351 - Remarkable CEOs Are Not Afraid to Break Things to Build Their Business

So I work on this and this over here breaks and then I work on this and then this gets jacked up. And then as soon as I think I got it figured out, I look around, it's like, oh, that's not working. Or I lose a person or it's like, man, what happened to the algorithm change? And now my new patients are off. It's literally like one thing after another. And I'm like, yeah, that's right. That's called being a business owner. That's called being in business.

That's called being an entrepreneur.

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. Stephen Franson.

What's up, Remarkables? Welcome to another episode of the Remarkable CEO Podcast, chiropractic's number one business podcast. I'm Dr. Stephen Franson.

And I'm Dr. Pete Camiolo.

And it is so good to be with you, Dr. Pete. It is so good to be home. It's so good to be back in the studio. Man, I've been a road warrior. My body has no idea what time of the day it is. But man, I am energized by the opportunity to be here and to be sharing what we're about to let loose here. Just coming fresh off the road. The material is going to be fresh out of the oven, as you like to say, sharing so much. We have so much new content that we just released at our recent immersions in Phoenix and in London and in Brisbane. Stoked to be back on the East Coast, stoked to be psyched back in this hemisphere and ready to rock and roll today.

Yeah, I got to watch you from afar. Obviously, we got to be together in Phoenix and I knew that was just the, the beginning of the journey for you. And, and, uh, it was just an awesome road trip just to watch and hear all the amazing, just blessings that happen, breakthroughs, relationship reconnections, establishing of new ones. And honestly, the, the need for what we are bringing to the marketplace is probably more than anything. We opened the immersion in Phoenix a couple weeks ago, and then of course the other immersions as well, with the statement that's true, which is that we as chiropractors inherited a broken business model. And it's a sobering reality, but it's really important when you recognize and understand that to be true. It's going to hopefully stimulate some rethinking of things and consideration of doing things differently than we did before. And so, Dr. Stephen, I'm excited because what we're going to be bringing today is going to be ultimately the third piece of the puzzle we've talked about in terms of breakpoints, and we're going to be this is fresh revelation. It's just coming in fresh out of wrestling through this with CEO after CEO after CEO, mastermind after mastermind, event after event, chiropractor after chiropractor. You start to get to this point where there's layers to the subluxation and there's layers to the correction. And so, this is what I would say is another adjustment we're going to make and help you understand and see your business through this lens. One of the favorite slides that I heard from many who shared was the slide where we showed the RPE breakpoints and that was really helpful to, to see it organized in that way. And so for all of you who are listening who were not at the immersion, it's a concept that we've taught multiple times on this podcast, which we talk about the rules of ones and threes and breakpoints as you grow your business. And we talked about it through the lens of the revenue per employee and, and how that looks in your business from 0 to 250, 250, 500, 500 to 750, 750 to 1,000, and then up and beyond. So, you laid it out up to $2 million and you realize, "Wow, there's these breakpoints that happen and there's these opportunity zones." And we're going to be unpacking one of them today, which are operational breakpoints, specifically looking at your systems and where those break down. And Dr. Stephen, you and I, we've talked a lot about this on previous episodes, but we talk about the things that you have to look, you have to operationalize, professionalize and optimize. And this is an operationalized conversation today. We talk about professionalizing and we talk about optimizing, and this one is going to be really tying all of them together, actually, when we go through it. So, for all of our note-takers, this one you're going to want to write this down. This is really, really helpful. Dr. Stephen is going to share a little bit behind the scenes where this came from, but I know this is going to help many of you understand. We're going to get a lot of nods today during our conversation. We want to keep this as conversational as possible, guys, because it's natural for Dr. Steven to go straight into academic mode, teaching PowerPoint type mode. So we want to be able to talk you guys through this as well. But man, just such great energy coming from Brisbane, London, Phoenix, and I know we're about to be in New Zealand soon here too. So there's just a lot of great things happening all over the world inside of the Remarkable Practice, and, uh, we're just grateful for the opportunity to serve this profession.

