109 - Building Patient Trust Through Presence and Connection with David Norrie

How can I turn on and make that switch? It's only a 10-second, hey, I'm getting ready to go in and see him. Okay, the last patient is behind me. The patients that are later on in the afternoon are off in the distance. Let's be in this moment right here. Let me be present. So one of the things that we're really talking about in Turned On these days is presence is at a premium. I think this is incredibly important, Dr. Lona. As we see technology and AI start to creep more and more into our lives, we'll know that there's one thing that will never replace it, and that's the human spirit. When we are present with our clients, our patients, we then give them that one thing that technology can't— the human touch.

Hello and welcome to Build Your Remarkable Practice podcast. This podcast is dedicated to chiropractors who are in the seasons of launching and building their practice. Join myself, Dr. Lona, and my co-host, Dr. Bobby, as we have conversations each week as it relates to building the practice of your dreams. And remember, you can have a remarkable practice as part of a remarkable life, not instead of one. We are here to lead you on the way. Welcome back to the Build Your Remarkable Practice podcast, and I am here today with one of our speakers from our last immersion. He crushed it. I have to say, you were probably my favorite speaker up there. I loved your message.

Yes, I take that compliment.

Yes, it was so good. It got you back in, like, I don't know, just like kind of take a deep breath. And, you know, be human again. That was your message, right? So, David Norrie, thanks for joining us. I had the good fortune of taking your speaking class a year or two ago called Speak Up, where you're really helping us craft our message and bring it through. So it's been great to work with you, and it's exciting to have you on the podcast today.

Thank you so much. It's great to be here. Thank you for the wonderful introduction, you know, and that group of chiropractors that we did that immersion with— that, um, well, not the immersion, but the cohort with You know, I learned so much from y'all. You guys were great. And what I saw was people who were already awesome and very articulate and had great skill sets. But I watched you guys playing off each other, and that's really the design of the class is not for only for me to teach a certain skill set, but for you to be coach at the same time as you are student. And I watched you guys just elevate one another. So it was a pleasure to have you there.

Thank you. Yeah, I know. I was like, afterwards I was like, how'd we do? Like, right?

Yeah.

Yeah, you're like, you're coaching us and then you got to see us in real time, right?

It was fantastic. Eye-opening.

Yeah. Thank you. Awesome. Well, let's, let's take it back to the immersion for a little bit because you came in as part of the sales training, teaching our clients, our members more about how to do this thing called sales, which we in chiropractic, we never use that term really. Like, and that's part of why we brought it up at the last immersion because our process of meeting the new patient or the new practice member, hearing them, learning about them, and then starting that journey with them is sales. Uh, and your message really circled around this idea of like what it is to be human with people and that emotional connection. And so if maybe you could share some of what you brought to the stage that weren't there. Yeah.

Well, here's the easy part. You know, I have been in sales all my life, but I'm also a storyteller. So sales and journalist. Basically, you're telling stories, you know, you're telling stories, either you're selling something, that's essentially what we're doing. So what I like to do is from the time I was little, I, I call myself a student of human interaction, like a people watcher.

Mm-hmm.

And so what I like to do is just watch how people interact and then ask myself questions about how I like to be treated. You know, if I went in to go purchase a car and I ended up buying this car, I go back and ask myself why. And it was mostly because not of the car. Sure, it had the bells and whistles or everything I was looking for, but it was more importantly, it was the staff, you know. So my big thing is, with any industry, all things being equal, yeah, would somebody choose you? That's most important. Because—

and keep choosing you, right?

Yeah, and keep choosing you and refer you. Because people have choices, and we know word-of-mouth advertising will really never go away, and it's the best form. Because people Now, more than ever, the, that T word called trust, that's what they're looking for. And we're so inundated with commercials. We're so inundated with ads every time we open our phone that people now are going back to, hey, I need a great recommendation from somebody who's actually done this. So, the Be Human Again philosophy is how can we as business owners or in any industry, 'cause this is industry agnostic. They work with HVAC, they work with salons, they work with doctors, they work with sales professionals. What we're looking for is for that human connection to say, hey, I trust you, you have my best interest, and I'm gonna therefore spend my money with you.

