279 - Building and Leading an 8 Figure Chiropractic Business

There's a reason private equity has, for example, a whole bunch of criteria. Right? There's a reason they have it. It's not like to make your life miserable. It actually makes your, it makes your life better, your business better. Not just that it increases the value, but businesses should be run in certain ways. So they're going to look at certain things in the business. And if you don't have this and you don't have that, your value is low.

Hello and welcome to the Remarkable CEO Podcast, a show dedicated to chiropractors who want to transform their job into a business so that they can have a remarkable practice as part of a remarkable life, not instead of one. With your hosts, Dr. Pete Camiolo and Dr. Steven Fransen.

What's up, remarkables? Welcome to another episode of the Remarkable CEO podcast. I'm Dr. Steven Fransen and I'm stoked to have a very good friend of mine and longtime success partner, probably one of our longest time success partners with Genesis Software from Clinic Mind. You guys know him as Cap. It's Dr. Brian Capra. Cap. What's up, brother? Thanks for joining us.

What's up, brother? Great to see you again. Great to see you always.

We were together, what, last weekend, bro?

Yeah, it's been a long time. It's been a long time. Never enough. That was a phenomenal UAC weekend, man.

It was great, man.

It was like. Say I redeemed myself after that other time. We won't talk about it here, but.

Hey, man, even, even a lousy hotel in Mexico. Still an awesome hotel in Mexico, man.

So.

But that place was spectacular in Boca. What was it? Boca Raton Resort? Is that what that place is called? I just want to.

They call it the, the Boca now or, or something like that.

That's all. Yeah, they, that's all they need to call themselves. It was. That place is awesome. And when you get that level of people, you know, 100 plus of chiropractic's best minds, business minds, in a room in, in a room like that, in a great environment like that and run, it's, it's spectacular. So I know, I've been looking forward to this conversation. I love to have conversations with any business leaders, business owners, business founders, CEOs, presidents. So the, the opportunity to be able to speak to somebody who's running one of the biggest organizations in, in chiropractic, in the industry, you're, you know, president one of the biggest businesses in chiropractic, which is awesome. I'd love to be able to have A CEO conversation. So that's what I'm going to invite you into. I've got some questions for you, for you and I to stay on the rails.

Yeah.

So I'm gonna frame it out a little bit in a framework that we use inside of the remarkable CEO podcast and program quite regularly, which is last now and next. Right, so let's talk about, you know, here we are, we're coming to the end of 2024. I don't know when everybody's listening to this, but it's pretty much fourth quarter closing out the year. Where were the wins and what were the learns? And, and if I could, I'm going to challenge you on this. It's the wins. You know, what were the wins? Some of the wins for the company. What were some of the learns? You know, sometimes the learns are much, much more valuable. So share some of those learns. And I know you don't mind talking about scar tissue. And then also, you know, truth be told, you, you know, you've got visibility, you've got eyes on 1500 plus chiropractic practices and you know, more importantly, the businesses, you know, running their software. So without letting all the cat out of the box, let's give us a sense of like, wins and learns. Looking back at 2024, would you guys find.

Yes, well, 2024 was a whirlwind of a year for us. A lot, a lot learned.

So it actually started in the end of 23 when we really started looking at, you know, what does it mean to take a company that is successful. And I think I remember talking to you in 23 and I kind of got bored a little bit with Genesis because it was running at a certain, in a certain way, at a certain level and it didn't need me to do anything and if I didn't, it would just continue to do that. But it deserves more than that. The profession deserves more than that. Like, you know, there are times in our careers, I think probably any business owner maybe would admit that there's a time where you just kind of rest, coast and get re motivated maybe and get repurposed, if that makes sense. You know, 23 was a coasting year and then 24 came and I realized a couple of things. One was doing research, talking to private equity companies. What are they really looking at? What kind of money is? How do multiples work? Right? How does a multiple work? How does a valuation work? What type of valuations do companies like Genesis receive? And what are the levers that you can pull to really accelerate Those kind of numbers. And we're not looking to sell Genesis, but it doesn't matter. Build it to sell it always. Right. So once I started to really, really understand those things. And you could also be bringing on money to acquire other companies, which is something we've actually looked at and done.