Yeah, I love that we have this technology where we can reach people all over the world and you don't really realize how many people you're reaching until you get out into the world, right? And you're out there shaking hands and meeting new people and people are coming up to you at a big event like that. Like we had, what, almost 700 people at the hotel in Phoenix and then we had a couple hundred people in London, a couple hundred people in Brisbane. And so many of those people are new faces. Like people come up and one of the first things, most common things we hear is, hey, thanks for the podcast. It was like, people are like, I can't believe you guys, you guys don't gatekeep. You like literally just teach on the podcast. I'm like, yeah, it's like, we just make sure we're democratizing this and getting it all out there. So it's so fun to meet you guys in person, by the way. We love it when you just come up and say hi. Right. So come up, give us a hug, give us a high five. Like we just love that. Cause for us, it's, it can feel like you're speaking into the abyss. Right. So, and it's like, and we know, we see our metrics. We like, we know the numbers. We know that there's a whole bunch of chiropractors listening and we're helping, but it, Man, there's nothing like putting a face to the story. So please come up and give us a squeeze and say hi. We just love that. And just being on the road, you know, I get to get the opportunity. People will pull you aside and you'll hear the sidebar conversations, the questions that you get. And, you know, to be honest, it's like we're all entrepreneurs, CEOs, business owners, chiropractors. There's lots of opportunities for frustration, like all over that landscape. Right. So, and very often they're like, ah, man, this is like, feels like it's always something. You hear something like that, man, it's always something, right? So I work on this and this over here breaks, and then I work on this and then this gets jacked up. And then as soon as I think I got it figured out, I look around, it's like, oh, that's not working. Or I lose a person or it's like, man, what happened to the algorithm change? And now my new patients are off. It's literally like one thing after another. And I'm like, yeah, that's right. That's called being a business owner. That's called being in business. That's called being an entrepreneur. It's definitely called being a chiropractor. And that's most The exciting thing is it's a big part of growth, right? And here's the thing, that's a feature, not a bug, right? So, it's just like, this is part of it, right? So, literally, you shouldn't be expecting— it's like being surprised that you sore after a hard workout, right? So, it's like being surprised that you got on the football team and you got on the field and you got hit, right? Or you stepped in the ring and you got punched. Don't be surprised, man. This is just like part of it. And in fact, you know, you should just be anticipating it. And today's conversation is about the anticipation, the very healthy anticipation. If you're the CEO, you're the visionary, you're the person that's to look forward and you need to be casting your vision forward and not just saying, oh, look at all the great things ahead, but just recognizing like there's going to be real challenges ahead and I need to be able to anticipate the challenges that are coming down the pike, right? So I don't have a knowledge gap anymore or I'm closing a skills gap. I know that I've got these challenges that are coming and I'm going to prepare so I can mitigate the impact of those challenges, make decisions on the front end. But all in all, accepting the fact that as we grow as the CEO, really, you know what, things are going to break as we progress.

When we went through COVID in 2020, we taught a concept called Buffalo Leadership, and it's one of my favorite concepts. I actually still have the, the flag that we made for the immersion we did, Dr. Stephen in Phoenix. we were a bit incognito there, but we did it anyway with a few people, 6 feet apart, of course, in Phoenix back then. And I remember the green flags and the theme that we had and Make America Healthy Again released to our tribe and many others. And it was pretty dang cool. But we taught buffalo leadership and one of the concepts was the only way through it is through it. And, you know, when you're facing a storm, the buffalo runs into the storm and it actually mitigates the amount of time you're in the storm. Which ultimately is just really smart. And so, Dr. Stephen, as we go through this topic today, I want to speak to your leader's heart. I want to speak to your heart. I want to say, if you find yourself pinned against the wall when we're talking, meaning they're talking to me, how they read in my mail, how did you know? Ah, you know, I feel like I've been stuck there a long time. Don't be. Condemnation is never the outcome. Conviction is, and then action. And our hope would be that wherever you find yourself recognizing where you're stuck, because we're all stuck somewhere. It's like, do we have a blind spot? Yes, everyone does. It's part of the way God designed your eye. So, we got to get over it. And so, getting some help here is really important that we're going to be able to show you and help you understand and see where things are, where things are not aligned and where things have been off. And I'm going to encourage your leadership function, which is asking the question, who do I need to become? That the leader, when they see a storm or in the storm, they go, they stay in it and they go through it. Don't run away from it. So, I just want to encourage you to run into the storm and run and then get through this. Whatever needs to be adjusted, whatever thing needs to break through, your breakthrough is going to happen when you go run into the storm, not when you run away from it. So, I want to encourage you as we go through this today because it's practical but it's real. And then when it's real and you're like, "Oh, this applies to me and my business right now, like, oh, I need to do something about this." Yes, you will. And if you find yourself at a breakpoint, which I expect we're going to find some folks listening, Dr. Stephen, today that are going to feel like they are, which would be appropriate, lean in.

