Optimizing Your First Chiropractic Visit: Key Strategies for New Patient Retention

That is the easiest way to get control of your schedule. Because if you're just scheduling people and you don't make them jump through a little bit of a hoop, they may not show up. And then your office ends up booking the schedule a little tighter and then all of a sudden you get all these people that show up and it's chaos.

Well, today I am super happy to talk about a topic I think all chiropractors need to really dial in in their practice. And that is the first visit doc. I appreciate you coming on to chat about this. I know it's an area you spent a ton of time personally. And for the docs out there who might not even know. How do you exactly define a first visit in a practice? I'll have you pick it up right there, if you don't mind.

Yeah, well, like the first visit actually starts from when they scheduled that visit. So it's everything that happens before the first visit and then it's the actual first visit. So like you call it a day zero and a day one or everything that happens before that day one. So it's just, it's a process and you just gotta follow it. And we figured it out trial and error. Like had a busy phys med office for years. To feed the machine, we had to have no less than 100 new patients a month, but most months were 120 to 160. So we had a lot of practice at streamlining that first visit and just making it as efficient and productive as possible.

I think that's so important. And when a doc starts to think about that or when I think about my first visit, it's a lot of times I think it can be a haberdashery. Right. There's not really those systems and processes that docs have in place that they need to have in place to be as successful as possible. How would you define some of those critical steps that really have to happen in what you'd call a first visit?

Well, when they're scheduling, you got to meet people where they're at. So like some of the people that are more tech savvy, if you have like those millennials or younger people, they may just want to book online. So just have an option where you can book online on your website or at least request an appointment online. If you have a lot of different kinds of providers and you don't want to just let people book, at least allow them to request the time. And then the other thing is a lot of people call on the phone and you have to pick up the phone and pick up the phone, and if they leave a voicemail, call them back. But you just got to pick up the phone and, you know, just a standard greeting. Hey, this is Dr. So and so's office. This is Morgan. How may I help you? Or something like that. Just be friendly when you pick up the phone. Don't act like you're annoyed when they call. Right. They're in pain. They. They want good customer service. So, like, that's gonna be the first part. You gotta meet people where they're at and just make that scheduling process really easy.

I love that. And when you talk about picking up the phone, is there, like, is. Is there a magic number? I mean, should you try to be. I mean, as quickly as possible. Is this something where two to three rings. Is there an optimal way to really pick up and answer that phone in terms of timing?

So we have voiceover IP interface, office. And then the way it has, it's got like that little ring tree. So the front desk, it's. I think they get the first two rings, and after that, on the third ring, it goes to other people. So we have kind of like an outside billing staff out of the office, and they get it on third or fourth ring. But, like, you just got to pick it up. Like these voiceover IP phones, they're actually cheaper than regular phones. So if you guys don't have them, you should really get them. And it just allows you to answer the phone. So, like, your backup staff doesn't have to count the rings. They just know. The office manager knows that when it actually rings on her desk, it's time for her to pick it up.

Gotcha. And how do you define, like, if I'm sitting out there saying, man, this sounds technical already, how would you define a voice over ip? What's the difference between that and a regular phone line?

Oh, sorry. It's just. It runs off your Internet. So there's a lot of different services out there. And there's the old school analog thing that runs on the actual phone lines, and then there's the newer phones that run off the Internet. You just put like this little. It looks like a phone in your office, but instead of a phone line going into it, it's an Internet line that goes into it.

That sounds like it gives you a ton more options and can be super dynamic in terms of. I think you were talking about call routing and things like that. Is that correct?

Yeah. And you don't have to be technical. Like, when you sign up for one of These services, a lot of times you have there's like a local guy in our area. We just tell him what we want and then he just programs. You don't have to know anything.

You nice.

Tell me why that's awesome.

So when you think about, okay, so that call is made, it comes in, you pick up, front desk is happy and excited. You get the person kind of scheduled for that first visit. How do you define what's the goal of really that first visit, as a doc should think about it, is it, you know, getting somebody started with a care plan is the ideal goal, to have them understand more about what's going. How do you define in your practice and with your experience? What's the goal of that first visit? What are those checkboxes that you want to ensure the entire team is hitting along that journey?

