Tag Archives: retention

Ask Lisa: Want to Sell or Grow? How to Elevate Your Practice’s Value Now

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how to elevate your practice's value now

In today’s healthcare landscape, practice value is a complex blend of operational effectiveness, modern technology, financial health, and clinical reputation. Whether a practice owner is looking to sell, partner with, or simply build a sustainable business, several areas can significantly enhance its market value.

Keep reading as I delve into a few of these areas with you.

  1. First, maximizing financial and collections management and diversifying revenue streams remains critical. Practices that depend on a single payer, service, or a narrow patient demographic are viewed as high-risk and are rare nowadays. Enhancing value requires rigorous billing and collections processes to minimize days in accounts receivable.
  2. Integrating ancillary services and hiring non-DC providers can boost revenue per patient while providing comprehensive, whole patient care one-stop. Group chiropractic practices are getting more on board with implementing a hybrid model by hiring PTs, LMTs, Acupuncturists, MDs, PAs, as well as continuing to perform ancillary services such as custom orthotics, ultrasound, EMS-Interferential, Laser, EMMS, Nutrition Counseling, Exercise and Rehab Education, ergonomic and backpack checks, and Shockwave therapies. Yes, all of these are billable and some are insurance payable.
  3. Clean, auditable financial records and practice statistical reporting are the foundations of a high-value practice. I’ve been there and have helped clinicians and managers with this while working at offices to help improve collections and revenue.
  4. Adopting robust, user-friendly digital systems and procedures. A modern (EHR) system that integrates seamlessly with billing and patient portals is a significant asset. Offices and clinic owners need and want systems that reduce administrative burdens. I’ve seen this – the better and more open staff are to learning the plethora of features in your practice management and EHR programs, the better collections are. Newer technologies in advance scheduling, automated appointment reminders, and digital intake forms minimize costly no-show rates and maximize physician utilization. The EHR-rating website Capterra just updated its list of top-rated, and compliant, chiropractic software programs. Click [Here] for details. Insert hyperlink with here as link name.
  5. A tech-forward practice signals to prospective buyers that the business is built for the future. For example, technology to administer and record a precise adjustment can help prevent wear and tear on your body, and includes devices such as the Activator, Impulse Adjuster, Sacro-Occipital Technique (SOT) Blocks, Impulse Adjusting Instrument, ArthroStim Adjusting Tool, PulStar FRAS Adjusting Instrument, and the Atlas Orthogonal Percussion Instrument.
  6. Patient retention and brand loyalty serve as powerful indicators of value. A practice with a high volume of recurring, satisfied patients represents predictable future cash flow. On the other hand, a steady flow of new patients under the pain relief only model can also prove a powerful indicator of value-based services. Implementing structured patient feedback systems and maintaining a strong online reputation can drastically lower patient acquisition costs.
  7. Additionally, standardizing clinical and operational workflows ensures that the practice can function smoothly without relying entirely on the founding physician. When operational knowledge is documented and transferable, the practice becomes far more attractive to external buyers.
  8. Cultivating a positive workplace culture reduces staff turnover, which is notoriously expensive in the healthcare sector. A practice staffed with skilled people demonstrates operational leverage and shows revenue generation is diversified across the clinical team.
  9. Ultimately, improving a healthcare practice’s value is about reducing risk and proving scalability. By implementing and maintaining solid financial workflows, embracing modern technology, and fostering patient and staff loyalty, practice owners can maximize their business worth and ensure long-term clinical success.

Now through October 31st I’m offering a complimentary 30-minute consultation on how you can boost your particular practice’s value and answer any questions you may have

Complete the easy form below for details on this complimentary offer.

Complimentary Offer

And just ask…
Lisa

*Offer does not apply to current active PM&A clients. You’re already getting the best bang for your buck in Abbondanza with us anyway!!  😉

Your Patient as the Hero

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stick man bending over

How to help your patients on their health journey

Last week, we reviewed your journey as an entrepreneur, a doctor, and a support professional.

