The Decompression Flywheel

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.

Hey, welcome to the video. Dr. Vince Leone here, and I think you're going to really like this training today. It's called the Decompression Flywheel: How to Find the Bottleneck in Your Decompression Growth. And this is really for the doctors who are actively, you know, obviously offering decompression and wanting to grow decompression. So this wouldn't really be for the, you know, the docs that are, you know, just thinking about getting into decompression because there's, there's more important things to focus on at that stage. So this is for the doctors that are actively offering decompression and looking to grow but not doing it right. They're not growing as fast as they want or getting as many new patients as they want. And Or getting the results right. So this is how to find the bottleneck and just focus there. Because most doctors who struggle to grow with decompression, they assume they have a lead problem, and maybe they do. You know, maybe they do. Hey, we don't know. But many times, the bottleneck is elsewhere, right? It could be that the leads are coming in, but they're not scheduling, or consults are booked, but they don't show. Patients show, but the ROF doesn't convert. You get the You get the idea, right? There's all these different kind of stages of the patient journey where, um, uh, you know, when optimized, the, the niche will grow. Um, but this is why we use the decompression flywheel. It gives you a simple way to look at the entire system and ask, where is the bottleneck right now? Because I understand, you know, you're running a business, you probably have a family, you're managing team, you probably want to do things outside, you know, whether it's hobbies outside the practice, whether it's hobbies, etc. So we don't have all the time in the world, you know. So what we want to do is optimize our time and really find what is the one thing that if I fix that, um, then I will go to the next level in my practice with decompression. So let's go ahead and dive in. Number 1 is measure. So we have to know where we're at in order to grow from there. Okay, so if you don't know where you're at, You know, and you don't have a target, it's like, how do you expect to grow? So we have to know the basic numbers. And I— trust me, I've been coaching since 2018. Um, and, uh, so this is a weak point for chiropractors, like bar none. Um, now, are there exceptions?

100%.

Um, Dr. Pankin is a great, great, uh, exception to this rule. He, from the moment we started coaching together, he He knew his numbers, but, but he is the exception, not the norm. Uh, most doctors don't have them. That's okay, right? But, but what I would venture to tell or advise you, right, coach you, know your numbers, at least the basics. Every single month, how many leads did you have? And that could be referral leads, Facebook leads, Google leads, whatever. How many leads, you know? Um, found out about your practice, found out about decompression, and was interested, right? Then how many consults were scheduled? How many showed? How many starts? How much revenue? And then what was your cost per start if you're running paid ads? What was your cost per start? So without measuring and without knowing your numbers, everything else is just— it's a guessing game, right? And so a doctor may think like the ads are bad when the real issue is that say the consults aren't showing up or he's not converting. So write this down. If you don't know, know your numbers, you don't know your bottleneck, right? So if you're not measuring, this is where you start, is know your numbers so you know what to fix there. Next, now diagnose once you have the numbers. And what I would recommend is get 90 days of numbers. Because, you know, look, in practice we're up, we're down, um, and it's like the stock market. As long as it's going up and to the right, that's— it's all good. But regardless, it's not going to be a straight line across the board. It's not going to be a straight line up into the right. We're going to be a little up, we're going to be a little down. That's okay. But take 90 days and get those numbers. Um, but once you do, now you can start to diagnose the biggest bottleneck. It could be, it could be not enough leads, right? Literally could be that. Um, could be a low booking rate. In other words, not able to schedule, uh, not able to reach the leads, uh, or a low show rate, right? You know, are they, are they paying for the, uh, evaluation on the phone? Are they doing the no-show, no-call fee script? What? Um, weak ROF, poor follow-up. Maybe the staff isn't promoting decompression, so we're not getting any referrals, limited capacity, etc. So the key is to avoid jumping to conclusions. Um, because for example, if you have leads but no consults, that is different from having consults but no starts. Okay, so don't fix everything. Find the constraint and then fix that first. Okay, so that's 2. Number 2 on the flywheel is diagnose. Now next, train. So once you know what the bottleneck is, now the team needs to be equipped Equipped to help fix it. Okay, so it could be phone scripts. In other words, if this— if the, uh, lead to consult booked is low, and I would say less than 75%, um, if that's low, then you need to work on the phone. Now that's a little bit different. Like, in other words, if someone's calling you, you— 7, 7, 8 times out of 10, you should schedule them. 100%. Now, if it's you're getting leads from an agency and you're calling them, that's different. That's usually like in the 20 to 30% book rate. Um, and, uh, so anyways, training, right? Um, it could be training on internal marketing, it could train on follow-up scripts, could be clear team roles, patient communication, etc. Um, a lot of doctors, um, frequently asked questions, it's another huge one, or Do they know what the heck spinal decompression does? Like, in other words, A to Z, do they understand chronic back pain, what decompression does, what does laser do, what does shockwave do? If you want a true staff-driven practice, then your team needs to be an extension of you. So obviously a lot of doctors understand decompression, but the team may not know how to explain it, may not be able to answer those frequently asked questions. How long is it going to take till I get better? What happens, you know, what is this table actually doing? What happens if I get worse? Like all these questions, does insurance cover it? How much is it gonna be? How much per visit? All those questions. If they have to run to you every time, it's gonna weaken the confidence of the patient and waste a bunch of time. So it'll fall back on you. So key for success in the decompression niche is having a really strong team.