Yes. Yeah. So, today's conversation, we just mentioned, the RPE or revenue per employee, which is a conversation around your team breakpoints, right? So, and team breakpoints, meaning as the business grows and goes, let's call it revenue. As your revenue increases, which is a reflection of typically your throughput drives your output, right? So throughput would be patient services and volume. As that increases, your output or your revenue and your profit increases, right? So it's like any remarkable practice and a remarkable business, right? So when you, as you grow from $250,000 to $500,000 a year to $750,000 year to a million a year, as your revenue is growing, you should be seeing that kind of revenue per employee ratio, we call it RPE, or how much revenue, annual revenue you're generating. There's breakpoints where as you approximate the next breakpoint, it's time to hire another person because you're going to be at capacity and you start overwhelming your team and your team's going to start to break and break down, right? So that's, you know, that's the whole concept of like a team breakpoint. Today we're going to talk about systems breakdown or operations breakdown, right? Operational breakdown or operational breakpoints. And the way we've got this figured is it's about every half a million dollars of annual revenue. This is when it's time to operationalize for the next iteration of the business, right? So the next level of the business to go from the first level, which is $0,000 to $500,000 to the second level, which is $500,000 to $1 million a year to the third level, which is from $1 million to $1.5 million, right? So for every half a million, it's time to operationalize, right? So, and to check your systems to pull you into the next level. And what ends up happening as you approach these breakpoints is that things start to break down, right? So like, for example, we just came out of Phoenix. We're teaching people how to optimize their marketing spend so they can invest intelligently in their marketing. In other words, they can have data-driven marketing. We're going to do an episode on that coming up here in the next couple of weeks where we just unpack this concept of intelligent marketing, right? So data-driven marketing, we're going to talk about the most important data or metrics to be looking at when it comes to your marketing. So you know that you're marketing intelligently, you're investing intelligently in the business, and you can hear us talk about LTV, right? So, and CAC and the LTV/CAC ratio. So LTV, lifetime value, CAC, cost required customer, and the LTV/CAC ratio. That's one way to be intelligently marketing so that once you get that aligned, then you can make more aggressive marketing and do more aggressive marketing and see more new patients, right? So In this example, once you figure that out, then you're like, okay, good. Let's push more money into marketing. And next thing you know, you're optimizing your marketing. So you crank up your marketing. So as you increase marketing, you increase your new patients that are coming into the practice. Well, when that happens, sales breaks. So sales is your conversion process, right? So now you've like, oh, I've ramped up my marketing. I see more new patients coming in and now I'm, you know, seeing my sales process break down, my conversion process break down. So then you get to work on your conversion process and you, You optimize your conversion process, right? So you train on that, you button up your systems and process, you tighten it up, and next thing you know, your conversions start improving. So now you increase your conversion process, so you increase conversions. So now you're increasing sales, so you have more new patients converting to care and starting care. So next thing you know, the practice is growing, and now delivery breaks or retention breaks. So now what ends up seeing— what you end up seeing as the business grows and you have more patients coming in to get adjusted, you start seeing progress exams falling off and patient education starts to fall off and everybody starts getting backed up and jacked up in the hot seats. And next thing you know, your retention breaks, right? So people start missing appointments, compliance drops, retention drops, referrals drop, revenue drops, right? So you fix your retention. Well, you fix your delivery. So once you fix delivery, the stress goes downstream. And next thing you know, your practice is growing. And now that stresses your team and your team is feeling overwhelmed. And now your team starts to break, right? So now your team starts getting overwhelmed or they start just disconnecting. And disengaging or even just quitting, right? So dropping off, right? So now your team breaks. So now you gotta fix your team, Dr. Pete, which typically means bringing somebody in, adding team members, your team grows. Now your team's bigger, which means your payroll's bigger, right? So your, now your overheads are up and your payroll's bigger. So now your money breaks, right? So it's just this, oh my gosh, the stress goes right through your system like a shockwave. And it goes in a linear fashion like that where you increase your marketing, Sales breaks. Increase sales, delivery breaks. Increase delivery, now you've got your team breaking. Increase your team, now your finances break. Man, it feels exhausting. And it's like, man, it feels like there's always something, Dr. Pete. And the answer is yes. As that stress goes down your system, the next thing is going to break. Hey, Doc, Stephen Franson 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 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 7 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 for the next cohort of the Remarkable CEO Program. We look forward to working closely with you in creating the business that supports your remarkable enable life, not competes with it.