This year through acquisition. And looking back.

Yeah.

Investment capital do growth through acquisition.

Right, right. So if you're going to do that, then you better make sure your company is optimized and tweaked because if you, if it's not, your valuation is lower and that money that you borrow is more expensive. Basically. That's right. All right. So that's one thing I learned in the beginning of 24, we merged companies. I think you remember there was Verrical and there was Genesis and there was this and that. Well, Verical became clinic mind. And we have been working for 20 years kind of side by side. It's really brother sister kind of relationship. Yeah. So we just merged all that together. One of the reasons was we realized that just the fact that we were separated made our valuation something like, oh, gosh, I just said it last week and what the percentage was, but it was like say 20% lower just because of semantics.

Yeah.

So we did that. We merged right. At the end of 23. So I learned about what a merger or acquisition, it's really the same thing. How actually complicated it is to put two companies together. Imagine we've been working together for 20 years and we made a mess. You know, we made a lot. I mean, nothing clients would necessarily see. But it's really difficult to merge two companies even when you know each other like the back of your hand. Yes. And so we brought on some advisors, private equity merger acquisition type advisors to teach us. There's a checklist, actually you can imagine a mile long. Right. Just through due diligence. Just through pre. Close. Close. There's a million things that have to happen that you got to consider. Yep. So I learned a lot about that and that there was also some other. Other stuff that happened this year that was. Was challenging. Very, very challenging. Yeah.

I mean, let's, let's stop there for a second because there's, you know, I want to make sure that there's doctors on here that are thinking, oh, mergers and acquisitions, I'm not into that. Or selling my business. I'm not into that. No, no, no, no, no. Don't miss this conversation. Right. So they hear it from me all the time. This is an oak tree conversation.

Right.

So we one day, you will be selling your business. Right? So it's an oak tree conversation. Because the best time to plant an oak tree 50 years ago, best next best time today.

Right?

So death started taxes and exiting. We're all going to exit, Right. So you want to build it, to sell it. And I'm going to say this very quickly, Brian, so bear with me.

I'm with you. Take your time.

You know, at the end of the day, what you want to be thinking about is your ultimately your most important customer is the person that's going to buy your business. Right. So the ideal customer is the person that's going to be able to see the value that you've created. So if your ideal customer is probably a lot like you or even more sophisticated than you, so where you're going to get the highest value, you have to think what is going to make my business ultimately most attractive to my ideal buyer so that I can attract multiple ideal buyers. So we start a horse race. They're competing about your business, which of course drives the price up, compresses time, reduces stress. Right. So, yep, this is a critical thing to understand. Here's the secret. Whatever would make the business more attractive to an ideal buyer is exactly what should you should do for your business today because it makes it a more profitable business that's more productive, more fulfilling and more fun.

Right.

It's literally, it's the fastest way to cut through the noise and say what really matters? What really matters in a business? Well, it's whatever would make your business most attractive, dare I say, irresistible to your ideal buyer. Right. So this is, I'm talking about this conversation now because it informs what we should be doing today. Even if we're 10, 15, 30 years away from selling our business. It just is the sharpest lens.

There's a reason private equity has, for example, a whole bunch of criteria, Right? There's a reason they have it. It's not like to make your life miserable. It actually makes your. It makes your life better, your business better. Not just that it increases the value. Businesses should be run in certain ways, so they're going to look at certain things in the business. And if you don't have this and you don't have that, your value is lower. Why? Because then they have to do it. That's it. Like they have to tweak those things.

They have to fast forward button to understand exactly what a good business looks like. It's amazing. And you talked about this checklist, we call it the value drivers checklist. Right. So we have a Value drivers cheat sheet that we do with the remarkable exit and the remarkable acquisition program. So, so you're, you're exact. You're exactly right. There's like literally a delineation of these are the things we're looking for. This is what we're looking at. And it almost gives you a homework assignment to be able to say, well, get your shit right, get it together. Stuff that needs to be tuned. That's great. I'm glad you brought that to this conversation.

