real dicey, real fast. Because if you have a rock star CA who's doing a great job, but your biller sucks and you lost a lot of money on insurance collections, that's not necessarily the CA's fault.

Yeah.

It's actually your fault because you didn't notice the biller wasn't doing a good job. So again, that's something that you need to evaluate and watch throughout the year and check. But like thinking of that type of scenario, like, well, what would I do if this happens and that happens?

I think it's really important when it comes to like those bonuses, because you don't want to lose people or scare them into thinking your business isn't healthy because like their bonus was smaller than last year or something like that. So good things to consider, I think, when you're trying to figure that out.

Yeah. I mean, from an employee perspective, I mean, hearing the word bonus is great, but, you know, not knowing what it's tied to I think is a little scary.

Yeah. And if you end up feeling like it was tied to someone else's performance or something that was out of your control, that is not even if even though they're getting a bonus, it's it doesn't it's not a good look.

I imagine it would create a toxic workplace. It becomes the blame game. And people leave because they're unhappy.

Yes, exactly. So got to be careful there, I think.

And plan. It's always planning. Okay, so we talked about bonuses.

Let's talk about taxes because we're coming up to the end of the year. And this is something that I don't want to say everybody is scrambling, but it's something that everybody's wanting to pull their hair out. Whether you're a business owner or not, tax time is often a nightmare.

But as a business owner, there are so many components that you have to plan for and set expectations for, for everyone involved.

So I was thinking just this past weekend how I really need to go through like all my, because I'm not, if I spend money for, I don't put it immediately. I don't have a good system of keeping track of this. I have my spreadsheet, but I don't fill it in as I go.

I like to sit down with everything all at once and put it all in, which feels really like a lot of work. So I put it off and I don't like doing it. So I should probably have a different system in place so that I'm not doing it all at once at the end of the year.

So don't do what I do. But I was thinking I need to pull all my stuff together. So how much have I brought in this year and what have I spent?

I have no idea. I have a general feeling that it's less than last year, but it might not be because I've spent money on different things. It's probably not.

No, it probably is less. Anyways, I don't know. So I need to sit down and look at that so that I can figure out a general idea as to what my tax liability is going to be.

And therefore, do I need to buy something before the end of the year, or do I definitely not buy something before the end of the year? So for me, I'm kind of like a small scale. Like that's what I need to look at with my taxes is, do I need to buy something before December 31st?

Yeah. And I mean, I know there are a lot of offices that sell products in their office. Some have like little boutiques and built in.

And so sales taxes are a thing, but are often forgot about. So take that into consideration when you are working through your finances and making plans for the next year.

Yeah. I mean, this goes back to the episode. I think it was the first episode we did together.

Like if you're opening your own practice or whatever, like you need to think about sales tax right then and there. And your EHR, when you put your charges in or wherever

it's going to be, should absolutely have a section for sales tax. And then there should just be a report.

I mean, this is like math 101. Like just let the computer do the work for you, pull a report so that you have that sales tax info. And like, boom, that way it's just getting tracked every time you sell something.

And that report is always there for you. And you can just like click of a button and get it out of your system. So I hope sales tax is an easy one, but it's a big one that you've got to make sure you think ahead about.

Because if you just start selling vitamins, but you find out halfway through the year that you're supposed to be collecting sales tax on them, that's going to suck.

Hey, no better do better. The following year should be better, but it's going to be a cleanup effort while everything's happening at the end of the year.

Earlier we were talking about sometimes being in network, pulling out of the network. When you're planning for the following year, you have to consider network status renewals. If you are going to continue with a payer and it goes back to your reporting, see how things went throughout the year, look at your demographics.

Who are your majority of your patients? Do you have the majority of your patients, do they fall within one payer? Maybe not, look at your revenue and then make that decision before the time comes whether or not you're going to continue with those networks.

Yeah, and a big one is Medicare. So you can only change your participating status with Medicare at the end of the year. So I'll see people like mid-year posting on social media like April, May, June, whatever that they want to become non-participating with Medicare.

