Pre-Framing The Close 4 Questions To Ask Before Talking Finances

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 Pankinen, 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. Hello, and welcome to the Practice Builders Podcast. My name is Dr. Vince Leone.

And I'm Dr. Kyle Pankinen.

Awesome. And welcome to our newest episode called Preframing the Close: 4 Questions to Ask Before Talking Finances. Dr. Pankinen, pretty cool topic, right?

Pretty cool topic. Obviously, we have to eventually get to the finances. That a lot of times is the The elephant in the room, right? But there's some things that we should address before we even get to that, and that's what we really want to talk about. Because if you don't address these 4 questions, the whole financial conversation is moot. It's, it's almost, um, it's almost a waste of time to even get to it if they are not on board or don't have the right answer to These 4 questions that we're going to address today. And so this will save you a lot of— if you use these questions in your report of findings, it will save you a lot of headaches. It will save you a lot of problems in conversion. You know, they start the program, but then, oh, I didn't have this question answered. Now they come back and they're not sure. And so, you want to set the stage with these people in these niches where you answer these questions upfront. So, with that being said, what is our first question, Dr. Vince?

Yeah, I think we want another thought really quick. By the way, we are coordinated on our shirts. You got a dark purple, I got a light purple. So, that's really good. And purple's like You know, the color for royalty, Dr. Pankin. And did you know that?

Well, of course, that's why we picked it on horror today, right?

I love it. I love it. But, you know, I think one of the keys to being successful in high-ticket niches and, uh, being able to quote unquote close or enroll patients is you need to improve your communication skill sets. If you want to play this game at a higher level, you have to be an excellent clinician. There's no doubt about that. You have to have the equipment, um, but you need to be able to confidently Speak about finances. But before you even get there, you know, like, why are we asking these questions? The reason why we're going to ask these questions is because we want to overcome or address common objections like time, spouse, schedule, and scheduling before we talk about finances. Because it's like, if you don't address these objections in the spouse— in the patient's mind, Um, If you immediately talk— start talking finances, what's going to happen is you're going to be essentially fighting a battle on 2 fronts. You're going to be talking about finances. The patient's going to be thinking, I don't know if I can do 3 times a week, or I need to talk to my spouse. It's like you can't fight a battle on 2 fronts. You need to address all the common objections and get those squared away and then talk finances. Doesn't make sense to talk finances until you get all these Uh, things addressed. So the next thought, really quick before we dive into the 4 questions, is when do we ask them? And so in our model, we want to— we break our report of findings up into 3 parts. We have the front half, which is the doctor stuff, you know, can I help, what's wrong, schedule, recommended services, etc. And then what we call the 4 Horsemen, or the transition questions. And so it's like you do all the doctor stuff, it's like, okay, Mrs. Jones, so Is it okay if I ask you a few questions? And so that's when we ask these questions, right? Because you have the front half, doctor stuff, transition, the Four Horsemen to address common objections, back half. Now we talk insurance and finances. So that's when we ask them. And so you want to— now you've been talking, explaining all the doctor stuff. Now we want to get the patient engaged and get them answering questions. And hopefully what we really want them to We want a yes, yes, yes, and a now. And you'll understand what that means in a second. So, Dr. Pankinen, the first question, is this a good fit? Does this seem like a good fit?

Yeah, so if you're offering a care plan to patients, and presumably this is a day 2, usually what we recommend for report of findings, But you've sent them home with hopefully some material that they can read about, a report or literature, a brochure, maybe studies, whatever, that goes over what you're proposing for treatment. Many times we're talking about a decompression program here.

Mm-hmm.

And does this seem like a good fit for you? Is, in other words, in light of all the other things that you've tried, And you are still suffering. Does this program, what we have described and how it works, does this seem like it would be a good fit to address whatever problem is that they are coming in for? In other words, you got to be specific and let them know that this is the best possible solution to whatever their problem is they are coming in for. And if you can make that match, both in their mind, then they can answer yes to that question. In other words, yeah, this is a— this is a— this is what I've been looking for, is a lot of times what they'll say.

Yep.