Yeah. So those. That's. There's a big learning curve with that. And it's was awesome. I mean, it is awesome. We're learning a lot. One of the things you're seeing with Genesis, with Clinic Mind. Clinic Mind is the. What we're calling the platform. Right. And we're adding products on top of the platform. There's a reason for that. Right. And Genesis is one of those products now. But we have other things like Patient Hub for the automation and we have credentialing service. We have virtual front desk and we have so on and so forth payment processing. The reason for that is, is because this is something that private equity companies look at. They look for because they're looking at your house and they're looking at how are they going to buy it and make more money with it. That's right. Right. But it's also the right thing to do because you have your customers. And this is same thing for your practice. You have your customers. You know what you sell sold to your customers on day one. But there's other things you can provide to them and to go out at least the way it works for Genesis. Well, to go out and get a new chiropractic patient from marketing can be very expensive.

However, you can market other products or services that are low barrier to entry, lower price, lower whatever, that build trust and relationship with a potential chiropractic patient that ultimately you convert, you upsell, you cross sell. Right. All these different products and you ultimately increase your recurring. In our business, the recurring revenue per, per month per customer. So you're providing more value, they're much more sticky. And your, your, your revenue is generated and you have more ways to engage people at different ways. So an example of that is credentialing. We have a credentialing service. It's actually super easy to get credentialing leads. It's very inexpensive. Not a lot of people are competing in that space. Believe it or not, in chiropractic, how many credentialing services are there? Right. You don't I never even thought to even look for one before. But also it goes into other specialties. So we don't only have to do credentialing for chiropractors. We have all these other Mental health is a big one, for example, that we do credentialing for. We build trust, we build credibility. And then in that process, we're talking about the ehr, we're talking about all the other products and services. So the cost per acquisition for that customer is very low. And then they're a paying customer and they're paying you to be a lead for your flagship product.

So this is how private equity looks at things. When you have these levers in place that you can pull to exponentially increase the valuation for yourself, but also for them in the future.

That's right. And I love the terminology and I'm, I'm a wordsmith, I, I, I love to understand terminology because it's incredibly informative. So that when you hear the terms like, oh, I understand what that means. So when you start describing, you know, when you describe Clinic Mind as a platform company, right? So if you pick picture what a platform is and what it looks like, you can bolt on other businesses on top of that platform, or it creates the, let's call it infrastructure or the, or the terra firma for other operating systems, businesses or products. It creates an environment, if you will. It's almost like a shopping mall is a platform for a bunch of different stores, right? So you get people into the, into the shopping mall and that is obviously advantageous for all of the different stores, right? So, and they'll walk onto the platform of the mall because they know they can conveniently shop other stores, right? So I love the expression you can't fire a cannon from a rowboat, right? So the idea of Genesis is a cannon, right? It's one of the products. The platform is clinic mind, right? So the clinic mind supports the product of, of Genesis and the other offerings, right? So, and that of course speaks to efficiencies as well, because you can start to centralize functions and increase your margins, right? So, and if you go to sell a platform company versus selling all of the individual parts, the sum is greater than, you know, the whole is worth more than the sum of the parts, right? So when they start doing valuations and you see, you know, a larger revenue, large a larger business, larger revenue, and more importantly, a larger EBITDA or larger profit, it takes you categorically into a whole nother set of multiples. When you're looking at the real value of the business. Right? So it's, it's a bigger number times a bigger number, which is a bigger number. Right. So we try to keep the math simple here, Brian. Right. So. And the last thing you said, which I don't want people to miss out on, was the upsell and cross selling piece of that. I love how Seth Godin says, don't just focus on trying to find more customers for your products, try to find more products for your customers. Right. And that's always been. My methodology is like, once you have a customer, if they are your ideal customer, that means that an ideal customer is a person that you are good at solving the problems they're hiring you to solve you at. And so they're happy and you're getting good outcomes for them. So you're building the trust and they have other problems. And if you have a, you know, a. At arm's length, you can solve other problems for a person in sort of overlapping fashion. And next thing you know, you can identify what those problems are. You can start solving those problems for them as well. And the purpose of a business is to solve a problem for another person. So next thing you know, they're adding services or adding products or doing businesses with the other businesses on the platform. And you know, one plus one plus one equals 111 when you do it, right, because you're saving on the cost to acquire a customer and you know, you're building stickiness. Right. So I'm sorry, I'm just reiterating everything you're saying, Brian. Because the chiropractic practice is such a small platform, right? It's just such a small microcosm.