You can't do it till November. They don't care what you want. So you have to wait and then you have to follow the process to do that.

So it's kind of like open enrollments at work, picking health insurance and stuff like that. They only let you change if you're participating or non-participating. As far as I understand it, at the very last part of the year.

If you miss the deadline, then you have to wait till the following year. So that's a really important thing to know and just keep in mind so that you don't mess it up.

Yeah. Then we talked about business planning and things like changing up the office, but things that you don't think about on a daily basis, like if you're renting a space, renewing your lease, and you mentioned a calendar. Have on that calendar when you need to renew certain things, whether it's network, your lease, malpractice insurance when you need to.

I have to do this week. I need to write that down.

Yes. It's so important, but it's often overlooked, and you never want to get to the point where you're getting a letter in the mail, and then you're scrambling. Not fun.

Yeah, bad.

Very bad.

Also with a lease, especially. For a second, let's talk about that. I have friends that own a gym, and it's in a plaza, and the way their commercial lease is written, I'm going to make this up, but it's three-year terms with three options to renew or something like that.

It was getting weird because the plaza owner wanted to relocate all the tenants to one side of the plaza and knock the rest of the plaza down to make way for a different building they wanted to put in. But my friends didn't want to move into any of the other spaces because they just wouldn't work right, like it just wasn't not going to work for the space that they have now. So the landlord was allowed to move them if the space was comparable, but none of the spaces were comparable.

So it became this thing and then they were like, wait, and they checked their lease and they were coming up on when they can exercise their option to renew for the next term. And so it had to be done a certain way. It had to be mailed a certain number of days ahead of time, postmarked with like return receipt or something, I don't know, and not insured, but signature required maybe, whatever, I don't know.

They had to do exactly what the lease said in the right amount of time. And because they, like the very last minute they remembered this, they exercised their option to renew for three more years right in time. The landlord, if they were going to follow through with that plan, would have had to buy them out of those three years.

If my friends had not been paying attention, they wouldn't have renewed in time potentially, even if they wanted to renew. Like they could have still renewed, but if they missed the deadline, then the landlord can do whatever they want basically in that circumstance. And they might have been kicked out because they didn't renew in time.

So because they renewed, I mean, we'll never know for sure, but because they renewed, they were able to stay in their space or at least know they would get a huge buyout for the term of their lease because the landlord would have broke it if they kicked them out at that point. So make sure you know in your lease when you have to exercise options to renew and that you do it the correct way is the moral of the story because it could save you a lot of heartache and make sure that you don't get kicked out of your space without realizing you're going to get kicked out of your space.

Yeah. And hopefully the landlords are keeping that open line of communication as well. So if they have intentions to maybe sell, letting you know ahead of time so you can then let your patients know that you're moving because that's a whole entire, you know, I would say segment.

You can have a different episode on that because we've had a move.

Oh yeah. There's a lot that goes into that. So stay on top of it.

Put it on your calendar. Put everything on a calendar. It's going to help you in the long run.

And that actually falls under personal and professional goal setting. Keeping the calendar. Schedule all the things so you know when to expect them.

And automate. Automate as much as you can. I mean, it's hard to come by tools these days that aren't automating tasks and reminders to let you know when things are due.

So utilize those resources instead of hoping for the best.

Oh yeah.

Yeah. I know we talked about renewing leases, but as chiropractors, you've got to renew your licenses. Every state, I think, is different.

Would you agree?

Yes. If you forget in New York, they'll just send you a letter saying, hey, you forgot. And then you'll say, oh, poop.

And you go do it online. Don't ask me why I know that.

Yeah. You've got your person. I mean, you want to be able to practice.

So having those license renewals, that's important. And knowing when you have to do it is going to help you.

Also, one other thing about that slightly related but off-topic, but same topic. In New York state here, I don't know if every state is the same, but we got like a certificate like, oh, here's your license. It's on like parchment looking paper.