Yep. And, and in our case, especially because we are one of those scenarios where You know, who knows a— who knows their community sometimes better than a chiropractor? You see people like sometimes multiple times a week, obviously, for period— long periods of time. And then eventually the goal is obviously that the person has transformation happen and recognizes this is something I'm going to do for my lifetime, right? And so I always say like at that point when we start to cross that bridge, we need to just not screw it up, right? Like they're clearly in, they like it, they're— but if if we misstep in that trust, right? Like we could unwind years of doing well, right?

Yeah. Well, you, you know, it's really critical cuz we'll just keep hammering on this trust thing. What we want as human beings is that connection. We look for it in our friendships. We look for it in our, certainly in our marriages and we look for it in business. And what we are, we are creatures of repetition. When we find something that we like, we wanna stick with it. Some of you guys, the easiest example is, You have your coffee in the morning and you know that how that coffee tastes, you know what it does for you. And man, that's your coffee. And to break that habit has to be something either drastic or something that let you down. But that's just coffee. The human part of what we're doing is making sure that we are turned on. And this is really the genesis of our company. If you go to turnedon.com, my wife and I coined this phrase. Back in 2018. And at first it was like, when I said, let's call it Turned On, yeah, Leek was like, well, that's a little weird. And I said, but babe, here, here we go. It's a metaphor really for what's happening in the world. The world is turning off. I say we're on cruise control. We go on autopilot. Why? Because this has made life so easy to go on autopilot. And at the convention, you know, I said, hey, here's how we know that we've entered the land of knowledge but skipped the encounter part.

Yes.

And, and, and that's key. It's not mine. I got it from a pastor years ago, and it just, it's stuck in my brain. And I'll say it one more time: we've entered the land of knowledge, meaning all this knowledge right here, but we've skipped the encounter part. So we have basically everything we need to know. This is a supercomputer, but the encounter part is critical. And the easiest way to explain that is when we go to a concert— remember I did this at the, at the event We go to a concert, everybody's filming it. Everybody's got their phones out. They're not immersed in the moment. And so how do we relate this to your everyday practice? It's so easy to go on cruise control and we're human beings. So we'll do that. We take the path of least resistance. If you look at the human body, right? The human body wants homeostasis, but also it will take the path of least resistance and it takes a fever or something to to kick in your immune system. So that's what's called a course correction. If our body does it, and certainly chiropractors know this, that you have to have correction, you have to have something to correct when things are going off course. It's the same thing with our subconscious brains and neuroscience. We will tend to go into that area of least resistance, and that might be just, hey, it's Tuesday, It's Thursday. I got to see 10 clients, 10 patients today. So we get off of that idea to, hey, flip the switch. So it's a simple concept is flip that switch. And if you feel yourself drifting or going off cruise control, or you see, you look around and you see the practice and you're like, hey, we're kind of, let's do something to flip that switch. Let's be human again. So that way when our clients and patients come in. They notice that difference.

Yeah. Yeah. So not living on autopilot, right? Like, actually not having a Groundhog's Day. Exactly. Yeah. I remember probably within my second year of chiropractic school, and I had called my dad, who was always like my ally, and I had said something along the lines of like, I wake up, I go, you know, I have coffee, I go to school, I get done, I work out, I go study, I go to bed, I wake up, you know, like that's how chiropractic school felt to me at times. And he was like, well, Lona, what do you think your adult life is going to be like? And I was horrified by his like answer that like somehow that is life. And I just remember thinking like, oh hell no, like no, like we're going to, we're going to be engaged in our life in a way where you don't feel like every day is just on repeat. But you do have to be so mindful of that because it is a headspace more than anything to stay aware and to be looking for, like, the beauty in the moment, even if it is a moment that you've gone through to the point of drudgery sometimes, right? Yeah.

