Boost Your Bottom Line with Singles and Doubles

Welcome to the Practice Builders Podcast, hosted by Dr. Vince Leone and Dr. Kyle Pankinen, your source for building cash services. Let's dive in.

Okay, welcome everybody to the Practice Builders Podcast. My name is Dr. Vince Leone, and joining me as always is Dr. Kyle Pankinen. All right, let's start, let's start over again. Sorry, that was my bad. I don't know why I did that. Um, okay, welcome everybody to the Practice Builders Podcast. My name is Dr. Vince Leone.

And I'm Dr. Kyle Penkin, and we're glad that you're here with us today.

Oh, absolutely. We're excited about this topic. Um, and if you haven't yet, give it— give the show please a like and a subscribe. And, and if you find value in it, please share with a colleague because we're trying to help all chiropractors looking to grow Cash Services. And today's topic is really interesting. We're calling it Increasing Cash Flow with Singles and Doubles. So growing in increasing cash flow with singles and doubles. So, Dr. Kyle, what is a single or a double in your— in our world?

Yeah. So most of the doctors that we work with are trying to grow niches, be it decompression, neuropathy, chronic knee pain. And those are bigger cases, bigger case fees. And, and we kind of like to equate that when you sign— I get a patient to go on board with one of those cases, it's kind of like hitting a home run.

Mm-hmm.

But just like in the game of baseball, you know, you might play a 9-inning game and only 1 or 2 home runs are hit the whole game. And so in the world of niches, I mean, it's not like you're gonna hit 8 or 10 cases like that on a daily basis. There's some maybe exceptions to that rule out there, but you're not gonna get tons of those cases. That's the bottom line. You're hoping you hit some home runs throughout the course of every month. That's gonna greatly increase your bottom line, but Singles and doubles are your, your smaller cases. Maybe those patients that don't need the home run, they don't maybe need a full-blown decompression protocol, full-blown neuropathy, full-blown knee, but they, but they definitely need help. And so, uh, they're smaller cases and they typically— a single would be more what you would do with an acute case. Maybe they don't need a long duration of care. They've only been in pain a few days or a week or 2 or 3, and they need a small package. A double maybe would be your case where they've had pain maybe for many weeks or a few months, tending a little bit more towards a chronic case, and they need kind of a more of a middle-of-the-road or a medium-sized.

Mm-hmm.

Package. And so in our case, we have different therapies that we use to— I don't know if I want to use the word upsell, but cash-based services that we would add on to our traditional program. So Dr. Vince taught me the concept of hitting, uh, or doing silver And goal plans. So I'm going to let him kind of expound on that a little bit, and then we'll talk about these various therapies that we use to hit singles and doubles.