The goal of the first visit is for the patient to have trust in the office, to feel like you actually understand their problem. Do you care about me? Can you help me? How long will it take? What will it involve? How much will it cost? Like, you're not going to get all of that, but, like, that's going to be the first visit is really like, to build trust. But like, getting back to that scheduling part, the goal of that first phone call or interaction is to get. Get an appointment. So another issue that I find that people mess up on that first visit is just on that first phone call, they answer too many questions. So when the patient calls and they're asking you questions and you're answering, that means that they're in the driver's seat and you're not in the driver's seat. So the goal of that first appointment is to get very clear. Like a lot of times, like with clients, like, I'll have. We'll just do, you know, call their offices and just see how they're doing. And they're getting into deductibles insurance.

That sounds like a scary proposition.

What ends up happening is the patient gets confused. And rather than saying, I don't understand what the heck you're talking about, they don't want to be embarrassed and say, well, let me just check my calendar and get back to you. Which is a polite way of saying, I don't want to go here, and they're going to just call another office. So the goal of that first phone call, that first interaction is to just get an appointment. Just be very clear, keep it really simple. You could just say, we accept a wide variety of insurances. We do a free insurance verification. Your first consultation is complimentary, and we'll let you know what your benefits are, what's best for you, or what day of the week is best for you, what time is best for you, mornings or afternoons. But, like, when you ask them a question, you want to just give them like one or two or maybe maximum three options. But if you give them too many options, they're not going to make a decision. And then the goal of the first visit is just to really not screw it up, Give them that wow experience.

But let's talk about that phone call a little bit, because you brought up a key point that I think is interesting. If I felt as though a team member or maybe even myself, let's say I feel like I'm getting pulled down that rabbit hole by somebody on the phone, what would maybe be a tip or two that you'd offer? So how somebody can sort of redirect or reframe or gain control.

You just said it like pattern interrupt. So the easiest way to knock them off their feet is to just ask questions. They'll just say, hey, what kind of insurance do you have? It's like, can I get your name and number in case we get disconnected? It's like, can I find out what you're coming in for so we can figure out if this is something we can help you with? Oh, you had sciatica. How long have you had that? What have you tried? Oh, and it's like, well, we could get you in right away. We have a morning or afternoon tomorrow. What's better for you? But like, you just when they ask a question, if you ask a question back, they usually forget what their actual question was.

And when somebody comes in and they're start. You're starting that in person. So you get them scheduled. You've done a good job sort of, you know, adequately guiding that patient through that initial conversation. You got them on the books. They're coming in for that visit. What's maybe the biggest mistake or two you see docs making during that first visit, during that first patient interaction?