You guys go back to chiropractic school, Lona, and Dad giving that great advice. It's wonderful. And sometimes, you know, we have kids now, and I remember my mom saying when I was maybe 13, I'm like, I'm bored. My mom's like, Hey, it's okay, cuz someday you're not gonna be bored, right? Life gets busy. And so what we have to do is we are in control of that. I mean, we can't just go off every day and do something different. We have to have, because systems are good. This is one of the things we talked about. Again, systems are good. We want things to make our life easier. The good part about these things and this computer that one is they do make things easier and systems will ease up with that. Should leave more opportunity and room for a personality. One of the first things that we talked about when we got on this call this morning, before we even started recording, was I said, man, I really love your glasses because why? They have personality. They make you come alive. I was dealing with something, uh, on, on a reel the other day, and it's just me jumping rope. So that's one of the few things I can do that I know every day I can jump rope to get my lymphatic system moving. But it gets boring after a while. So sometimes it's the music will change or I'll put on different outfits and I'm like, I am my own best motivator sometimes. Right. You know, we can watch videos, we can read books, we can listen to podcasts like this to get motivation and ideas. But we wake up on a daily basis saying, hey, you know what? Mom and Dad aren't waking me up today. Tony Robbins isn't getting me outta bed going, come on, David, let's go. It falls upon us. And as the leader in your practice, I think there's a huge area for any chiropractor to say, hey, I have to motivate myself first. My CAs, I gotta, you know, make sure that they're ready to go. And then, but the patient is really the, is really the central figure. And how can I turn on and make that switch? It's only a 10-second, hey, I'm getting ready to go in and see them. Okay. The last patient is behind me. The patients that are later on in the afternoon are off in the distance. Let's be in this moment right here. Let me be present. So one of the things that we're really talking about in Turned On these days is presence is at a premium. I think this is incredibly important, Dr. Lono. As we see technology and AI start to creep more and more into our lives, we'll know that there's one thing that will never replace it, and that's the human spirit. When we are present with our clients, our patients, we then give them that one thing that technology can't— the human touch. And I feel like that presence will be at a premium, and people pay for what? Premium. I want a premium subscription. What does premium mean? Is that you're getting the best possible thing. And that's what people will pay for and keep coming back for when everybody else is giving them the minimum or treating them like they're just in a factory.

Yeah, yeah. And, you know, I, I say this in, in my associates as we are training, because I think one of the most challenging things in a busy family practice is that you are in a scenario where things move very quickly, right? Like, adjustments don't take long. And for some of the younger chiropractors who are just starting out, like, think about how long it takes you to adjust your brother, your sister, your mother, your father, it doesn't take long, right? So the people we love, you know, it takes us 2, 3 minutes, whatever, maybe 5 depending on your technique. So that's really what an adjustment takes. Well, so how do you have presence with somebody in such a short snippet? But it is, it is something that is instantaneous too. And so I say to, you know, my docs as we're training, I'm like, one of the hardest things is to realize that you may move from one table to the next, and the table you just left, the person is having their very best day. They just bought a house, they got a new job, they had a baby, and then you move to the next table and that person just lost a loved one, might even be on their way to the funeral, right? Like, because that happens where sometimes because of the presence, people come sometimes and you're like, wow, like, why are you here right now? I know you're like on the way to the funeral. And I think it's because there's a felt sense of like, I can be who I am right now and you see me.

100%. It's such a great point you bring up. And let's talk about that. Maybe you're only in there for a couple seconds. How can we make each patient feel seen and have, uh, the presence that we need?

Right.

The statistics are, and this goes back to a UCLA study in the '60s, is basically, and you probably heard it, is that most of what happens in communication is nonverbal. It's body language, it might be tone, it might be eye contact or the smile. So really, in human, uh, performance, We are creatures of that, that amygdala fight or flight, that 8-second, I'm making a decision. Some people say it's milliseconds. We're making that decision subconsciously of how we're going to feel. So the best things you can do for each patient is even if it's a couple of seconds, direct eye contact and a genuine, what we call the Duquesne smile, where the teeth come out and the cheeks go up. We practice these things a lot. I talk about the Duquesne smile whether I'm talking to a bunch of high school kids or whether I'm talking to a group of doctors, because the smile does so much for that connection. Eye contact, the genuine thing. And I've had doctors that come in and I know they're busy, but if they just take that 30 seconds and they make that connection and they give me that time, and then human nature says, hey, I needed that from you and I got it.

Yeah.

You know, we can be in a room with somebody for 30 minutes and still not feel that connection.

Correct.

So it's not, it goes back to everything. And we'll, let's make one more analogy with our children. Sometimes we're busy, our kids come up, they got their drawing or they got their paper. My daughter, hey dad, I got this speech.

Right.

It only takes me 3 seconds to read, 30 seconds to read that speech and give her feedback. But if I'm just like, daddy doesn't have time, or, oh, okay, that's good. And give it right back to her. She knows. But if I sit her on my lap and go, come here for a second, and I look at it and I read it over with her, and I look at her and I go, that's really good, that's really good, sweetheart, I'm so proud of you— it's just the tone. It's me looking at her. It's me putting her on my knee for 5 seconds to let her know that. So it's— it goes back to really the quality of the time that you're with the patient, right?