But what we renew every year is, I mean, it's your license, but you get a registration certificate reflecting that, oh, it's current and it's every three years we have to do it. And so the last time I renewed my license, so I forgot to renew my license. That sent me the letter and I was like, oh my God.

So yeah, I went online and did it like that day. So they send you the paper still and it still had like my original date. It's like July 1st or something.

So it was like backdated. And I'm not kidding. This is what I did.

I took the frame off the wall. I pulled out the old one. I got the new one.

I signed because we have to sign and date the new ones. And then I cleaned the frame because it was dusty. You know, it had been on the wall.

And then I put it back in there and I hung it back up and I threw the old one out. Well, it turns out I threw out the new one, not the old one. I put the old one back in the frame without realizing and I threw out the new one.

So, I don't know, I just happened to look at it like a few months ago. It's literally behind me on the wall. I was like, that looks wrong.

And so I just went online and ordered a new one. And so when it comes to stuff like that, also, like, don't be scared if you do make a mistake, just make it right as literally as fast as possible and you're probably gonna be okay. But when it comes to little stuff like that, like, make sure you sign something if you're supposed to sign it and don't throw the new one out.

Yeah, for sure. I didn't know you were supposed to sign social security cards until I was, I want to say 20.

Okay, well, it's probably better that you signed it then because I think I signed mine when I was like six or seven. I mean, what does that signature look like? It's not normal.

It's like the day I learned cursive writing and it's not a regular signature. So yeah, you're supposed to sign stuff, so make sure you check. I might have caught my former employer on that because when I got mine in like 2008 or whatever it was, I had to sign it and I think I noticed his wasn't signed.

I'm like, you're supposed to sign these things. He might have just forgot. It's not a big deal.

Not valid. Anything you did prior to signing it doesn't count. Perfect.

Okay. So we've got your chiropractic license so that you can practice, but we also have business licenses. I'm not familiar enough to say whether or not those have to be renewed yearly, bi-yearly, no idea, but checking in with an attorney or someone in your state that would know can put you in a good spot.

Yep. Just check with your local peeps.

Yeah. We already talked about malpractice. Put it on your calendar.

Like we said, it's going to make your life easier as the year goes on. So nothing is sneaking up on you. And speaking of scheduling, as chiropractors, you have to keep up with continuing education, right?

So planning for that in the year is necessary. Whether you're going to take time away from the office or not, I think they offer online CEs. But having those plans is, I mean, I'd say it's important.

Yeah. And it's a good way to tie in some time out of the office or a vacation maybe. So, you know, maybe you're going to park or seminars to get a bunch of CEs, but you stay a couple extra days after or before.

And people don't think of Vegas as like a family place, but it could be. You just got to be careful where the kids go. But, you know, you could bring your family there and have a great time, enjoy some food, some sunshine probably, or just meet up with friends or just whatever.

So you could tack a few days on at the beginning or the end and tie it in with getting a way to do something like that is a great idea. Also, just a tip, keep track of your CEs as you go. So if you, I have a spreadsheet, obviously, as I complete something, I like date, type it in and how many hours.

And then in New York state, like we have a category, a couple of categories or whatever we have to like do a certain number in. So I'll make a note about that. But I got audited by the state one time and I was like, no problem.

I already have this all written down. And I also, when you get the certificate, I mean, here anyways, we get a thing saying, hey, you did these hours. So I would scan them all in and had them saved.

I was like, take this in New York. Boom. And I was like answered it that day.

It was not stressful. I didn't have to go searching for what I did. So if you just keep track of it as you go, unlike myself with my receipts for my taxes, keep track of it as you go because then when you do need to say, hey, I did my things like piece of cake, you're already going to have it and it won't be a big deal at all.

Yeah. Makes sense. I know there are a lot of classes and such that all of the employees in the office can take advantage of and it's professional development.

So yeah.