So, as you're listening to Dr. Steven walk through that linear breakpoints in your systems, I want us to be thinking through this and ask ourselves the question, what is breaking right now? The goal isn't to avoid things breaking. The goal is to actually be breaking things. Like Dr. Steven, we talk about the goal of the CEO is to break stuff and then we're going to fix it, but we got to break stuff. So, What breaks is always the question when you grow. So if you are investing more in your, like you said, attraction and marketing, if that's where you're— the season you've been in, be wise as you're planning ahead your quarterly projects and your quarterly focus points. What are going— what are those going to be? Well, anticipate that the sales department and the conversion department is going to be under stress because we're about to double our new patients or we're significantly increase the number of leads. And leads and day ones and people going through the conversion process. So let's be aware of that and be ready for— let's look at our schedule and make sure we have enough blocks per week so we can operate inside of the rule of 72 with the between day zero and day one and day one to day two and, and make sure we have team that is trained up. And if we need people backup training to make sure we have a secondary situation in case we need to cover for double booking because we're all the online things that are happening, as well as external events that are happening and internal. And these things happen from time to time. That to me is, that would be the project for this quarter, knowing that we've just invested in fourth quarter and first quarter in 2025 and 2026 into our marketing. We're spending more, we're investing more to drive more leads, and it's starting to work. We're starting to get traction from all these videos we've been recording, and we've got our external marketing team out now doing things. Our internal campaigns are cranking, and we got our reactivations going. Yeah, we just did all of that energy into that. So now what's gonna happen? You're gonna feel the pressure in sales. Q2, you need to anticipate as a CEO and start thinking ahead and say, okay, we're gonna bolster up our sales department and making sure we're ready for the increase. Does that make sense? You guys tracking with me? So that's how I listen to this, what Dr. Stephen, you laid out and said, as a CEO listening, this is how you listen to it and say, okay, cool. Where are we at right now? Maybe it's not that, maybe it's, different. Maybe we just went through a season of tons of new ones. We came out of a season where, you know, we've been going through the conversion process. Now we've added all these new people. Our volume is going— it went up big time because we had these— a lot of these 2 and 3 times a week people starting, and it was starting way faster than people were graduating. So, we had this inflation of visits per week, and now we're loving it at the same time as we're like, oh, we're starting to skip out on, you know, progress. We've been missing more progress reports and exams than we've ever before, and table talk has kind of gone Oh God, we stopped doing table talk. And, you know, next thing you know, we push our fours back because we're waiting for people to finish all their visits, which isn't really abiding by the rule of stick grading. And we should be doing those on a timely fashion. You guys feel what I'm saying? So delivery has started to go. Recognize that this is part of it. And it's not something you need to escape. It's something you need to lean into and understand. And going into a level of understanding enables you to plan ahead and start to prepare so that there's less of a, what I would say, a dramatic break. Dr. Steven, I loved when I first started with TRP, I remember studying through the academy and building out some of the things that we use now in our coaching. And I remember the spinning plates analogy you used. And in many ways, this is speaking to that.

Exactly right.

You know what? There's the spinning plates concept versus the gears, which is actually the— what is the image that we used in the academy is that's what happens. You take your eyes off of it. There are a spinning plate, one, the other one's the attraction. You take your eyes off of it and next thing you know, two plates drop to the ground or one plate drops. So, if we can make this as a gear, like a nice Rolex watch, Swiss watch, where everything works together and you realize that breakpoints are part of the growth process, it's built in, it's expected and we work through it. It's not dramatic. It's data. And we use the data to inform our decisions. And we systematize that and we build our projects and our trainings and our team-building strategies and all that and all around knowing we're coming up to a breakpoint. That's a remarkable business, Dr. Stephen. And I think that's what we're speaking to is this is what's possible for all of you, every one of us, moving forward, we start to have the understanding of this.