Hard to.

It's hard micro.

Yeah, yeah, it's. Of course, yeah, I love it. It's just hard when you're in a, in a, a practice to be able. So I encourage you to take a step back and look and try to get yourself. I know this is what you teach, right? How to, how to become a CEO, how to be objective and take a step back and look and realize that this is a business. It's just not. It's not the thing you drive to after you drop the kids off at school and get to adjust people. It's a real business and it needs that level of attention, which is very difficult while you're doing the job inside. So that's why it's so important, why I've loved TRP for so long, because you really teach people business, how to run a business and you have the stages and you pull them out of that. You know, owning a job, basically. Yeah. And it's super important. Yeah.

Looking at the differences, there's your practice and then there's your business. And those are two different sides of the same coin. But you do need to. You got to have a handle on both, so. Hey, Doc, Steven Fransen here. If you're like me, you know that we're in the business of saving lives. And when business is good, everybody wins. That's the good news. But here's the bad news. Most chiropractors don't own a business at all. They own a job. It's a job they love, but it's a job. And far too often it feels like that job owns them. Is this true for you? Do you own a business or a job? Have you built and do you run your practice on brute force? Does it rely fully on your time, your effort? A pound of your flesh? Are you responsible for all growth, for all new patient generation? How about new patient conversions? Is it all up to you? How about patient care and delivery? Are you a sole practitioner, an owner operator who owns the practice but is also the only one that is head down and bum up taking care of all the patients? Is revenue generation or collections all up to you? Let me ask you the most telling question, Doc. What would happen if you took 90 days off? What breaks in my experience, most on purpose chiropractors do not lay awake at night worrying about their practice. They worry about their business. Let's slay that dragon. The Remarkable CEO program has helped hundreds of chiropractors, characters just like you, turn the job that they love into the business that they've always wanted. Are you ready to run and build your practice on leverage instead of brute force? Do you want to create the scalability and durability that will allow you to make a bigger impact and a bigger income? What would it mean to grow your practice, increase your productivity and your profitability? Do you want to get your time freedom back? Are you ready to turn your pirate ship into a battleship? If this sounds like you, then the remarkable CEO program is for you. Just last year, 53 of our remarkable clients received the Seven Figure Club Award. Meaning they hit the million dollar mark for the first time or their next million dollar level, be it 2 million, 3 million, 10 million, up to 36 million and growing. Now, Doc, is it crazy to imagine that your practice could be next? Click the link below and learn how to apply Buy for the next cohort of the Remarkable CEO Program. We look forward to working closely with you and creating the business that supports your remarkable life, not competes with it. All right, so let's shift gears to now. Like, you know, what do you guys focus on right now? I know that you've made some changes in the business. Of course that comes with some pain and learnings. So, you know, as you're sort of recovering from that, transitions are tough, right? So. Oh yeah, transitions are tough. So what did you, what did you learn in this transition process? Because I know there's been moments that have been hairball for you.

Yeah. In the, in the midst of all this, we had the largest health insurance company buy the largest clearinghouse in the country, subsequently had a cyber attack and basically shut down all insurance billing. So that in the middle of all this was not fun.

Is that bad? Is that a bad thing?

When that's bad thing, it's bad thing. It's very bad.

That's a bad day.

Oh, what. So that was brutal. That was brutal. Basically no claims could get to them and no eras could come back. And it, we've been, we've, our platform has, we pioneered leveraging artificial intelligence and automation and all kinds of things to really get our docs paid.

