Let's Play Ball - Singles, Doubles, Homeruns, and Grand Slams

Hey there and welcome back. I'm Dr. Vince Leone, executive producer and co-host of the Practice Builders Podcast. With my partner in crime, Dr. Kyle Penkinen, we deliver proven strategies to help you grow fast, specialize with confidence, and build profitable staff-run practices. Let's go ahead and dive into today's episode now.

All right, folks, welcome to the Practice Builders Podcast. I am your host, Dr. Kyle Penkinen. And I will be your solo host today. Dr. Leone is taking a little break over Christmas and New Year's here. And so I will be your host for a couple of sessions in a row. And I'm really excited about this, what we're going to bring you today, because this is one of the most common questions I get from our clients in specialized practice, especially when they, they come on board and they They team with Specialized Practice, and we teach this concept, and it's, it's one that I've taught for a while. It's the concept of hitting singles, doubles, and home runs. So I call this— we're going to title this podcast, Let's Play Ball: Singles, Doubles, Home Runs, Grand Slams, a Deeper Dive. And this is something that if you follow what I'm going to teach you today, this will build your practice. A little background about me. So, uh, I really got into the world of niches about 2016, but I really hit it hard starting in 2020. And I practice in a town of about 850 people. For those of you listening to this podcast, you probably already know that. And that sets up a unique situation. I'm in a pretty low socioeconomic area, very rural area of southern Minnesota. Actually, my town of Lamberton is really one of the bigger towns for a small little area around me. You gotta drive about 25, 30 minutes to get to a little bit bigger town. And a bigger town in my area is like 2,000, 5,000, 10,000 people. That's a bigger town. So all that to say, What I'm going to teach you now, if I can do it in a little rural area, you can do it in a rural area or a big area. Okay, and so let's, let's talk about this concept of singles, doubles, home runs, and grand slams. I'm just going to give you examples of each and how I apply this in practice. So baseball analogies here, obviously. So what you need to be successful with this is you need a laser Or a shockwave unit. And for those of you that have decompression, that is also a very good tool to have. But for you, for sure, need lasers, shockwave, and hopefully decompression as well with it. And so let's, let's go into what I mean by hitting a single. So in baseball world, if you think about how are most baseball games won by teams, They're typically won by the team that gets more hits, right? And they hit way more singles and doubles than they do home runs. That's how I— and a grand slam is exceedingly rare. But that's kind of the concept that I embrace and practice for myself. So a single is this. Say you had a patient that came in, they were a weekend warrior, and they They injure their low back over the weekend. They maybe they have some just acute low back pain that spreads across. There's no leg symptoms, no buttock symptoms. Just generalized low back pain. It's acute. That's a case when they come in. I'm thinking, okay, this is probably not a long-term plan. It's an acute injury. This is probably going to be a single. So what I do with a case like that is whatever I would normally recommend for that case. So, so short series of chiropractic adjustments, maybe I'm gonna put them on a supplement to support inflammation reduction, usually a proteolytic enzyme supplement, and maybe I'll show them a few stretches I want them to work on at home. But I'm also, whatever that your normal recommendation would be for that case, but now we're going to add laser therapy to it, or we're going to add shockwave to it. Typically for acute cases, I'm going to use laser therapy. And so this is a case where I'm kind of a blend practice where I have mostly some insurance. In fact, we're providers for almost all insurances. But we're about 50/50 of insurance, cash. So here we have a hybrid of, okay, we're going to do the adjustments, we can teach you some exercises, we can bill that through insurance, but the supplement and the laser, well, those are going to be cash-based services, but it's a small package. So most cases, patients will say, you know what? Let's, let's do the little more comprehensive approach. So usually I'll provide a gold plan or a silver plan type model here. I'll say we can do the adjustments, show you the exercises, or we can do those plus add the laser. And the advantage of the laser, Mrs. Jones, is it's going to help you get better faster. We're going to reduce pain quicker. We're going to reduce inflammation quicker. We're going to stimulate healing with the laser.

Okay.

And 8 out of 10 times, and from my experience, they choose the laser. It's a small package and they're gonna see results quicker. And so we all day long in clinical practice for more acute type conditions, just your general average everyday chiropractic patient, you hit singles. And it might be the same for a case of tennis elbow or plantar fasciitis or shoulder bursitis or hip bursitis. Maybe they've only had a few days or a week or 2 or 3 or maybe a month. You're thinking a shorter package. You're thinking maybe 6 to 8 sessions, 6 to 10 sessions. I usually do 6. That's kind of my starting point for most acute conditions. And I'll do usually 3 times a week for 2 weeks. And that's usually enough, give or take a visit or 2 one way or the other, to settle a lot of acute conditions down. Unless it's a, you know, a real significant injury. Well, what's a double? A double would be the person— so with a single, they had acute back pain. A double would be, Doc, this— I have some back pain on kind of an ongoing basis. Well, do you have anything going down your leg?