Yeah, so, you know, when you're looking at the business, look at it like it's a machine, right? So if you look at it and you just recognize, listen, there's a process, there's a system that patients are going to be going through, and that as much as this thing is a living organism, right, so it's going to function like a machine. And it's like, as things ramp in attraction from a data perspective, you'll see more new patients coming into the office. And to your point, Dr. Pete, it's going to strain, it's going to stress your conversion process, right? So your day 1, day 2, day 3 process. If we have a ton of new patients, all of a sudden you're like, oh man, we're running out of places in the schedule book, right? So it's like next thing you know, you start breaking the rule of 72 and you start pushing them out 3, 4 days, 5 days, or next week we start scheduling people and we know that there's a snowball effect to that that's negative. You see more no-shows coming in and that's demoralizing, right? And then you start pushing out people that are scheduling tomorrow and the next day and the next day, pushing them out a week, 2 weeks. And now you're really in trouble because you're just pushing this whole thing out. That's your conversion process breaking, right? Or you jam them in, right? And you rush it and you have, you start breaking down the process. You know, your new patient conversion process, you start compromising, you start cutting corners, you start trying to compress it, right? You start skipping steps, right? Skipping the, you start tweaking the process, right? When you tweak in the process, you weaken the process and you weaken the conversion. So conversion rates start to drop off, or even worse, you start letting people convert who were not ready to convert. It's like a weak start. So now you've got these misbehaving children that you've raised in the first 3 days of the practice that you're trying to manage as patients, right? So next thing you know, that's so taxing on you, on them, on the team, right? So it just literally starts to unravel, right? So you'll start to see your conversion metrics changing, and then you'll get buyer's remorse and people dropping out of care or people just not committing to a financial plan or following through on their financial plan. Nobody goes workshop, right? So we just didn't do expectations and agreements, right? So that's your conversion process or your sales process breaking. So then you tighten that up and the stress goes downstream to retention and you look at your delivery mechanisms, right? So next thing you know, the schedule book's getting full. You're getting backed up in the adjustatorium. You're running behind. Now your patient wait time goes from 15 minutes to 25 minutes. When that starts happening, people stop trusting you. They start blowing you off because they're like, hey, love Dr. Pete, want to get adjusted, but I don't know whether it's going to be 15 minutes today or 25 minutes or worse. He seems to be getting more backed up. I'll just go tomorrow. Right. Next thing you know, that's how it starts. It's a slippery slope. They start missing appointments. And because you're so backed up, you're rushing, table talk stops, you stop woodshedding people. And they're like, he didn't even notice I wasn't here yesterday or skipped Monday altogether. I'm just going to sneak in on Thursday. Everything just starts to denature. Right. So now their commitment denatures, the importance denatures, they miss it. And now you stop table talking, you're rushing, you're not present. They pick up on that. Like this just starts unraveling. Now you're late going into a new patient, which is a terrible way to start a relationship, or you're late going into reports, or you're late coming out of reports, or guys, all of the above, right? So now delivery is breaking, right? So you fix that and tighten up all those bolts, right? So by analyzing your process, adding to training your team members, making sure that everybody is focused on improving our delivery mechanisms, right? So then the stress goes downstream because now we start growing and that existing team is like stretched beyond capacity. The capacity tachometer is pinned, right? They're exhausted, they're overwhelmed, and they start checking out or dropping out. So your team breaks, right? So next thing you know, you're focused on your team, making sure you get everybody back in the boat. You're investing in them, maybe giving people raises.

Right?

So you start adding people, right? So it's just like building out the team to increase capacity. Maybe you were missing somebody's skillset. You hired them in, right? So great. Now the team's doing great. Unfortunately, team's really expensive and now you've jacked up your money model and your money breaks, right? Your profitability's gone. Dr. Pete, this is a cycle, right? And if you don't recognize this as being part of it, in other words, it's not a linear experience. It's actually cyclical. right? This is called cycling. And as you are climbing that mountain, as you're going through these breakpoints of $500,000 to $1,000,000 to $1.5 million to $2 million, $2.5 million, $3 million, and beyond, your business is going to continue cycling through that. And you as a CEO, you've got to recognize it's like, my goal is not to avoid those breakpoints. My goal is to break shit as we go. I know that that's going to happen. I'm not surprised by it. And I'm trying to mitigate the impact of that. By preparing my team ahead of time, I see ahead, right? So, and you're not surprised by it. You're not frustrated by it. You're energized by it because you know what to do as you go through this process. You operationalize, you professionalize, and you optimize knowing that this is exactly what it takes to create a remarkable practice and a remarkable business that is in growth mode.

Please stick around for more business insights from this week's bonus interview with our remarkable success partner, dedicated to helping you more successfully help more people. Enjoy.

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 on the 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, Kyra Health 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, 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 Miss 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, Miss 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, and I'm sure this has happened— you ever walk into a room and you just know something's wrong? Yeah, well, I knew something was wrong. And, 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 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 health care. And I'm going like, wow, that's a kick in the gut, if not somewhere else. And I said, no, Miss 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 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 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 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 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 overcomplicate this, but the reality is most of the doctors are already giving discounts. I run into this all the time. Docs will 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 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 have 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 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 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 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, 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 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. 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 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, Additionally, direct message us on Facebook, LinkedIn, or Instagram. Now go and be remarkable.