Yeah.

And really, An optimized decompression program should be staff-driven, not doctor-dependent. So that's number 3, training your team. So next, number 4 is optimize. Now we want to optimize, and this is where we're going to optimize the front or improve the front end of the growth system. In other words, who or what is generating the leads? So this could be ads, funnels, landing pages, could be the creatives, you know. What type of videos are you creating for your ads? What type of offer are you putting out there for patients to come in? Could be the follow-up. You know, the old saying is the fortune is in the follow-up. So I recently read a study about 50 to 60% of revenue oftentimes comes after the 5th touchpoint. Now that may sound crazy, You know, oh my gosh, is my team really going to follow up with leads, you know, 5, 6, 7 times? I mean, let's not fight the data, right? I mean, if you're not gonna have the team do it, hire someone to do it, get AI to do it. Like, but someone should be following up with people that have expressed interest, um, really indefinitely. If you use AI, I mean, why not just set it and forget it? I mean, Are you, are you going to piss off a couple of people? Yeah, maybe. But look, what are they going to do, like go tear you down on social media because you followed up and asked and continued to ask them if they were interested in helping their back pain? I don't think so. So the point being is we need to optimize where the leads are coming from. And so if leads are too— for example, if leads are too expensive, In other words, like, you know, if they're at a KPI, you know, maybe they're greater than $20 to $30 if you're running Facebook ads. Well, you need to look at the ad itself, like the creatives. Now what's working really well right now are educational creatives, right? Doctor in front of camera using some AI, right? With some cool, you know, video or imagery with it. You could look at the offer. If you're charging, you know, whatever, $149 on Facebook, Yeah, your cost per lead is going to be really high. If leads aren't booking, well, now we need to improve our follow-up process and the scheduling. And this is why, you know, training your front desk is so important. I mean, they, they're a true extension of you. They're often— oftentimes the first impression patients have of your practice. They need to be a rock star on the phone. If people book but don't show up, well, now we need to you know, improve— we kind of talked about that a little bit— the confirmation process. Maybe we get prepays, maybe we have a no-show, no-call fee instituted, etc. But we need to optimize where the data says people are dropping off. Okay, so moving on, number 5. Now we're going to activate. 5th stage is activate. Okay, this is about creating demand from inside the practice. Okay, so if you're going to try to just you know, run paid media, trust me, I've done it. It gets really expensive. Can it work? 100%. Is it very expensive and a little bit stressful? And on top of that, um, put you a little bit— I mean, in other words, if you're gonna, if you're gonna go all in like we did— TV, radio, newspaper, digital— uh, we invested about $15,000 to $20,000 a month in ads. So, um, was it profitable? Yes. But if you're not tracking that stuff super tightly, and, you know, we had the bandwidth to do that because we had the team. But if you don't, you need to internally market in addition, because what that's going to do is it's going to— or sorry, decrease your CAC, your cost to acquire a client or a customer. You could say cost to acquire a patient, like whatever you want to call it. CAC is the is the kind of a general term, cost to acquire a customer. And so for instance, say you're running Facebook ads and your acquisition cost is, say, $700 per start. Well, if you're able to, you know, get just as many internally from internal sources for free, basically referrals, etc., um, it's gonna— is, uh, in essence cuts your overall CAC down in half. Do you know what I'm saying? So you got to look at internal strategies like tapping into your current patients for referrals, or at least letting them know about the service that you offer. Some patients will just come in, they're just coming in forever. Oh, I just come in to get, you know, my monthly adjustment. They may not know that you offer decompression. Past patients, right? Past patients that haven't been in a while. Are you doing email marketing? Are you doing some type of referral campaign? Are you reaching out to them on a regular basis? Like, are you doing patient appreciation events? Like, All that kind of traditional stuff that always actually still works. You just may have stopped doing it. Old leads.