Yep, yep. That's so good. Well, and, and we talked about how when you were speaking last weekend, we talked about how that first, was it 5 or 6 or 7 seconds?

Yeah, 7 seconds usually.

Yeah.

So critical for those exact reasons. Like, because it's not, it's not really what you're saying. It's that presence that initiates immediately. And is it not there?

So let's talk about that. Okay. So there's the power of the pause. So when you're speaking from stage, and I have to practice this all the time and be present because I have a tendency by human nature I'll just speed up naturally. Uh, once I get going, I mean, it's, it gets going. I'll hit the gas. The power of the pause on stage lets people know that you're present. It lets people know that you're confident, and it lets people know that I have time and I'm not worried about the clock running. So think about the power of the pause now in the clinic setting. You take that first couple seconds where you're not rushing in and say, okay, let's go, let's get down.

Right.

First couple seconds, and maybe it's just silence.

Right.

Hey, good to see you again. Yes. You having a good day? All right, let's get started. Right. I mean, it seems you, you practice this. It, it's, we can do it in, in role play very easy, but when you're in the real clinic, practice that pause. Silence sometimes is the biggest connection because you're communicating with your eyes, you're communicating with your body language and your smile. And when you pause for just a couple seconds, either when you first walk in or even between, as long as you're still engaged with them, it lets their nervous system calm down. Yes.

Yes.

Because think about this, we, we mentioned this, they're coming in that day and our central nervous system is on overload. Not only are we being inundated with ads and we're all so busy and we're all overwhelmed, but most of us are drinking a lot of Coffee. I mean, it's the big thing. So our central nervous—

not getting enough sunlight, maybe not moving enough, all the things. Yeah.

And picture this, someone coming in to see you. If their central nervous system is on overload and you're trying to get them to relax to get a quality adjustment, right? Okay, you have to do your part as the doctor and say, okay, how can I help them to really relax? And a lot of that is tone.

Yes.

Even now, when you hear it, when we slow down, when we take a different tone, but then we come back up, hey, it's great to see you. And then how you doing? You know, I learned this valuable lesson when I was going into one time to have acupuncture and my central nervous system was through the roof because kids and getting them off to school. And the guy said, well, let's talk for a second. And I was like, oh no, here you're going to give me a therapy lesson. I just really want you to put the needles in my shoulder to feel better. Right? But he said, what's going on? I said, you know, I just, I had a hard time last night with the kids. They weren't going to bed and I was yelling at them because it was a school day. And all he said was, interesting. He goes, so they were present. They weren't worried about waking up and getting 8 hours of sleep like you because you're an adult. They were literally present in play with what they were doing. I said, wow, you got me. You know, we are so worried as adults. Like you just said, we're busy. You got a lot of patients. So, that 30 seconds, minute in the adjustment room, if you can be present and your central nervous system calms down, then their central nervous system, it's called mirroring. The neuroscience is mirroring. We see it in sports all the time. The quarterback, if he's calm, the rest of the huddle's calm, and then they can perform at a high level. If the quarterback's rattled, guess what? The rest of the team's rattled and you're not performing at a high level.

Right. Yeah.

A mentor said to me, like, slow down to speed up, right?

Yeah.

Everything from, like you said, your tone, your energy, your pauses, your hands move slower when they're actually more efficient, which is practiced, right?

And you get practiced. Yeah. So that is counterintuitive and it's, it's funny your mentor said that cuz on the back cover of my book, I go, we almost have to do what's counterintuitive. We have to slow down to get ahead. And what you said is it's practiced. So again, being a former sports journalist, there's this clip and I've shown it to you guys. It's of Allen Iverson. And what happened is he had this great year, but they didn't win the championship. And he comes back in and coach doesn't see him as the leader practicing. He's not showing up to practices doing the things. So there's this famous interview with him and he says, We're talking about practice. He says it like 23 times in a 3-minute clip, just over and over. The game I love, the game I would die for, but you're talking to me about practice. And there you go. Because Michael Jordan, Kobe Bryant were known for practicing on their own. They were known for practicing in the middle of the night, calling up their trainer to come stretch them at 2 o'clock in the morning because they were shooting hoops. Now, we're not NBA professionals, but in our everyday work, we must remember that we are talking about practice because practice then makes habits. If we practice praying every night before we go to bed with the family, and now that's a habit that we don't break. If we practice drinking 8 ounces of water every morning before we put that first cup of coffee in our system, that becomes a habit that we don't break and it becomes part of our daily routine. So practicing these normal things in your practice, right? The where you will take that time, reset yourself, be present, be focused, even if you course correct. Because look, human nature says, that's why people go on diets and they can't be on a diet full-time because they will course correct. They will cheat a little bit, but then you get back to saying, this is, this is who I'm supposed to be. So that's a really good point.