Yeah. Maybe you're a staff would like to go to Parker too and then they'll feel valued and stuff. But then just a tip, if you're bringing them, you better be paying for their ticket.

Give them a daily sipen for food and you're covering their hotel and airfare. Just don't be the person that thinks they're going to pay their own way because that would be weird.

Yeah. And I mean, hey, plan for it. Plan for the events that you're going to attend during the year.

I'm sure there's maybe room if you're local, like if you live in Florida and you're close to the Florida National, I'm sure you could work that in because you live there. But for out of state events, you're going to want to plan those ahead of time and determine, are you bringing everybody or you bring in a few folks or none at all.

So we talked about like branding, marketing, logo, colors, but like your physical environment in your office. So if you still have posters from 1980, buy new ones. Maybe consider buying new ones.

You know, bring a family member or friend in through your office and like the most critical friend you can think of and tell them to just come in and rip your office apart to give you some feedback. Because maybe you'll find out like, gee, I should get new chairs for my waiting room. Like just to freshen things up.

Also, like are the chairs even safe? I mean, once in a while, we would literally find like I would be cleaning in our waiting room and find a chair that was broken. We don't realize it because we don't ever sit in them.

And the patients didn't tell us or didn't notice. So have someone go through your office and just be brutally honest with you and do some of those things yourself. Like walk through the same paths that they take as patients.

Sit in the chairs in your waiting room. You probably lay on your table if you get adjusted by somebody. But like do all those things and pretend like you're a patient because you'll probably find things that you need to either fix, update, maintenance, replace.

You might not notice that the fake tree in your waiting room is super dusty unless you sit down next to it. You know what I mean? So like that's an example because that, I mean, I did that.

I was like, wow, I need to dust this tree more. It's so dirty and I want someone to see that. But evaluating those kinds of things, looking at your office physically through your patient's eyes as much as you can, I think is a really good idea.

So again, maybe you're not doing that on New Year's Eve, but figure out at what point in the year you are doing that. That could coincide with when you might have a dip in patients. If there's just a slower month, then you plan to do some of those things with your staff even then too, maybe.

That's just an idea. Planning ahead for big purchases like your chiropractic equipment, table, stuff like that. Again, it's best to plan those things ahead of time, not when you need it because if your front desk computer breaks, you're probably going to Best Buy and just getting whatever they happen to have.

That might not be what you would have bought if you had just planned ahead and got what you wanted on purpose. Planning some of that stuff and all the way down to what you wear in the office. Does that need a refresh?

I'll tell you guys, we had uniforms in our office and there came a point at which I suddenly looked at myself and the doc I worked with one day and was like, we don't look good. It's a good thing people are facedown most of the time. The thread on my shirt was starting to come loose and stuff.

Patients probably don't notice what you do, so you should evaluate those things and then figure out when it's time to make upgrades to things that are physically in the office and what everybody's wearing. If it's just a new shirt of the same thing, fine, but if you're going to switch it up, then it should be planned ahead and thought out pretty well.

Yeah, I agree. And that goes along with the colors we talked about earlier. I think maybe with uniforms changing up, if you want to change colors, that could be the area that you change throughout the year.

If you're toying around with colors and wanting to change things, that's something small that's feasible.

Yeah, totally. Yeah. So I think that was a pretty exhaustive list.

Again, we've got a copy of Organized Nicely that you guys can use.

And if you have any questions or feedback, let us know, send us an email at chirocast at chirotouch.com. And we will talk to you next time.

Thanks, everybody.

Bye.

Thank you for joining us on this episode of ChiroCast, Insights for Modern Chiropractors, brought to you by ChiroTouch, hosted by Dr. Stephanie Brown and Danielle Javines. Produced by Debbi Brooks, editing from Matthew Dodge. Our theme song House Five is from Scott W.
Brooks. If you enjoyed today's show, don't forget to like, link, and subscribe. We appreciate your support and we'll catch you next time.

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