Yeah, and I think that's, that's a great intro into this topic. And I think the value of a singles and doubles is, um, it's going to keep your laser— because typically this, this can be laser or shockwave. Right? That that's what we're talking. That's the primary therapies that we'll be using to hit these singles and doubles. And with the with say decompression though, I mean we we don't want to sell half a plan, right? So we we know based on the research, well 24 visits is minimum viable dose. So so this is not this is not like oh well this patient you know is not super severe disc. So we're going to give him a you know we're going to try to pick a number out of the air. That's not what we're talking about here. I kind of want to be clear on that. So this is, this would be more like a patient that, you know, maybe has an acute shoulder, right? Or a knee, and it's not super severe. Maybe they had a weekend issue, like they played pickleball, right? By the way, if you want to get your laser busy, go get dialed into the pickleball circuit because those guys are hurting themselves left and right. Uh, you know, I just actually saw one of the laser reps from Cutting Edge just had a Uh, an Achilles. So, um, uh, but, but that acute injury over the weekend, that may be like a 6-visit, um, or a 12-visit plan depending on the severity. I think cutting edge— so we like the MLS laser, and there's other good lasers, but we like the MLS laser. Um, I'm not, I'm not afraid to say that. Um, and so they typically say 6 visits for acute and 12 for chronic. I kind of feel like that's a little under-recommending. I would, you know, it just depends on severity, right? And, and kind of your clinical experience. But the point being is that's your singles. Those are your singles and doubles, right? So shockwave doctors doing a lot of, you know, discovery days, and then I think a 10 or 12 visit recommendation on those for knee pain, shoulder pain, you know, that type of thing. Um, and so, you know, I think it, it's, it's filling the gaps, right? So if you look at your kind of the revenue of your whole practice, And then I'm gonna— I'll go back to the silver and gold plan. Sorry, I kind of got off track here, Doc. But the point is you have your chiro revenue stream, right? So you have your, your, your bread and butter chiro, and then you have your big ticket decompression or off with your knee pain. And then in the middle there, you kind of have your higher value kind of cash services where you're doing these singles and doubles, 6-visit plans, 12-visit plans. You're charging roughly $100 per visit. And so, you know, that's $600 or $1,200. Per patient. Now, how do we increase value on the chiro? Um, every single chiropractic patient, barring a contraindication, will get better, faster results with laser, right? So what we do is, um, our silver and gold. Okay, so Mrs. Jones, you're a great candidate for chiropractic. I'm going to recommend 12 visits over 30 days, and we, we'll reevaluate. We have 2 options for you. Silver is chiropractic only, and gold, if you want to get better faster, is chiropractic with laser. Okay. And that's that. You don't have to sell anything. All you're doing is offering it to the patient. And oh, by the way, probably about 35% of patients will say yes, because most, you know, a lot of people, they want to get better faster. Maybe they can't afford it, but a lot of patients can afford it and will take you up on that.

100%. And that's those smaller plans, your conversion rate, I mean, 35%, 40%. Say you had a 100— let's say the average chiropractor out there sees, like, latest statistics I read, is about 110 to 120 patients a week.

Mm-hmm.

Well, every patient that walks through your door in a typical chiropractic office is a laser— a potential laser patient. 'Cause most of our patients are coming in with some kind of pain, and laser helps address pain and inflammation, helps stimulate healing, and all the conditions that we typically see in a chiropractic office. So let's just say you had 100 patients, and every single one of them, you at least offered them laser therapy along with whatever else you normally would do with that patient. Just like Dr. Vince said, whether it's adjustments or Exercise or any other kind of therapy, try to add laser into that protocol. And if you can get shoot, even if you can get ten of those a hundred people to sign on to that at a six visit or a twelve visit package week after week after week, that's going to add to your bottom line significantly. And so. In 2023, I was able to crack into the Million Dollar Practice Club, and one of the biggest reasons for that was because of this concept that we're talking about right here. I have a little higher, little bit higher volume than most docs, but still, it's just simply offering these services and hitting these singles and doubles and getting multiple cases of that through the week where we're able to Take a practice that was $45,000 to $50,000 a month to $100,000+ most months. And we're in 2023, we did about $260,000 just in laser therapy services alone.

Hmm.

And another $50-some thousand with shockwave. And so, and that's all cash, mind you. And so, adding those simple things with your everyday chiropractic patients can be a major game changer, even if you're not really good at closing cases yet. Yeah, it can make a big difference. Yeah.