That's, that's what I hear people say. This is— you're the only doctor that's ever talked to me like this or really explained this MRI or these x-rays to me and really explained how this could be a solution For my specific problem. And that's good doctoring to do that. And if you do that, they will then recognize that, oh, I'm in the right place. This is the right fit. This is the right solution for my specific, in this case, disc problem.

Absolutely right. So the question is, does this seem like a good fit? And then you're just, just be quiet and let them, you know, talk. Let them answer. Don't jump all over them. And, and they'll let you know. You know, you ideally, you want someone that is looking for a non-surgical solution, does not want to be on drugs, um, understands that they have a disc problem, and then the only way to solve that is through spinal decompression, or they have chronic knee pain, you know, etc. So does this seem like a good fit? Very simple. We call that a temp check, right? We're getting a sense, hey, are they on board? Uh, question number 2, can you make this schedule Pretty key, right?

The schedule, because these programs that we're doing, these niches, are typically about a 3-month program, whether it's peripheral neuropathy, chronic knee, or chronic neck or back. And, and then there's a certain protocol that we lay out for them with a recommended— or I shouldn't say recommended— a precise, precise schedule Mm-hmm. That is laid out to produce the best possible outcome or result for this patient. And so they have to understand that this is not only— this is a commitment, it's a commitment of effort and time and travel and eventually finances that I'll get to later. But if they're going to be going on vacation or going down south for the winter in a week or two, Well, these are, these are things that need to be addressed so that it might be the right fit for them, but it might not be the right time for them.

Mm-hmm.

I've had several patients, you know, well, this is my busy time of year, Doc. I live in farming community. And so they're busy in the spring planting and they're busy in the fall harvesting. So they'll say, Can we do this after I'm done with fall harvest? So that's, in our case, that's usually November or so. So if they're going to come in in September, October, a farmer, they're just not going to do the program. They're going to wait unless they're really in dire straits with their condition.

Hmm.

But they need to be able to commit to that window of time without any significant interruptions. Now, if it's just, oh, I'm going to be gone a couple days here or a day there or something, maybe where it might mildly interrupt the schedule, that's probably not a big deal. But if they, if they can't commit to that window of time to give themselves the best chance to get better, that needs to be addressed right up front.

100%. And a good example of this, Dr. Patel had just brought up on our last Q&A, Uh, he had a client, a patient that he was in construction and he had to continue to work throughout the care, which, you know, was not ideal, but he would also not come in for 2 or 3 weeks at a time. And now he's complaining about not getting all the results. By the way, he went from a consistent 8 down to a 2 out of 10 in the morning. To 5 after work. So he's getting results. But if that was addressed— and I don't know if it was addressed properly with Dr. Patel or not— but if it was, then you could, you know, if you address that, hey, can you make this schedule work? Are you able to, you know, over the next 90 days come in this, you know, this time, number of times per week in the first 4 weeks, and etc., etc.? Um, and you get their consent Well, great, you're able to move forward. If they don't abide by that and then question the results, hey, do you remember back when we started how we talked about the schedule and I asked, can you make this work? This is a two-way— this is a relationship. You have responsibilities that you need to take care of to make this work, and I have responsibilities. If one of us doesn't hold up our end of the bargain, Well, the results are going to suffer, right? So that's why this is so important. This is not a get-fixed-quick protocol. It is a get-fixed-long protocol, but it's going to take some commitment over this first 90 days. So that's why I think that's, uh, really, really imperative. By the way, you know, if, if you start off at 3 times a week and they, you know, can't do 3 but they can do 2, well, maybe you can adjust the schedule a little bit in that regard. And, and still allow them to take care. So, that's number 2. So, number 1, does this seem like a good fit? Number 2, can you make the schedule work? Number 3, number 3, Dr. Pankinen.

Number 3 is your spouse.

Oh my gosh.

On board with this. You can have, you can have a patient come in and they're like gung-ho, like, yes, this is, this is the program for me, Doc. I'm so excited. Nobody's ever done an exam like this before. Nobody's ever explained this problem to me before. And, and then they go home. Usually it's the wife I find. They go home and, and the husband is just like, you're going to do what? You're going to spend what? You're going to— things like that. Have you ever heard—

have you ever heard someone say, They're going to do submarine decompression. What the heck is that?