No.

It's just kind of some chronic nagging back pain. I wake up, I'm stiff every morning, or as I go through my workday, by the end of the day it's worse. You x-ray that patient and yep, they got some general discogenic degenerated discs, but maybe not severe. It's just mild to moderate disc degeneration. To me, I look at a package like that, that's a double where I'm going to do like a 12-visit protocol.

Okay.

And maybe it'll even be decompression with it, but I'm sure going to recommend 12 chiropractic adjustments. I'm going to recommend 12 lasers or shockwave depending on how bad I think it is. Generally, the more chronic it is, the more I'm going to recommend shockwave, and a little more towards the acute side, I'm going to recommend laser. And there are some cases where I'll do a hybrid, where maybe I'll start with shockwave for maybe 4 to 6, and then the middle 3 or 4, I'll maybe do both, and then I'll end with the laser the last few sessions. And that works really well as well. And in my practice, we have the Back on Track, plus we also have the Hill DT decompression table. So for the more garden variety of cases, For acutes and some garden variety chronics without significant radicular component, I'll use the Back on Track. It's simple setup, patients like it, feels good, and it helps. And so we have a package of 6, so the adjustments are covered with their insurance, or at least billable. Maybe we teach them some exercises. That's a billable thing, therapeutic exercise instruction. And even the traction from the back on track, we just build traction for that because that's what it is, it's traction. And but then the laser, there's cash, or the shockwave, there's cash. So it's always a hybrid model of 6 visits hitting a single, 12 visits hitting a home run or a double. And all day long in practice, Folks, I hit those. And we see 250 to 270, 280 patients a week, or patient visits anyway. So all, you know, through the course of a week, you get patients that call in, Doc, you know, did this to my back or did this to my elbow or whatever. You just— every patient that walks into the door basically in a chiropractic office, Is a laser or shockwave case? Well, you know, 98, 99% of the patients that walk in my door are some type of a pain patient. And so it's very— so they're all candidates for laser or shockwave. And so I see too many doctors that have laser and shockwave, but they're not— it's not booked full. They're not busy with it all the time. You should be recommending those to every single patient that walks through your door, doctors. And those smaller packages of 6 or 12, they are easy peasy. If you are confident in your recommendations, you are doing good exams, good histories, you exude confidence and the patient has confidence in you. If you recommend it, 8 out of 10 times, they are going to do it. Unless they are just very, very poor and just simply cannot afford any cash-based services. But even those, I give them the option. And, you know, so a large percent— but even if you could get 30% or 50% of the people to say, yeah, okay, let us do the laser shockwave with this care plan that you are recommending, doc. That adds up. And so that's one of the reasons that's why we have 6 of the— or 5 of the M6 robotic lasers from Cutting Edge and 1 of the M7, because I'm rec— I just recommend it. Well, whatever comes in the door, well, let's do laser with that along with good chiropractic work. And so you just package these all day long, singles all day long, some doubles. And then throughout the course of the week, I don't hit them every day, but every week we get 1, 2, 3, 4, what I call home runs. Well, what's that? That's a decompression case. That's a case where they have chronic low back, it's down their leg, or they have an acute bulging or herniated disc, MRI confirmed. We got some imaging studies. We got some low back x-ray findings. We got exam findings to correlate that. This is a little more involved. This is a little more complex case. Well, in that case, I'm going to recommend what they need. They need a full-blown decompression program, 24-visit protocol. That's what the research 20 to 24 is the kind of the minimal optimal dosage. So I'm going to tell the patient the truth and tell them, this is what you need. And so 24-visit decompression protocol, we do laser every visit, or sometimes we do laser the first half of the program, and if they're not responding as well as we like, then we switch them to shockwave.

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And so that's a home run. That's a bigger care plan. And that is— and just like in a world of baseball, you're not going to hit a home run Maybe every game, but through the course of a week and through the course of a month, you hit several home runs. And by the end of the month, if you say you only hit one home run a week, if you had five new starts for decompression and your package is three, four, five grand, that's a game changer for a lot of clinics. You don't need. To hit a lot of home runs to really have an impact on your bottom line and your monthly collections, Doc. And so of course, there's some big decompression practices out there that are hitting a lot of home runs. I personally, being in the rural area I'm at, I hit tons of singles, quite a few doubles, and some home runs. Now, if you're in a big city, you might be able to hit a lot more home runs than I hit. But we're going to do about $1.2, $1.2, a little over $1.2 million this year. And the majority of that is from the singles and doubles. It's just the average everyday chiropractic patient that we're adding in cash-based services for. Well, what's a grand slam? I just hit a grand slam this week, so that was exciting. A grand slam is a dual decompression. So I had a patient that came in from our advertising for low back. We worked that up, put a program together. She came in the next visit, says, you know, I didn't tell you, but I've had chronic neck pain for years too following a car accident. Can we do this program on my neck as well?