As fast as possible, every penny they deserve. And you know, we did that. When you break it, it's really bad. But we, yeah, that's just something that happened this year and we're, we're, we're digging out of that. It just wasn't fun for us or our customers. Obviously it's unprecedented. It's not like there's a roadmap to fix it. Right. So that's. Right, that's the problem with it. It's not like, oh, I've seen this before. This is like never happened before. So. But we fixed it and it's, it's getting way better. We're just at the, of cleaning up 200,000 claim backlog.

Right.

If you could imagine that. Right.

How expensive was that? If you would have put a number on it, I'm putting you on the spot, bro.

Millions and millions.

Yeah, it's millions of dollars. Right. So I know it's millions of dollars. So I want people to just kind of just open your eyes to the fact that like for the first time we're contracting cyber security next year, like for the remarkable practice we've had our in house and we subscribe to all of the elements that you're thinking of right now. But this is like literally now a service that it's going to be expensive, it's going to be an investment. But it's like it's cheaper than getting, you know, hacked and shutting down. Right. So it's just like, luckily wafting that out there for people.

Want to be clear, we weren't hacked. It was change. Health care.

Yes, yes.

Yeah.

And you were downstream from that and add effect. But, you know, it's real. You know, cybersecurity is a real concern now.

Brutal. So that was one thing. But what we're doing now is and have been doing since the beginning of the year. One of the things, maybe I'm digressing a little bit, but is how do you build an infrastructure? Because as we merge, we also started to grow really quickly for all the reasons we talked about. So it's like, you know, when you were in a practice and you were at 100 a week, it's a lot different than 300 a week. Right. The little problems get magnified. You see them much more clearly. So we realized that our entire training of new customers, onboarding of new customers, our support for new customers, even though we're developing at a super fast clip, new technology, new everything for Genesis, there were so many little problems that when you add tons of new customers, you really. It gets magnified. So the structure of onboarding we had, for example, just will never work the way we were doing it. For 50 to 100 new customers a month. It's not going to work. Right. It just doesn't. You can learn the system, but it's not the level of experience that we want to create. So what do you got to do to fix that? Well, you need triple the number of people on the team, right? Well, how do you hire triple the number of people?

You know, how do you hire to build a team of 60, 60 for support, onboarding support, and so on and so forth. And it got to a point where they were. They're working their tails off. There's so many people working, but they were so busy that they couldn't interview anybody to hire to help them scale. So you literally need to pluck out and create an entire department, HR hiring department. One person to interview everybody, one person to like, you have to hire 20 people or 40 people every month because you don't wind up through their training process with 40, you wind up with like 20, we hope. Right. So and then from there, you're always looking at the, the numbers and performance and replacing the bottom 10%.

Yep.

So I've never done that before in my life. But, like, that's one of the things you gotta do is completely like, with this department and that same department that now trains the onboarding team. The teams is also a centralized hub for all training for all employees and is synced up with marketing, which you would think how, why marketing? Well, I'm rolling out a new schedule system. So everybody on this support team and sales included needs to know this thing, right? They're going to get questions about it. So they need to know. We got to have a process that we know. Everybody in the company has been trained on this one feature and then you got to market it. Because nothing worse than investing money in a new feature and product that you take a year to build it and then nobody knows about it.

That's right. That's right.

Yeah.

I'm thinking of Sullivan's book 10x is easier than 2x. Because what you were doing before to build a team was not going to work. You, you know, the, the demand was going to break your previous system, right? So you needed a new system. You needed to operationalize your hiring process and professionalize your, your hiring process. Right. So where it actually became a department in your business. Like wait a minute, what do you mean? We have an HR department. Where are they?

Who are they?

Right? So it's like, well that's what they do full time now. Right. So.

That is a totally new deal. And marketing type 2 is now we have to market to hire people. It's one thing to do B2C consumer marketing. That's type one marketing. Type two marketing is actually marketing to higher employees. Then it's a whole other marketing narrative to find a players, you know, who share your core values and buy into your vision story. So the whole concept of even just hiring people, never mind onboarding them, never mind training and equipping them, never mind the ongoing training that comes with new product rollouts and overcoming drift. You know, all the things that hopefully chiropractors are listening to me right now being like, oh man, it's hard enough for me to hire one or two people a year. Can you imagine hiring that kind of volume? But just the concept you can take away from Brian's pain is how important it is to have a process and have a system and have somebody who's accountable to it.