Well, like I was going to even get a step before that. So Rand is like a research group, and they went through and looked at all these different complaints that people have with the medical industry. And all I did is I looked at, like some of the complaints, the most common complaints and what you could do. And one of the biggest complaints is waiting too long and then feeling unheard and not getting enough time with the doctor. Those are some of the top three complaints that come up over and over again. So waiting too Long. You got to realize that if the patient comes in and you give them 40 minutes of paperwork to fill out, and then they go sit in a room and wait there for 10, 10 minutes, already sitting there by themselves, they're already frustrated before you even walked in the room. So you have a big uphill battle. So what we always do is we send them their paperwork online. I remember before, like we had a ton of technology with some of the old people. If they booked out, we'd actually mail them their paperwork way back in the day. But now you can send them an online form, they fill it out and it automatically pulls in. Your software automatically is sent to you. And what a lot of people don't realize that if someone sits in your office and fills out paperwork for 30 minutes and then they have a one hour appointment with you, they are classifying that as a 90 minute appointment. And then when you tell them to come in three times a week for a month, two months or three months or whatever your treatment style is, they're thinking, I'm coming here for 90 minutes plus drive time three times a week. And it's an instant no. So, like, that is a big mistake that I see a lot of people make. And then another thing is people don't have an organized schedule. Sometimes they're booking all these Facebook leads that a bunch of people don't show. Then all of a sudden you have a string of all these double booked people that have all shown up, and now you're running behind schedule and you're just rushing that office appointment and they're feeling like it's unheard. So there's a lot of things that get screwed up. But one of the easiest way to make them feel heard is to read the chart before you walk in the room so you understand what their actual chief complaint is. And then we know that a lot of people, when they call shoulder pain, it's not actually shoulder pain. They're referring to like upper trap, levator, scap, referred pain from like facets or something like that in the cervical spine. And if you think that this is the shoulder, they're referring to this as a shoulder like their upper back. They're not on. You're not on the same page. So one of the first things our case manager does is can you point to where it hurts, find out, like, what makes it hurt, but like making them feel heard. So even though they wrote it down on their chart, if you ask them a couple of questions based on their responses on their paperwork, they feel like they've been hurt. And it's. If you take a good history, then it's easy to come up with a good diagnosis and treatment plan. So that's like a big critical step rather than going off on this big soapbox speech.

I like that and I like how you brought up some about kind of controlling and managing the schedule and how do you think about scheduling with your team? How do you go about booking in an effective and efficient manner? What are some, maybe some tips docs can take away as they sort of outline their schedule so it's not just sheer chaos Monday through Friday.

So we're pretty quick. So, like, we book them on 30 minutes and we have a little over 90% of our new patients show, even ones from Facebook. And the 8% that don't show, they call and they reschedule. And the easiest way to solve this problem is we will take a tentative appointment when people schedule it. But we let them know that, you know, you got 24 hours. Here's a paperwork. Obviously, if they're older, elderly, and they say that they can't fill it out and they need to come in the office, we give them an exception. But like we say, here's a paperwork link, reply back, letting us know that you've received it and you know, you got 24 hours to fill it out. Otherwise we're going to just give this appointment slot away. And if that person does show up to their appointment, they didn't call, they didn't like, because, like, we've called them two or three times to remind them to fill out their paperwork. There's auto texting and email with links to remind them to fill out their paperwork. So if they show up and someone else is showing up, the other person has to wait the person that did not fill out their paperwork in advance. And that does happen. And it's pretty rare that you have someone throw a fit because we've given them multiple calls, we've texted, we've emailed them, and they understand that they did not do what they were supposed to do. So that is the easiest way to get control of your schedule. Because, like, if you're just scheduling people and you don't make them jump through a little bit of a hoop, what ends up happening is they may not show up and then your office ends up booking the schedule a little tighter. And then all of a sudden you get all these people that show up and it's chaos. Right.

I like having the patient have a little skin in the game, I guess you could say, or, you know, go through A little bit of a process. So you know, they're bought into that appoint as opposed to, as you said, when they, when they haven't done anything, when the more, the less that they've done, the more connected to the office they feel and the less likely they are really to follow what you'd like them to follow. And as we dive into patient gets, their schedule's looking good. What are some of those other critical steps during that first visit that you think docs should know about?

Well, like getting back into the waiting. So when the person comes in the office, we already have their paperwork, we greet them by name, right, Greet them by name. We say come over here, sign in. Your sign in is your cell phone number. Walk them through that process. You know, they're new in the office. And then we take their picture and then they don't sit down, we bring them over and get their vitals taken right away. And then they go into a room and they watch a four minute video that describes what's going to happen on that first visit. And we actually, before they even arrive to the office, there's a video that's automatically sent to them with me giving them a tour of the office and what to expect. Because if someone's never been to a chiropractor's office before, they don't know what to expect. So now there's, even though I may not, I'm not seeing them. It's an introduction from me. Welcome into the office, walking through the process, you're going to come in here, you're going to put in your cell phone. So we let them know what to expect. And even if they didn't watch that video, they watch another video that describes what's going to happen on that first visit.