Yeah, no, that's so good. Oh, so many good things. If somebody, like, let's say a doctor's listening and they're like, I want to work on my presence, I also want to work on how I like present, you know, how do they find you? I'm assuming you still have Speak Up groups and events that you're doing. Yeah, tell us.

Yeah, turnedon.com is our domain. You can find everything on there. We are, we are always doing cohorts. We have so many going on. And here's the best thing, they are highly interactive.

Yes, they are.

In other words, when we talk about immersion, when you are with somebody for an hour, I remember when I first started in the self-development world and I would take courses and I'd be like one person on a screen with 30 or 40 people, and the person would be lecturing. Mm-hmm. And you get some great notes, but I believe in immersion learning. So it's small group, it's 5 people, sometimes 6 tops, but it's immersion. So you're always either speaking or, you know this from experience, we're coaching. So I would call on Dr. Lona and I would say, okay, Lona, Dr. Pete just went, give him some feedback, give him some love. And Dr. Lona would say first the things that she liked that he did, always positive feedback first. And then what would we say every single time?

Permission to coach, right?

Permission to coach. So then we asked for that permission to give constructive feedback. What this does is you're always learning. Human nature is when you're on stage or when it's your spotlight, you're focused. But human nature is also when somebody else is going, yeah, I'll have the tendency to drift. Unless you know you're gonna be called on to give them feedback, then you're critically, uh, studying them, looking for what they're doing good and what they need to improve on. So then the process is always learning. You're always immersed in how can I see what's going on? And that way, we kind of, iron sharpens iron. And so, now more than ever, this is how I want to remind you because I've seen some, I've had some conversations and I just saw something on social media, kind of depressing news about where the world's heading and how some of the, the top, top jobs will be taken over by AI and what that's going to look like in our economy. And you think, okay, well, what are some of the jobs that AI can't touch? Yeah, yours. Yeah, yours out there. Hey, clinic owner, guess what? AI is never going to come in and adjust you, okay? Because that human touch, that feel— they can do maybe surgeries, but they're not going to be able to feel and touch and do the things that only another human, and especially a chiropractor, can do. So if you're looking for job security, but you're also looking to stay ahead, you know, because there's competition all around you. You know, Dr. Pete said this, hey, there will be other chiropractors in your neighborhood, in your, in your range there where people can make a choice. So it goes back to that same thing is all things being equal, degree, price, efficiency, why would somebody choose you?

Yeah.

Sometimes they're going to choose you based on just, hey, if I'm going to go in there 3 times a week, I want to like this person. I want to feel comfortable with this person. I want to look forward to going in and maybe sharing a laugh or a smile or just a hug, whatever it may be. That's why they'll choose you.

Yeah, I 100% agree. Yeah. Thank you, David.

Well, thank you for having me. It's always a pleasure to talk to you. Look, Dr. Lowney, I'll be honest. When you came off stage, you asked me, hey, how did I do? And you wanted— you wanted the feedback. And I said, look, you own that thing. Like, I was so impressed with you. You have a real connection to people. You can see it here. You have a genuine smile, a genuine concern. And I think certainly that comes across on stage. And thank you. I'm guessing it comes across in your clinic as well. So you're a great example.

Thank you. I appreciate it.

Thank you for having me.

Of course. All right. We'll see you guys on the next episode and we'll definitely have to have David back. So thanks again.

Thank you.

Hey, everyone, please listen in for this next bonus interview of one of our remarkable success partners. They all help us help more people find the benefits of chiropractic. So listen on.