They're going to put you on the torture rock chamber.

I literally had a patient say that. I'm like, this is lost in translation. That's why you need the spouse at the ROF.

The bottom line is, yeah, spouse at ROF is huge. Having them both in agreement that this is a good plan. I've had some patients over the years where The patient was the one that was hesitant about going forward, but their spouse is sitting there listening to everything that you're explaining and saying. And literally the spouse is like, you've been complaining about this for how long? You're going to do this program, basically.

That's so true. They're tired of hearing about it.

Well, that's just it. They're the ones that have to live with this person that's in pain. on a daily basis, and they see the, the struggles. They, they see how it affects their, their work, their, their, their relationship, their love life, whatever the case might be. And, and so in some ways, that spouse many times wants the patient better, if not more, than the person themselves that are dealing with it does. So I have seen that many times.

Hmm.

But then I am conversely I've also seen where the spouse sabotages the care. In my experience, it's just one of two things. Either one, they're just not a chiropractic fan or believer at all. So one spouse is and one isn't. And/or it's finances.

Like they're never— the spouse will never do anything outside of insurance. And that's— look, that's part of the deal. I mean, it's just the reality of the situation. Some people There's no way in heck they're going to pay for anything other than what's covered by insurance, and that's okay. They are not a candidate. It's not because they're, you know, they have disqualifications due to, you know, clinical reasons. It's, you know, personal reasons. So, um, now there's obviously— we can't go deep on, you know, how to get the spouse to the report of findings, but, you know, obviously you're— when the patient is scheduled, your staff member should say, will your spouse be joining us at day 1? Ideally, they're at day 1.

Right.

So that they can be there throughout the whole consultation, the whole examination, develop the trust and rapport. And then when you schedule the day 2 ROF, you're scheduling it with both of them and get them both at the ROF. If they're not at day 1, then, hey, will your spouse be joining us at the report of findings? I feel like it's very important that they are, and then address it there. But you can't drag a spouse kicking and screaming to an ROF. So if they're not at the ROF, You know, then obviously you want to be able to have as much literature and, you know, information that you can send home to back it up. You can offer to schedule a second ROF when the spouse is available. You could schedule a phone consultation with the spouse going through the information. But by and large, you know, people usually need to check with their spouse if they are not there when they're making a Investment of $3,000, $5,000, $7,000.

And as a man and as a husband, I would say always check with your wife before you spend any money over about $100 or you're going to be in trouble. That's good, Dad. A little marital advice there.

Good marital advice there. So that's, do you have the support of your spouse? That's number 3. And then finally, when did you want to get started? So it's a timing issue. And, um, you kind of touched on this a little bit, like when you were talking about the, the farmers. And a lot of times, you know, it could be a vacation, you know, but if they're gone for like a week or 10 days, I haven't really found that that affects overall progress very much. I typically say, where are you going? Hawaii. Can I go too? You know, lighten the situation up. But great, would you like to feel better before you go? You know, we would have patients that, you know, they're going to Europe for 10 days or something like that. Would you like to feel better as you're walking along the cobblestones of Italy? Hey there, it's Dr. Vince. And if you're getting value from this episode, please make sure to hit that subscribe button so you never miss an episode. And if you know another doc who's ready to grow their practice, share this with them. It might be exactly what they need right now. Thank you in advance, and now back to the show. I mean, it's a, it's a rhetorical question. Of course they'd like to feel better. And so usually, if there's enough time, you can get in 3, 4, 5 visits, start knocking the pain level down a few notches, and, um, then they go off to their trip, they're feeling a little bit better. Um, you know, if you need to, you know, if for some reason they do regress, you need to add a few visits, you know, complimentary onto the back of the program, Big deal. You know, it's like, do what, what the patient needs. Um, but when did you want to get started? What are your thoughts on that, Kyle?

Yeah, obviously the answer you're looking for is right now.

Yeah. ASAP.