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. Old leads. I mean, if you've been running Facebook ads for a long time, you have tons of old leads. Go back again. You should already be continuing to follow up with them, but you may do some type of, you know, a campaign around an event, whether it's a holiday, etc. Referrals. We talked about this. Reactivations, maintenance plans. Anyways, a lot of practices rely almost entirely on cold external marketing. The big one. Paid marketing. But you're— the people that already know, like, and trust you, what I call our 3 assets, those are the patients under care, the new patient flow each month, and then the past patient base. So your 3 assets, they already know you, they already trust you, right? Know, like, and trust. So main point here, your existing patient base should become a growth channel. Okay, so 6 now is convert. Okay, this is your patient systems, patient processing systems. So we're looking at the consultation, we're looking at the exam, ROF obviously, the close, objection handling. And a lot of doctors are looking for some silver bullet in the ROF. And, um, now, is communication, uh, very important in the ROF? Absolutely. You know, you have to, um, demonstrate or create value in the patient's eyes for what they're doing. But in the consultation, if you don't, if you don't figure out like what they're trying to achieve, I mean, like no one's going to go— they don't want to buy decompression visits. What they want is their life back. They want to be able to sleep through the night or, you know, play with their grandkids or, you know, work without pain or, you know, play 18 holes of golf without being in pain, etc.

Right.

They're buying the transformation. Okay, so we need to figure out what that is in the consultation. Then we need to do a world-class exam to demonstrate that you're an expert. So that is all— that is your patient process, um, and leading up to the ROF, right? Um, but if conversion is weak, more leads won't fix that problem. In fact, it'll cause more frustration because then you're going to see all this opportunity loss and then the The advertising numbers mounting up, I get it. So you'll just create more consults that don't start. Anyways, write this down. Conversion comes from clarity and confidence, okay? So this goes both ways, by the way. Confidence starts with you. Hey, I've evaluated this patient. I'm excellent at what I do in terms of my evaluation process and my exam skills. I know I can help this patient. That confidence is then transferred to the patient, right? The clarity comes from the step-by-step explaining what exactly decompression is, does, and is different, and how it's going to help them achieve that outcome, right? So clarity and confidence for the patient ultimately. All right, next, moving on, elevate. So now improving the clinical side. Right. Do you have a strong protocol? And we talked about this a little bit, right, in terms of the exam patient selection. Are you choosing the right patients for spinal decompression? You know, are you choosing the right protocols? You know, are you putting everyone on the same protocol, or do you have some truncated ones for less complex cases? Decompression is extremely helpful for lots of different conditions, and it's You know, the research is coming out to support that. Expectations in the ROF. Are you setting the correct expectations? Not, you know, not overpromising, underdelivering. We did a whole nother podcast on that. Progress checks, right? Progress checks when patients are doing well, great time to ask for referrals, you know, generate some referrals, get testimonials and reviews, et cetera. And then obviously outcomes. So, This is really what separates doctors who own a decompression table from doctors who become known as a specialist. Okay, so the better the clinical process, you know, the better the exam, ROF, patient experience, the better the outcomes become. So key here, clinical confidence drives patient confidence. Next is when, and we're getting to the end here. So now it's when You can see the sunlight coming in my window here. We like sunlight in the Northwest. It rains a lot here. But anyways, 8 stages win, okay? This is where you wanna capture the proof. Capture the proof, get it on camera. Do the whiteboard testimonials, get videos of the patients talking about their experience. Ask them to do a Google review. You should have a QR code on a little sign, a little plastic sign all over the office so patients can shoot that with their phone and write a review very quickly. Case studies, all this stuff, it can be used in marketing, can be used on the website. In other words, marketing, like you can run these as paid ads. You can use it on your website. You should have one page just of patient stories. Um, but you know, a lot of good clinics will get great results, but they'll miss this.

Right.