And I think what you want to, you know, from a doctor's perspective, as we— because we like to train doctors to become more like the CEO of their practice, right? So that they start to look at their practice more as a business versus they're just going to be working in the weeds week in, week out. So, if you can pull pull yourself out of your practice a little bit and start thinking like, well, how do I— and again, look, we're serving at the highest level possible. If you're going to invest in a laser, shockwave, etc., you're, you're investing in, in trying to deliver a higher value service, right? So, um, so when I talk about, you know, what I'm going to talk about in terms of like, uh, increasing value of a patient, like, just don't, don't, don't get the heebie-jeebies because we're talking business. Like Look, this is how you get better, is, is start looking at it as a business and not being just the doctor. You got to take your doctor hat off and put your owner hat on, right? So start to think, how do I increase the lifetime value of my patients? So if you look at your PVA, um, and say it's 10, the average— so the average chiropractic patient around the US is around $700 to $1,000. That's your average chiropractic care, you know, that's what someone's going to pay you. So some, you know, some patients come in for one visit and bail, some people come in for 30 visits, right? So the average of all that is around $700 or $1,000. Our average decompression neuropathy and knee pain is around $5,000 to $6,000. So you can see, oh wow, I mean, that's how they're making so much money. But when you add a laser or shockwave, you can increase the LTV, or the lifetime value, of your patient, because now instead of Because, uh, like collecting an average of $50 per visit, which that is what the average chiropractor collects per chiropractic visit. If you can start adding laser or shockwave to say 30% of your chiropractic patient base, now you're— and you're charging $100— now your, your LTV is going to go up, right? So you got to be thinking like, how do I without getting more new patients— that's not the goal. You don't need to go out, run a bunch of marketing for laser. Like, that actually doesn't work very well. But without, you know, doing more marketing, how do I use my current new patient flow and my past patient base, right, and, and increase the value, right? Help serve them at a higher level and have them pay more. So now your, your LTV— so you're, say, so let's use an example. So say you're You know, your PVA is 10 and your average collection per visit is $50, right? So what's that? That's $500, right? So that's your lifetime value of an average patient in your clinic. If you're able to add, say, you know, laser to 30% of those, now you can increase it to say $750, right? Now your LTV for each patient is $750. Um, so that's— what is that, a 50% increase? So 250 on top of 500, 50% increase. That's a lot. It's a lot when you extrapolate that over all those new patients every month, month after month for the entire year. So, so you, you need to be— what I recommend, zoom out a little bit and start thinking, how can we add value and increase lifetime value of patients? And singles and double doubles are a really Easy way to do it.

100%. The other thing I would bring up here too is that a lot of docs out there have lasers or shockwaves and they're just flat out— they're underutilizing them.

Oh, so bad. They, they're like gathering dust. Harold from Cutting Edge, he's like, I have these doctors, they have these lasers, they're not using them. It's like, to me, like, laser is the easiest thing to make money with. Those things should be turned on. Like, like Dr. Kyle says, hey, You should be turning that thing on every day, ideally multiple times.

Multiple times. So if you have a laser shockwave in your practice and you're under— you're not utilizing it, boy, follow this concept we're talking about of hitting singles and doubles, offering silver and gold plans. And if you're somebody listening to this and you're like, well, I don't know, that's— it's $30,000 or $70,000, some shockwaves are, I think, Close to $80,000.

$80,000.

And some of the lasers, they range in price from cheaper ones to like $9,000. Some of the cutting edge are closer to $50,000. And Dr. Vince had 4 of those when he was in clinical practice full-time. I have 5 of them currently. And you think about, you know, a lot of doctors are afraid to invest that kind of money thinking, oh boy, I'm gonna go into debt. I can't recoup that. If you use it just like what we talked about here, It won't even be a problem. You'll have that laser easily, or that shockwave easily paid for in 1 year or less. And then you're, it's all gravy from there on out.

And I would make that a goal. Like if you, if you do invest in a piece of equipment, there's a couple, you know, I always advise clients when they invest in a piece of equipment, there's, there's a few things that you should do. One, have a goal paying it off that year. Or within 12 months. 2, you're going to be able to get some tax write-offs. Now, you don't get to write off the whole $50,000. Okay? So I don't, I don't know exactly what it is, but it's like, you know, on $50,000, I think it's maybe like $20,000 or $30,000 you can write off. You know, they'll give you all that information on how to do that. You just give it to your accountant. But then how do you integrate it into your practice? You know, this is probably a whole new, whole other topic, but I'll just go really, really quick. One, you should 100% have signage. And this is another reason why I like Cutting Edge, is because they give you, you know, big signs. Like, you should— you know, these things are working for you. They should go in your reception area, and they should— so every single new patient, existing patient that comes in, they're going to see this big, nice, professional-looking sign touting laser therapy or shockwave or whatever it is. And then you should let all your past patients know. You should be emailing and texting your past patient base and say, hey, You know, did you know that we now offer this new service and it helps these conditions? And if this is something that you're suffering from, you know, click or call today. That's how you, you know, very inexpensively market these services, these laser shockwave services, without breaking the bank, without spending $2,000 on, you know, Facebook or Instagram or Google. It's just like you just tap in and tap into your existing Assets, which is your past patients, your current patients under care, and your new patient flow.