ASAP. How about right now? But usually it's, usually it's that second visit. I mean, if, if you've done a good job in leading them through a good history, good exam, good day 1, send them home with a report that answers a lot of their questions. You go through the fit, the schedule, the spouse is all on board. A large percentage of them are— they're ready. They're just— they're ready to start, you know, and then it's just a matter of, can they do it financially?

Exactly.

And, but you gotta, you gotta build these 4 questions in and get the right answers ahead of time. And if they say they're not ready to start, Well, then you have to ask, well, why? Or what haven't we answered thus far that we— that you need addressed in your mind? You know, do we need to understand— do you not understand your condition as well as we thought? Or is it the schedule? Any of the things you've covered? What is— I'm here right now. I'm the doc.

Mm-hmm.

I can answer your questions. I set aside this time for you. What question can I answer for you that hasn't been answered yet that would get them to that point where they are ready to start? And so that's, you know, a lot of times when they say no, you just gotta dig in deeper and ask more questions.

That's a beautiful point, Dr. Pankinen, because inevitably you're gonna hear, well, let me think about it, right? 100%. It's an important decision, and you need to be clear on every aspect of this. That being said, we're here right now, right? I know your case intimately. What questions or what are you not clear about so that we can address this now? Right. Sometimes, you know, I always feel like in that relationship between patient and doctor, the doctor needs to be the alpha. And what I mean by that is not a dominant, it's just they need to lead the relationship. They need to be the leader in it. They are diagnosing and recommending care. And so sometimes you need to dig a little bit, like Dr. Pankinen said, and ask some hard questions. Well, I don't know if I want to do this. Have you thought about what life would look like in 3 years if you don't address this? What happens? What happens if you don't do anything about this? You know, what's going to happen with your relationship with your grandchildren or your husband? Will you be able to garden anymore? Now, we're talking about things that should have been discussed in the consultation, like what has this condition taken away from them? You know, commonly called like a trigger, because that's, you know, everyone wants to obviously get out of pain. But the reason why they want to get out of pain is usually because they want to get back to doing something that was taken away from them. So that should be pulled up in the consultation, right? Is because, you know, we want to get— we want to fix— we want to fix patients' backs and get them out of pain. But what's really rewarding is when a patient comes in and said, I was able to play 18 holes with no pain, and they give you a hug. Like, that's what's really rewarding to me, uh, or was to me when I was in practice.

Yeah, you're basically— you're giving them their life back, their quality of life.

100%.

And I mean, I just had a patient this morning that was basically in tears because it's the first night she's been able to really sleep for like 2 weeks. Oh, and that's amazing. Yeah, so I mean, her life— you imagine how your life is when you can't— your pain is so bad you can't sleep, and now suddenly you can. That's, that's life-changing, and it's very emotional for A lot of those people. So that's the, that's the stuff you got to get at. And the other question I see that comes up is, oh, I'll say to them is, well, some people think, well, I'll just wait a little longer. I just got to think about it. It's like, well, this condition's been there for 6 months, 3 months, a year, 2 years. I always say if, if the body was going to heal it on its own or these other things you've tried were going to work, they would have by now. Because some people, especially guys, think, oh, it will go away. I just give it more time, it will go away. And, you know, 6 months, a year, 2 years, 3 years goes by and it still has not gone away. And it is like, well, when do you think it is really going to go away if it has not by now? And so, those are things, common things that you will see. And eventually, you just got to move them to, okay, are you in with this or not? Yeah, you got to come to that. You got to come to that point.

Yeah. And I like just to get, hey, it's a yes or no, we're going to move forward or no, we're not going to move forward. I don't think it serves anybody to sit on the fence. You know, let me think about this for a few weeks. I mean, here's what I would recommend. How about we schedule an appointment in 3 days? That gives you time to think, speak with your spouse about it. Can come back in. You know what, I'll even— we can do even a little test drive. You can get on the machine, get a laser visit, but let's make a decision at that point. And it's either less— yes, we're going to move forward, or no, we're not. Uh, you know, we're a busy office. You can see, you know, we just want to— we want to work with patients that this is something they really want to do. If that's not you, no problem. But if it is, then let's get going. So, being that You know, having that kind of, um, very forward, just kind of laying the chips on the table. Hey, it's a yes or a no. It's like, you know, it's like they will respect your time more. Um, I mean, if you don't respect your time, they're not going to respect your time. But I, I like just, look, it's a yes or no. Let's just— let's either move forward or, you know, then you go your way, I go mine. Um, uh, and I don't think there's anything wrong with just being upfront and honest with patients. You're a busy doctor, most likely, and If they're not going to get help, then there's someone else that can and wants to get help. So, you know, you want to clear out the space so that the right people can come into your office. So, that is pre-framing the close, 4 questions to ask before talking finances. Dr. Pankin, any last thoughts on that?