And because here's what this does. Not only can you use it in the marketing and all that for like outside social proof, and, and the— and this is too true— proof creates belief. But also what it does, it fortifies yourself and your team. In other words, sometimes as doctors, we almost become a little immune to like the outcomes. But when we actually see people on camera like share their stories and sometimes they're crying and, oh my gosh, you saved my mom's life and all this type of stuff. And the team and what the team gets out of that, that can be huge, huge morale booster, right? And really keep you guys on track. 'Cause inevitably, right, we can have some dips. And then finally scale, right? Final stage is scale. So once the flywheel's working, now you expand what's working. So in other words, you may look at more capacity, you may need another table, you may look at, You know, are we optimizing our schedule? Do we need another team member so that we can serve more patients? Do we need to look at increasing our pricing so we become more profitable? Do we need to put more money into marketing? I mean, if your CAC is like $400 or $500, I mean, you know, and your care plan's $4,000 to $5,000, that's a 10x ROAS. So that's hammer downtime, right? Put more money into marketing. So all of that, right? Is now you're in the scale mode because you've fixed the bottlenecks. Then you're going to lean in, push it up, and inevitably you'll get another bottleneck, right? Because I've found every $20,000 to $30,000 in increase in monthly revenue— call it $25,000— every $25,000 in increased monthly revenue, you will hit a new bottleneck of some sort. It could be equipment, it could be marketing, it could be team, but you'll hit something that you'll need to then fix that. So that's part of— that's just growth, right? You're having— you're, you're, you're growing, you get better at some things, you fix some things, and then boom, you hit another kind of ceiling. Figure out what the new bottleneck is. Boom, breakthrough. Now you go to the next level. So that's what scale looks like. And so the main point here is scale the system once the system is stable. Right. So in other words, like, don't try to like pour a bunch of money into ads if you can't close or you can't do an exam or you don't have the team to support you. Right. And again, you just have to go through this whole flywheel and figure out where is my bottleneck. So how do you use this flywheel? Well, simplest way, right? Just go stage by stage. Hey, are we measuring? First of all, are we measuring numbers? That's the first thing. And then are we measuring the right numbers? Based on that, do we know what the actual bottleneck is? How trained is our team? How often are you doing training? Are you doing training? Are you meeting regularly? Are you meeting at least once a week? Are the ads, the funnel, and the follow-up improving? Are we tapping our 3 assets that we talked about? Are we converting qualified patients into starts? Can you close, doc? Are we improving the clinical process? Are you becoming the true specialist? You know, I mean, only you can answer that. Are we capturing the proof so that we can boost morale and use it in social media advertising, et cetera? And then are we ready to scale? Are we ready to make that next jump, next $25K a month in rev? And then You know, until we hit that next bottleneck. So usually 1 or 2 stages are creating most of the drag. That's where you're going to focus first. But again, just 1, just focus on 1. Now, common bottleneck examples, and then we'll wrap it up. If leads are low, look at the optimize and activate stage. If leads are coming in but consults are low, look at train and optimize. If consults are booked but patients aren't showing, look at the confirmation, pre-education. You know, are you sending out webinars, reports, etc., prior to patients even coming in? If patients show but don't start, look in the mirror. I'm joking. But look at, look at convert, right? If patients start but outcomes are inconsistent, ooh, look at elevate. And then if patients get results but growth still feels slow, look at win and scale. Right? So just to close, decompression growth, it's not typically one thing. It's not just buying a table. It's not just running ads. It's not just having a good ROF or getting better clinically. It's really all those things working together and synergistically spinning and growing the flywheel. When I first heard this concept, it was really around Amazon, right? So people would buy products, which would expand the number of sellers, which allowed Amazon to expand their distribution. Which would then get faster delivery times, which created happier customers who bought more stuff because now there's more sellers. You know what I'm saying? So it just got the— in other words, the more it spun, the better it got. And so same concept here. If we can get these things optimized, the more it spins, the better it gets, and the, the more you can actually pull yourself out of the day-to-day. Whereas with the traditional chiropractic, Chiropractic practice. The more that wheel spins, the more your body breaks down, the less time you have with patients, the more kind of a mill it is because you got to get patients in and out, the more of a grind it is because it's all through insurance, or most of it's through insurance. So that's, that's a negative flywheel in my opinion. Okay, in my opinion. But with decompression, it can be a positive flywheel if we focus on this. So if you want more information about this, you can always check out the Decompression Accelerator. This is exactly how we work with our doctors, right? It's just, you know, follow these different waypoints. Where are they having the bottlenecks? Help them fix those bottlenecks and go to the next stage. So you can watch that free training at decompressionaccelerator.com. Here's another look at the flywheel. I hope this was helpful for you. Go ahead and dive in, figure out your bottleneck, and get to the next level. I hope you— wish you You know, all the best. Go help some people, uh, grow your practice, make more money, uh, you know, create a better life for yourself and your family. Um, it's all on the other side of optimizing this flywheel with high-ticket niches, and in particular spinal decompression. We'll see you on the next video. 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 to www.decompressionaccelerator.com to learn more.