100% right, in the sense you don't have to spend a ton of money marketing this thing. Oh, I'm gonna spend $50,000 on a laser. Now I gotta do this big outside marketing campaign before I have a patient in the door. They're already there. Just start recommending it to them in a simple email campaign. And it's amazing how many people come in, uh, Through word of mouth. So somebody gets better, they get help with the laser, they think, wow, that's really cool, this advanced technology of the shockwave. How many people come in from word of mouth, say— they don't even say, I want to see you, doctor. I want— they say, I want the laser. Yeah, I want that shockwave thing that my friend told me about. They don't even care about me.

I almost feel like, Doc, if you're not investing in some of this technology, you're kind of falling behind.

Yes, because, you know, when I first got into practice in 2020— or 2000, 24 years ago, I mean, and even still to this day, a lot of chiropractors just, they have an ultrasound machine and an interferential machine. Those are—

Yeah.

That's the classic therapies, or they use hot packs or something. And not saying that there's no benefit in those therapies, I'm not saying that, but those For what we have today, those therapies are outdated.

100%.

If you're still using those to a large degree in your practice, you're, you're probably 15 to 20 years behind where technology is today. It's time to up your game and, and incorporate these newer therapies in a big way because you're gonna get better results. You will, guaranteed. Your patients are going to like it, and it's going to significantly increase your bottom line.

Yeah, 100%. And, you know, look, I— it's not that we don't recognize that can— it can be a little nerve-wracking making an investment of 50 grand. By the way, if you're interested in, in getting a cutting-edge laser, you know, let, let us know. We can connect you with Harold over there, and we'll make sure and get you kind of best terms, best prices, because they always run specials and all this type of stuff. But the point being is, you know, sometimes you just got to take a risk. You know, no, no. What's the old saying? No risk it, no biscuit. Dr. Pankinen.

But dude, I've never heard that one before.

Yeah, that is a very good one. I think that's what the kids say. But the point being is, hey, sometimes you got to go out on the limb and, um, and, and make an investment in yourself, in your practice, and in the future of your practice so that you can grow. So if you're stuck You know, you're kind of wondering, why am I stuck? Well, there's probably, you know, probably more than one reason. But if you're kind of doing the same thing month in, month out, year in, year out, you're probably going to get the same results.

Couldn't agree more. And sometimes you got to shake things up. Like you said, you got to take a little risk. Sometimes you got to have a little faith and just believe that the good Lord is going to provide and You know, and it's easy to say it. Like I said, I've done it. Dr. Vince has done it. It's easy to say it once you're on the back end of it. It's a little harder at the front end to take that, that step, that leap of faith. But if you follow these principles we're talking about, it's really, it's, it's gonna work out. It really is. And those patients are already there. You just gotta be willing to Take one step forward, and sometimes that's when the, the Red Sea parts, right?

My dad used to always say, you know, everyone wants fire, but no one's willing to put in the wood.

That should be in scripture too, or something. Proverbs.

I know, I know.

Wisdom.

It's like, it's so funny because you can see this picture of, you know, some, some guy that's freezing. He's sitting in front of a, a wood-burning stove, but there's no wood in it. You know, we got to put in the wood, and obviously that's Investing the time, the energy, the money into your practice so that it can, uh, you know, provide that heat. But I think that's a, uh, a great place to end. I, I think we covered this topic pretty well, and I, um, I, I hope this is, you know, valuable for doctors. Any last parting words there, Dr. Kyle?

No, just, just believe in yourself and believe in, believe in what you can accomplish. And really Think about not only your business, but what's best for your patients. And doing these things, these advanced therapies, is going to increase every— your patient care and your bottom line. And that's a perfect marriage. It's a win-win.

100%. Okay, so that's going to wrap it up for this episode of the Practice Builders Podcast. So again, if you haven't, um, given a like and a subscribe, please do that and share with Your fellow colleagues. We want to help as many doctors as possible add cash services, increase the value of their practice, and just create a better lifestyle. So we will see you on the next episode. Take care.