Final thought I have is one way that I've overcome a lot of objections even before they come in for the second, and I've mentioned this before, but if you have a really good report that explains In this case, say I have a report called Dr. Pankinen's Guide to Chronic Neck and Back Pain. It explains disc conditions in detail. It explains kind of some of the medical treatments, but then it explains our protocol in detail. And it has a page of frequently asked questions and answers. In other words, does insurance cover this? How much, how many visits? How long does it take? What are my odds of success? Things like that. It pretty much, it answers a lot of their questions up front. In other words, I, at the end of a day one, if I have a decompression candidate, I say, Mrs. Jones, take this home. If their spouse is not there, you sit down with your spouse and you read this very slowly, word for word, every word of it I want you to read in detail. And I say, this will answer the majority of the questions that you guys are going to have. And if they come in for day 2, I know they're pretty serious already about it because they, they have a pretty good grasp on what I'm going to be expecting of them and what this protocol plan is. And so when it comes to this, the second visit report of findings, it's, it's a lot. It reduces the redundancy of what are we all going to do with this program and what How many visits is it? All that stuff. You've already had all that answered, and you can just cut to the chase, do these 4 Horsemen type things, and then go to the finances. And it saves, in my experience, a lot of time on the report of findings. And I know Dr. Leone and I have bantered back and forth about this, but I actually put in my report basically what the rough cost of the program is. And I know he doesn't necessarily agree with that, but you can do whatever you want. It's a little more bold and upfront. We just put it right in there. So, when they come in for that second visit in my office, they already pretty well roughly know about what it's going to cost them.

I'm warming up to that idea, honestly, Doc. I've thought about this a lot. And, you know, to me, it's making more and more sense to You know, give them an idea of what the investment's going to be. There's no beating around the bush. It's, you know, saving the doctor time on the day too. Look, if they read— and I love, I love your verbiage on that— read it word for word, right? That's being an alpha. Again, not alpha dominant, alpha leader, right?

Mm-hmm.

Read it word for word. Why? Because it's important. This is your life. This is your health. This is what we're going to do to fix it. And it's all in here. So I need you to read this really carefully with your spouse. And then if they don't come back for the day 2, big deal. It's like saves you an hour, saves them an hour, and then again opens up your schedule for those people that are the right fit for your clinic, right? So I, I, um, and very much warming up to that idea. I think it's a confidence thing, and I think it's a volume thing. Um, you know, if you are lower volume, in other words, you're not seeing very many decompression patients, you need to get as many ROFs in front of you as possible so that you can increase your communication skill sets and explaining what and how you are going to solve the problem. For Dr. Pankinen, because he's more advanced, he— his time is the priority, right?

Right.

So he doesn't want to sit in front of people that there's no way in heck that they can or would be able to afford care, right? So, I think you kind of got to earn the ability to put that in a report, what the price is, what the investment is. But when you get to that level, I think it makes a lot of sense.

I knew you'd come over to my old residence. I love it.

And that's a great way to end. So, thank you all for listening today. Appreciate all of you. If you got value out of this, please share it with a colleague. You know, we'd love to have as many, uh, doctors in our industry. We are chiropractic-specific, and we'd like as many doctors getting value out of this. So, Dr. Pankinen, thank you for your time today, and we'll see you all on the next episode. Take care. Hey, it's Dr. Vince again, and hope you enjoyed that episode. And if you're ready to grow your practice fast 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 to www.decompressionaccelerator.com to learn more.