Describe the power and importance of those two videos. Why are those so important and how have you seen that really transform your patient experience?

In the videos, like I talk about, like where to park in the parking lot, you know, directions to get to the office, we give them directions automatically. Like they're not flustered, they're not lost. Like when they pull into the medical complex where we're in, like they know exactly where our building is, they know exactly where to park. And when they come in, there's no surprises. So they're in pain. So when someone's in pain and they come to the office and they've been running behind, now they're stressed out, it changes the whole dynamic. Now they come in, they're not late, they know what to expect and then they're sitting in a room that describes what their first visit is. And then we have a case manager go in. So a lot of the docs you're running around treating patients and it's fine. So like if you're kind of like more of a low overhead practice and you're the doc that does the exams, the history, the rof, the day to and all the treatments, like it's, it's a little hectic. So what we do is we actually have a case manager that, you know, they're not running around treating patients and they could go in and see that patient immediately after they've finished watching that video. They take a nice relaxed history, finding out what their problem is, finding out what they've tried, finding out their pain points, finding out what their goal is, why that's important to them. And then they message the doctor and the doctor just has to come in and maybe ask like one or two key questions to kind of help form their diagnosis, maybe do their exam and then take their X rays and just very clearly point out what the problem is and describe what they're going to do for treatment. But it's not rushed, so the patient doesn't feel rushed even though it's in less time than a lot of doctors first visit.

I love that. And it reminds me to some of when I was in a couple multidisciplinary and interdisciplinary practices, really having a medical assistant with me that was able to go in as your case managers do and gather that information became so critically important to my process and ultimately to the patient experience. Was that a difficult training? I know a lot of docs out there maybe don't have that going on in their practice and was adding on that case manager, obviously there's an expense associated with that, et cetera. How did you finagle that? You know, how long did it take you to think about it? How long have you been using a case manager and what do you see as those primary benefits of them being able to get in and do that work for you?

Since like 2014 maybe. I've been doing that. I would say it's a very good thing and you don't have to run out and get a case manager. If you just had a CA go in and get the preliminary information, like I don't want people to run out and thinking that they have to get a case manager. Like if you just scheduled a little bit more efficient or like if you just knew if those new patients were going to show up, you wouldn't have to cluster books. I Don't want people to feel like they have to run out and get a case manager to kind of make it work. If you just had the people fill out their paperwork ahead of time so you knew that they were going to show up and they didn't have to wait for like 30 to 45 minutes. Plus, like I remember sometimes when we had people fill out paperwork and you know, we give them. Our paperwork is an extensive. We figure it's 20 minutes and then some people are reading like every single line on like the, you know, on the patient privacy agreement, like HIPAA and stuff. It's like you've never ever seen a doctor before and they want to see like every single document, they want to get copies. So something that should be 15 to 20 minutes is now taking an hour. So like, if you just made that day zero point, a little bit more efficient, then you're not going to have to run out and do that. And then if you had a CA that just went in there and just made sure that all that preliminary stuff was there, you had their X rays pulled up, their MRIs pulled up, all that stuff shaves off time. So when the doctor walks in, if they have an MRI on a disc, it's pulled up, the reports are pulled out, everything is already done. And the doc just loves it because the whole history is pretty much done for them. And you could just give them some.

Questions to ask the patient that is impactful and important. And again, I remember, you know, when I practice in practice, having a medical assistant and part of my team do that, it enabled me to go in and ask a few qualifying questions and just be so more efficient, so more effective with the time that I had with the patient. So after that handoff takes place, you know, in your practice goes from case manager to doc. What are some of those things that a doc should be looking for? As they go through their process during.