Okay, podcast listeners, I'm excited to have on the program today Dr. Ray Foxworth from ChiroHealth USA. I'm Dr. Chris Greer, one of the coaches here at The Remarkable Practice, and I for one, Dr. Foxworth, am very pleased, very excited to have you on, and also very much want to express my gratitude for you being a success partner with The Remarkable Practice. We're all same mission, which is to help more people help more people. And I know your product in particular helps practices do that. Just to kind of lay the groundwork, I have utilized my own practice, ChiroHealth USA, for years, probably 15 years or more at this point, and use it as a way so that my practice can more compliantly see large families, which we have a lot of large families in our community, and that's particularly who I like to serve with the way that I utilize ChiroHealth USA. So if you would take a moment to introduce yourself, uh, let's start with that.

Oh boy, I don't know where you want me to begin. I'll just start with the part that, um, when I decided to start ChiroHealth USA, it's kind of my why. Long story bearable, uh, I tell about my Miss Jones story. She was a cash patient who came in I saw her, her husband, her kids, you know, I'm happy, they're happy, life is good. And then Ms. Jones was in, uh, probably my fees were around $35, $45 at that point for them. And then, uh, lo and behold, about 3 months later, Ms. Jones is in an auto accident. And so I billed my normal fees, which by default means my others were abnormal fees, apparently. Miss Jones comes in about 3 weeks later with her explanation of benefits. And I always have a staff member in the office with me, you know, in the treatment room. And I walked in and I'm sure this has happened. You ever walk into a room and you just know something's wrong? Well, I knew something was wrong. And so I just asked her, I said, Miss Jones, I said, you look upset. Is everything okay? She says, no, it's not. And this sweet little lady that I've been taking care of for years. Gets up, walks over to me, shows me these papers and pokes me in the chest and says, I know what you charge me. I know what you charge my insurance. And it's guys like you ripping off insurance that keep me from affording healthcare. And I'm going like, wow, that's a kick in the gut, if not somewhere else. And I said, no, Ms. Jones, it's guys like me that bend over backwards to help people like you. But I did make a horrible mistake and I'll never make it again. I never let you know what my actual fees were or that I was trying to help you. And so I can see how it would look, you know, to you. I'm billing $95 or $100 to your— on your PI case and $35 or $40 to you. And she said, well, I don't care if you were trying to help me. I've reported you to the state attorney general. Lovely.

And the story—

so it just gets better, right? So the good news is We didn't have a law in our state that said that you could not charge more to insurance than you did to private pay. But here's the bigger takeaway: whether it's against the law or not, nothing looks right about that in the eyes of a patient. And it made me start wondering, you know, why is it that Blue Cross, Aetna, and Cigna can all pay us a different fee for the exact same code, but I can't have a different fee for my cash, my underinsured, my Medicare patients with non-covered services? And the reality is you can if you understand how— and this is everybody's acronym for the day, write it down please— it's DMPO. Why is that important? It stands for a discount medical plan organization, and we're regulated by the Department of Insurance. So just like when one patient has Aetna, one has Cigna, one has you know, another policy. They all pay us different. This is nothing more than a contract than the doctor enters into with us, and they get to set their fees for their cash, their underinsured, their high deductible patients, their family plans. And because it is regulated by the Department of Insurance in most all states, in 18 years we've never had an issue with anyone having you know, being reported to a board and running into a problem because we're using the exact same gold standard as the Blues, the Aetnas, and the Signas. I started this off primarily as a compliance issue, but man, it's kind of— it's turned into like a Swiss Army knife. And Chris, probably the most important thing I can share with the listeners is whether they realize it or not, most of them are undercharging for their services. And what I mean by that In a lot of states, there's a published workers' comp and a PI fee schedule. And when we look at doctors and their— how they set their fees, we actually did a survey of 10 clinics out of Texas, and 100% of them were not even charging what workers' comp allowed. 80% were not charging what was allowable on the CMT codes. And so when you begin to understand that I don't care if you ever see a workers' comp case. The reality is, if that's what they say the going rate is, even under workers' comp, which is regulated, shouldn't I be charging at least what the insurance companies think I'm worth? And I know the pushback that we get. Doctors say, well, I don't want to raise my fees because it hurts my cash patients and my underinsureds and my families. That's in the past. Because if you use that DMPO model, it allows you to set your fees for maximum reimbursement and still be able to keep care affordable for all those that we want to take care of. And so it, you know, it really turned out as a revenue tool rather than a, just a discount plan. And that's probably, that's kind of the, the short story of how it started and how we got here. And fast forward 18 years later, over 7,000 docs nationwide have been a part of it. At one time, 4.3 million patient family members are getting the care they need. And so it, you know, it started out as a problem for me, but I'm a problem solver by nature, and that's what made me start looking at the different models that were out there. And we formed the company in 2008, and here we are 18 years later, and Helping a lot of people get, get the care they need.