Okay.

So we worked up the neck. Examined it well and said, yeah, this is definitely a case that we can do. So we're doing a lumbar and cervical full-blown 24 decompression visit protocol. Well, that's all that's a grand slam. You know, I don't hit a lot of those in a year, but every year we get a few cases where we do a dual program like that. That's a like I said, that's a grand slam. That's a fun one when you get those. And that is how you do this, docs. Concentrate on building confidence by hitting singles and doubles, those smaller packages, and see that, oh, your bottom line starts to go up every week just by recommending it to every patient. Laser or shockwave, laser or shockwave. And the worst they can say is no. And then you just do your normal chiropractic stuff. But my experience is a large percentage of the patients are gonna choose the laser and shockwave, which is why we can keep 6 lasers and we have 1 shockwave. We're thinking about getting maybe a second one. I've only had the shockwave for 2 years. The lasers I've had since, well, the first one, 2016. But the reason that's grown is just recommending it patient after patient after patient. And the neat thing is you'll have a case, say you had a tennis elbow case and you did 6 extremity adjustments and 6 lasers on it and it cleared it up. Well, that same patient will come in a year later, 3 months later, whatever, and say, you know, Doc, that laser sure worked good for my elbow. I got this shoulder thing going on now. Do you think that laser would help that? Well, let's examine it and let's see. And you examine it and, oh yeah, I think that is going to help that. The laser works so good on so many different conditions, patients will literally request it. They'll say, well, the laser worked good for this last time, or they won't request it, but you'll have had success with it with another case in the past. And so they'll come in with a new presentation of something and say, well, Let's do the laser. That worked pretty well when we worked— when we did it on that other condition last time. Oh yeah, that did work well, Doc. Yep, let's do the laser. And so it's really that easy. You don't have to make it complex. I see so many of our— so many clients and so many docs I talk to that they have one laser and they barely use it. Or they have one shockwave unit and they better use it. You're sitting, docs, on a Mercedes-Benz that's sitting in your garage, in a sense, in storage, collecting dust. Old school therapies like ultrasound and electric stim, they have their place, but they're— the technology we have nowadays is so far beyond those things that if you have these Services, you need to recommend them and recommend them with confidence. And I promise you, if you do that, docs, you're going to see so much increased revenue. Uh, it'll be, it'll be a game changer over the course. So right now I'm about 50/50 with insurance and cash, like I said. So, you know, We're gonna do— last year we did just slightly under $300,000 of laser therapy cash-based service. This year we're gonna be quite a bit above that. And so with one laser though, docs, you can easily, easily add in $50,000 to $75,000 of extra revenue. And I, I'm on the low end of the scale when it comes to the, the fee I charge for those. If you're a little higher end, you're gonna do better. So you just gotta, you gotta price these things so that they are, they match your area. The bigger area you're in, the probably the more you can get away with a little higher fee, especially if they're a more advanced socioeconomic area. Me, where I'm in a very rural area, I gotta People are pretty price sensitive. So I've kind of found the sweet spot where it's low enough that the majority of the people will sign on to it, but it's high enough that, you know, it's worth it. It pays for the equipment and then, and the staff running it and well beyond that. So, so I hope that that concept of singles, doubles, home runs, and grand slams, that that resonates with you. It's a, Wrap your mind around those simple concepts. And I think that that will pay great dividends over this upcoming 2026 year as we enter into that, as we're recording this towards the end of 2025. And put it to use and see if it really makes a difference. And if it does, let me know. Let Dr. Leone know. Let us know how this podcast has benefited you.

Yeah.

If you like it, give us a 5-star review. And if you don't, well, don't say a thing. No, but no, we're just here to deliver. We're here to help. And we love teaching doctors how to grow their practices with especially spinal decompression, but these cash-based services and niches. So thank you for joining me for today's Practice Builders Podcast. I'm Dr. Kyle Pankinen signing off.

Hey, it's Dr. Vince again, and hope you enjoyed that episode. And if you're ready to grow your practice fast with high-value decompression patients, then the Decompression Accelerator could be a phenomenal option for you. This is our 90-day sprint to help you scale with proven systems, staff-driven protocols, and full marketing support, and it's all guaranteed. Spots are limited. Head Head to www.decompressionaccelerator.com to learn more.