That first day, they want the patient to feel like they've been heard. So usually what the case manager is going to do is like, hey, this is Mrs. Jones. She's coming in with upper back pain, upper back and neck pain. She's done an epidural like two months ago didn't last. She's been doing physical therapy. So even though they could read that in a note, they like seeing that little handout that happens right there. So it's just like a quick little 1 minute handoff and then the doc again, I just still say, hey, can you point exactly where it hurts? And you just say, okay, can you look up does that make it feel better or worse? And you get like traction in the head right here. Does it make it feel better or worse? Oh, that makes it feel better. Then you do like one or two tests. We're going to take a couple of pictures to see exactly what's going on. Take their pictures and it's like, okay, you point right here and this is where the problem is. And a lot of people, when they go over those X rays, they get into all the details. I remember some of the people might cringe when they hear this, but like the guy that I learned from that I was one of my mentors when I was a student, I wanted to go work for him for a year. And he says, patients don't care how much you know, they just care how much you care about them. And it's like they have no idea. So he's like, watch this. I'm going to put the cervical X rays upside down. They're not even going to know. I'm going to point and then I'm going to get them to commit to care. And he just like he went in there, put the cervicals up clearly upside down, just pointed, this is where the problem is, and then just went over what he was going to do with the care plan. And they don't even know what you're looking at. So if you're talking about sclerosis and you know, here's a little osteophyte and you're just, you know, just, you got to get rid of all that doctor jargon and just make it as simple as possible. And even though it may not be like a pinched nerve, you got to come up with like really easy explanations because what's going to end up happening is they're going to walk out of there, they're going to talk to their spouse and they have no idea what's going on. You want to give them like really high level things, very clear and try.

Not to confuse them as they go through that conversation. The day ones in your practice, does that include care and treatment or does that start as day one, all about conversation? And day two, how do you delineate when the treatment actually starts and what do you do in practice?

We're kind of like the, not an anti consulting thing, but like pretty much everything I've learned we've kind of like done the opposite. So like we treat on the first visit. Like, you know, my first consultant said never, ever, ever treat on the first visit. And you know, they want to know exactly what's going on and we'll just quickly explain that. So the reason why I do it this way is that on the second visit I have the case manager just start and finish the whole thing. And then the doctor doesn't do that and it doesn't mess up the flow because what was happening before is the second visit happens. The case manager comes in there and then we had a physician assistant, we had like part time MDs, and then we had chiropractors. And it was like just a little bit of a cluster where, you know, the case manager goes over their stuff and they have to go grab the provider, they have to come in there, do their like quick little explanation of what's going on. So I just decided to say, let's get rid of that step and we explain what their problem is on the first visit right there. And that way the provider isn't interrupted on the second visit. So we'll just say, hey, this is what the problem is. And realistically, like a lot of you guys, obviously if people are doing like things like CBP and they're marking up all the different X rays and stuff like that, they have to mark that up and they have to come up with the treatment plan. But for a lot of the other docs that are on this call, like you kind of know what's going to happen. So we just treat on the first visit. We'll explain kind of succinctly what their problem is and what we're going to do for treatment. Because at that point a lot of people still haven't gained that trust and we let our first treatment actually do the selling for us and we'll just say, hey, here's your problem. It's going to take you probably three to five visits to get out of pain. However, getting out of pain isn't going to solve your problem and you know, it's going to take you say 12, 18 or 24 visits. Now we're in a vacation area, so like a lot of the people are in and out of our Palm Springs area. So like one of our biggest objections with our treatment plans in the past was, you know, I'm not going to be here that long, so I don't want to start that. So we just went down to five visit plans and 12 visit plans and then people can kind of re up there because some people are in town for one to two weeks and some people are in town for 30 days. So I'm not saying that, you know, be the doctor, make your own treatment plans, but that's the reason why we did that. So we'll just say, you know, it's going to take a few visits to get out of pain, but this is coming from, say, a chronic postural problem. To get that well on its way, it's going to take you at least 12 visits. And at the very end of that, you'll have, you know, 10 to 12 minutes of exercises that you're going to do, some in the morning, some in the evening. And as long as you do those, you're going to maintain those gains that we've done on those treatments. That's pretty much it. They still won't remember any of that.