You bet. Well, that's great. And, you know, like you said, you're a problem solver. And I think one of the things is, for the listeners out there, many of the listeners might not know they have the problem. There's a, there's a lot of confusion in the compliance world. There's definitely a lot of confusion in what we should charge for our services, even though, you know, in, in my opinion, and I, I hope most of the principled chiropractic opinion out there, is that we have the best, most elegant solution to health and healthcare that exists. That's very valuable. We should be able to charge for that. But the problem that I think people don't understand is that it, it can be a legal issue to have one fee for this thing and another fee for this thing unless you're using a DMPO, a discount medical plan organization like ChiroHealth USA to set those parameters and talk a little bit to that because I think the other thing is lots of times the parameters get set for you, right? In ChiroHealth USA, you get to work with you guys as the experts for your own clinic to set those parameters. Will you speak to that a bit?

Yeah, one of the challenges is when a doctor opens a practice, what should they charge? And I swear, I think some of them actually use a dartboard and just, you know, throw a dart. They don't know their numbers. They don't know their cost of delivering an adjustment. And for those that want to figure out what that cost is, it's real simple. We've got an overhead calculator. They can go to our website at choosa.com and download that and put your last year's numbers in there. And it will come up with— it'll self-calculate and it'll come up with it costs you $27.17 to deliver an adjustment. Why are you charging $25? Why are you signing contracts that are under that rate? You can't make that up in volume. And so when doctors begin to understand that the fees that they're charging— there are a number of ways to see what's the normal rate in any given area. And so We will never tell a doctor what to charge. We will show them, here's what the going rates are in your office. And then it's totally up to the doctor if they want to get paid well, then you bill out what should be billed rather than this artificial number that we sometimes come up with in our head. Oh, everybody's charging this. And so it really starts with knowing the numbers and then figuring out where you want your fees to be. And the beauty of what we do is because we are nationwide, I could have said, well, anybody that's in ChiroHealth is going to charge this much for an exam, this much for treatment. And because we are all across the country, the fees in New York compared to Jackson, Mississippi, or compared to where you are, they vary widely. So that's why we thought it was important to build in the ability for the doctors to actually set their fees. Now, we don't want to overcomplicate this, but the reality is most of the doctors are already giving discounts. I run into this all the time. Doctors say, well, I don't really want to discount my fees. Why do I need to fool with you guys? Well, if you're part of Blue Cross, you're part of Aetna, and Cigna, guess what? I have a secret for you. You're already discounting your fees. So it's not a matter of if you discount, but how you discount that makes it— that is most critical. And I can tell you real simply, and it took me 18 years to figure this out, I'm a slow learner, okay? If doctors are charging or offering discounts, time of service discounts, prompt pay, whatever you want to call it, more than about 10 to 15% at the max, then you have a dual fee schedule. You're charging more to insurance than you do to private pay. Where do I get that number? From the OIG, an opinion they wrote for a hospital that's, that said if you're giving a a time-of-service discount or prompt pay when patients check out. We think between these numbers are reasonable. That was not for chiropractic office, but OIG opinions give us what's called broad guidance. If you are charging more to insurance than you do to private pay, there are fines and penalties for dual fee schedules. And what I said earlier about my state not regulating that, guess what? Most states do regulate it now, just like the OIG does. For Medicare. And they say if you're giving anything of value more than $15 or a total of $75 in a year, it's an inducement violation. $10,000 fine every time you do that. Well, docs, don't do that. What you can do though— and we initially look at most doctors' plans, their financial policies, and their discounts— they're offering 25% and 30% discounts. and you cannot call that a time of service discount or prompt pay. Why? Because it— the discount that you offer has got to be directly tied to your actual cost of doing billing. National average, go search it on Dr. Google, national average for billing services, and it's around 5 to 7, maybe up to 10%. So when I say If you're giving up to 15%, if that's not your actual number, you shouldn't be at 15. You won't know that until you actually know your numbers and know what your, your overhead expense is when you're actually doing billing. So we discount to try to help patients. We discount in a way that is putting us at risk. And if you want to never have to worry again, about inducements, any kickbacks, false claims, all of the things that can cause us, quite frankly, that can generate fines and penalties that could be career-ending for some. You can literally make all of that go away if you just simply move what your discounts are now inside the DMPO model. So you get to do what you want to do. Bill how you want to bill and sleep well at night because you're— it is a tremendous burden not to be looking over your shoulder wondering, geez, you know, I'm trying to run this new patient special or I'm trying to do discounts to entice people to undergo care. Believe me, I'm not a fan of discounts, but it's kind of like everybody does it, like if you're involved in insurance. So all we're encouraging doctors to do is just to do it the right way.