Right.

And it's, and you're not making it up as you go. And it's, it's not a reactive thing. It's the, it's very much a planned out, systematic approach to building a world class team. So all right, let's look into the, let's look into the future, Brian. So what do you see for 20, 25. Like, what do you see for. For Genesis, for clinic mind? What do you see for chiropractic? Like, I'm super stoked going into a new year. It's going to be an awesome year. What do you see?

Yeah, I think it's going to be a phenomenal year, especially now that that stuff's behind us. Yeah. So the, everything is just going to be smooth sailing from here.

I mean, there's definitely not going to be that.

It's going to be perfect. Well, I'm looking forward to new challenges because these were big ones and I feel like we put them behind us for the most part. So I'm excited. We've got a whole new. Basically, Genesis is new. Right. It's like all the new features and functionalities are. We actually haven't marketed it full tilt yet because like I told you, we're ramping up our team, getting them really well versed on it before we go full bore on it. But there's, I see a lot of AI coming. There's AI on top of AI on top of AI inside of Genesis. Whether it be documentation or the marketing automation things, we have an AI bot that literally schedules your patient, schedules new patients for you. So we can, and if, if you're listening to this and you're interested in it, we can, we can give it to you for. You can test it. You just go and you put your, you can take your URL for your website, your practice website, you put your URL in this thing, it goes to your website, it scrapes your entire website, it creates FAQs, and then in that minute, basically you can go and start having conversation with it about your practice. Now that wouldn't necessarily based on whatever's on your website, get them scheduled, but all you gotta do is teach it a little bit and it learns and it'll literally take them all the way through to scheduled. And that can happen from your website, it can happen from your Instagram, from your LinkedIn, from your Google page, from your anywhere. It can take a patient all the way through scheduling. And that's just one thing. We have like, there's like 20 or 30 AI bots and things like this that work. A lot's happening. It's. And it's all really exciting. It's.

The platform is scaling through technology. Right. So it's one thing to handle, you know, hiring all the bodies that you'll need to work there, which is great. But scaling through people is a lot harder than scaling through technology. And, you know, I know that AI, I think that people might feel exposed or at risk because they've got. It's like, no, this is just creating more growth, growth, more expansion, more opportunity, higher level stuff. Right.

So, yeah, you know, it's always the same. Right. I know we probably got to wrap up, but Paul Zane Pilsner came and talked about the. Yeah, it's always the same thing. Everybody feels threatened. When we started Genesis, people were afraid of the Internet. That's right where we were in the cloud 20 years ago. Nobody knew about it. Or if you did, you were scared that, you know, your information was going to go into the sky.

That's right.

And 20 years later, it's a requirement. So just get on board with AI, you know?

Yeah, 100. I know. We are fully embracing it at the Remarkable Practice. We've got some really badass stuff coming down the pipe and I'm psyched about it because I just see that we're going to be able to help more people. Help more people. So. All right, brother. So as always, just thank you for all that you got for chiropractic. I love you too. I appreciate your support of our clients and of our company. You guys have been with us from the beginning, bro. So that is not lost on me. When there were 20 people in the room, you guys were there. You guys, you guys were 17, 18, 19, 20 in the room.

And now it's just so awesome.

It's been amazing to watch so many.

Of our clients loving you guys and I appreciate you and embracing our vital signs and just working with our doctors with our remarkable practice system. It's. You guys are great partners. All right, Bell.

Appreciate you, brother.

Appreciate you too. God bless, man.

See you soon.

Thanks for listening to this episode of the Remarkable CEO podcast. Remember, what the world needs now is chiropractic. And what chiropractic needs now is more successful chiropractors. If you like this podcast, please subscribe, share with a friend and leave us a review. And if you'd like to connect with us personally, direct message us on Facebook, LinkedIn or Instagram. Now go and be remarkable.

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