I definitely know how that goes, but I love the simplicity of how you broke that down, because for so many docs out there, it is. They get caught in the jargon. They got caught in over explaining so many things. And I think there's a lot of clinical pearls that I'm taking from how you communicate and how you train your team that I think are really, really important. And we've cruised through. I feel like we barely scratched the surface and there's still so much more to go through. What's another key point or two you want to make sure don know about before we get towards wrapping up this episode?

Confusion. So, like, getting back into that topic so there's confusion with what their problem is and that you can provide a solution. But like, if you're going over fees and you're going over your financials, just make it as clear as possible. So a confused mind can't make up their mind. If any of you guys haven't read any Robert Cialdini stuff, he's got a couple really books on human psychology. They're kind of like, well known in the marketing community. But it's like there's one of the things where they're giving out like, free jam. And they did one thing, I think, where they laid out like five, three or five samples of jam, and they had one where they had, I think it was like 24 samples of jam. And they had one of them where they allowed people to sample all the jams. And then they say, which one would you want to get after that? And they couldn't make up their mind. But when it was three or five samples of jams, they could make up their mind. So when you're explaining your financials, you're explaining your treatments, when you're explaining what office times to give them, don't give them too many options. You want to be the in and out. So I'm in California. So like in California we have something called In N Out Burger. And like their menu is really simple. You get a burger with one patty or two patties with cheese or without cheese. And then you get fries, you get a shake, where you get a drink, that's it. Or you get animal style or you get nobody. That's their entire menu. And it's always busy, it's always packed. And you want to be the in and out of chiropractic. And I'm not saying that in a derogatory way, but you want to keep things as simple as possible. You don't want to be the Cheesecake Factory with like, I'll go to Cheesecake Factory, I know I have the ability to pay. I know I'm hungry and I go.

There and I look at the menu.

And I was like, what the heck here. Looking at specials, looking at that, ask for recommendation. And it's so many fricking choices. So I eventually come up with my choices. But like, it's not like that dramatic. But I know that if I go to In N Out Burger, I know exactly what I'm going to get. If I go to Cheesecake Factory, I was like, I have to sit there and like sit there and think about it. And it should be a very simple decision, but it's not.

So confused. Mind cannot buy, that's for sure. And confusion kills conversion. I think those things are very true. And having people, especially as you said, and you brought it up a couple times, and I think it's important to reiterate, people come in, they're like in pain, they're stressed out. Going to a doctor in the best case scenario is stressful. You know, they have an issue, they don't know you like, all of those things play a role. So communicating in a very clear and direct way, you know, minimizing those options, building that trust is so important. I definitely know we gotta have a part two of this because I think there's so much more to dive into. But we were talking pre roll, where can docs learn more? I know you've kind of broken this out in something that can be super helpful for docs. So I'll drop the link down in the show notes. But where can docs learn more about this process and sort of how you've put it together for success?

I put together a free PDF download, so it's on our website, trackstat.org first FirstVisit visit. I'm gonna put the link right in there. You go there, pop in your name and email Download it if you're curious about other efficiency processes in the office. That's like what I do now. It's our software, so our fismet office. I actually shut that down when track stat started taking off quite a bit because I feel like I can make more of an impact in our profession doing the software thing than doing a bunch of back braces, knee braces, hyaluronic acid injections, trigger points and rehab. Like and it's not like it wasn't rewarding, but my heart really is in chiropractic and that's kind of like the profession I love serving. One other thing, when you have a good first visit, you get more reviews. You get more reviews, you build more trust before they even came to the office. So like there's a million reasons why you should really tighten up that first visit.

I could not agree more. We will make sure to drop that link down below. I appreciate you coming down and breaking down these topics because it's so important that docs really have their patient experience dialed in. You clearly are an expert at it. I'm going to drop that link down in the show notes and thanks for coming on today. Hey, what's going on? If you loved that video, be sure to subscribe to this channel. The Evidence Based Chiropractor puts out videos and all the time at the intersection of marketing and research, showing you how to grow your practice while also growing your knowledge base. So if you liked it, be sure to comment down below or hit subscribe and I'll see you in the next video.