Yes. And man, you said so many things there that I just want to touch on for the listener so that they can go back and make a choice on what they want to do. First, you have to know your numbers, right? Know your numbers, Doc. This is what we talk about in the Remarkable Practice all the time. You have to know what your cost of services delivered. You need to know your cost. Once you know that, then you can look at your current discounting and ask two questions. Am I being profitable and am I being compliant? The OIG, as you pointed out, has made it very clear that if that discount is over 15%, it's a red flag. And then people oftentimes think, ah, yeah, but everybody in my office is happy. We have a big happy family. Well, your story right at the beginning of this woman who was part of your practice's big happy family had a change in things, and that was what caused the issue for you in the first place. I really encourage the listeners If you aren't currently using ChiroHealth USA, if you aren't using the discount medical plan organization system, this is something that allows you to sleep well at night. One of my highest values in my personal life is peace of mind, and this is why my wife and I way back decided we're jumping on with the, with ChiroHealth USA so that we know that these, the discount plans that we're offering our families are compliant and can't be touched. And it certainly has accomplished that. So lastly, just to wrap it up for the listeners here, how do they get in touch with you? What are the next steps for them, whether that's an email or phone? How do they get in touch with you?

Sure, they can, they can just go to choosa.com and schedule a consult call. And let's face it, not every practice needs us. And quite frankly, we tell doctors, hey, you're doing everything right. Go forward, be, uh, have some peace. You're doing fine. Yeah, but if you don't know the rules and regulations though, you don't really know if you need it or not. And so a simple phone call, 15-minute phone call, kind of a discovery call, will let us know what you're doing now. We can identify the areas you might have some risk, and if you don't have the risk, we'll tell you, hey, you're doing great. Or if you do have a risk, then the first thing we're going to do is we're going to take a look at your fees because Most doctors don't know what the resources are out there to really give them an idea. I mean, I don't think a doctor should be paid less for ADP and lateral lumbar in their chiropractic clinic than they are at the hospital. Why? Still takes time and staff and overhead for that. So simply reaching out and getting on that discovery call is critical. And I'll add one other thing. This started out as a discount medical plan strictly focused on getting you compliant. Well, guess what? It is not just a discount plan. It's actually a profit strategy, because what we've seen when we survey our doctors is their revenue actually goes up about 20% when they plug in a discount plan. That seems counterintuitive, but the reason it goes up is because you're finally charging what the insurance companies have said you're worth. And in my opinion, you ought to be charging more than that for the service that we deliver. So, uh, it's a real simple process. Identify where you are now, see where your fees are now. If you want to make adjustments or corrections to those, great. And then rather than getting all caught up in what do I want all my discounts to be, the reality is most of you are already offering some discounts. So, and your patients are used to them, your staff are used to them. Don't rock the boat, just move them inside of the DMPO. And then life's good.

There we go. Nuggets all over it. The no risk, give them a call, they'll look things over and tell you if you're on the right track or not. And if you're not, they have a solution for you. Thank you, Dr. Foxworth. You can catch him, as he said, at chusa.com. I appreciate what you do for the profession. I appreciate what you do as a success partner for the Remarkable Practice, and we look forward to seeing you hopefully at the upcoming immersion.

Looking forward to it, Chris.

Excellent. Take care.

You bet.

Thanks for listening to this episode of Build Your Remarkable Practice podcast. Remember, what the world needs now is chiropractic, and what chiropractic needs now is more successful chiropractors. If you like the podcast, please subscribe, share with your friends, and leave us a review. And if you'd like to connect with us personally, please click the link links in the show notes to schedule a call.