But what about your patient? What about their journey?

Are they making it all the way to better health, or do they leave after their symptoms subside?

Generally, most offices look at a patient’s journey, or pathway, covering three phases of care: Acute, Corrective, and Maintenance. I have seen other variations, but they are all similar.

The idea is that as patients make regular visits, they progress through their phases of care.

Patient Visits (for example):

I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I

Acute ————> Corrective ———————————> Wellness

How to Improve Patient Retention?

First, it is NOT about improving retention. That is secondary. It IS about helping the patient achieve their health goals by getting through their Phases of Care and into Wellness/Maintenance.

  1. Make a list of key procedures for each visit.
    1. Break down what happens on each day, by each team member. Who does what?
    2. Make a list of key procedures done on Day 1, Day 2, Day 3, etc. Progress exam on Day 12? Good Patient Award after visit 12? Patient education on Day 8 and 14? Great Patient Award after visit 24? (You can download a sample. Link at end of article.)
  2. Practice – rehearse — these steps with your team.

Practicing Your Patient’s Journey

Below are simple steps for a fun team-building and practice improving drill. It WILL improve retention as a byproduct of helping your patient better achieve their health goals.

  1. Schedule extra time over lunch. Get your team together.
  2. You, or someone you delegate, act as the patient. (This is something I often do when I visit offices.)
  3. Each staff member, and the doctor, goes through their procedures for each day.
    1. On Day 1, for example, how did the Front Desk greet the patient and what did they say?
    2. How were they routed to the consultation room?
    3. What did the doctor say?
    4. Who did what for the rest of the exam and x-ray? Review it
    5. How were they routed back to the front desk, and how was the next appointment made?
    6. Day 2. – Same step by step. Practice it and then discuss it.

 

What you are looking for is:

  1. Procedures
    1. Were any procedures dropped out?
    2. Missing procedures.
    3. Redundant procedures.
    4. Unnecessary procedures.
  2. Application of procedures.
    1. Was the team member genuinely interested in the patient
    2. How well were the procedures communicated — with kindness, intention, and patience?
    3. Were the procedures correct – nothing left out, nothing extra included, everything correct?

The best teams practice.

Do this exercise at least once per quarter and be the best… and help your patients be heroes on their journey to their health goals.

And, of course, stay Goal Driven.

Ed

Download: Sample Patient Pathway and Flow Chart 2026

2025- Health Never Takes a Holiday – Complimentary Posters

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health never takes a holiday signature promotion for december in chiropractic offices

Health Never Takes a Holiday is our signature holiday post for many years.  It has proven to be very helpful for many offices to keep their patients on schedule during the holiday hustle and bustle.

For this program we offer free downloads of posters and tent posters you can use in the office to remind patients that we believe “Health Never Takes a Holiday” and it’s important to keep their schedule of care to stay well.

Please visit https://www.goaldriven.com/post/health-never-takes-a-holiday-in-chiropractic for this year’s complimentary posters.

Boost Patient Retention Through Genuine Curiosity

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Why Patients Leave Chiropractic or Healthcare Practices

Patients don’t primarily leave due to cost, outcomes, equipment, or location. Studies reveal the real reason: lack of empathy and perceived indifference from staff.

Study #1: 68% of customers leave due to employee indifference, far outweighing issues like price (9%) or product (14%). Empathy fosters loyalty.
Study #2: Disinterested, unempathetic staff drive dissatisfaction and churn. Personalized, caring service is key.
Study #3: 59% of customers abandon a brand after one poor, unempathetic experience, while 73% stay loyal after a positive, caring one.

Patients value feeling cared for over clinical expertise. As Jimmy Parker, D.C., emphasized with “Present Time Consciousness,” staying fully engaged with patients is vital but challenging in a busy, high-volume practice.

The Solution: Stay Curious and Be Interested

Empathy starts with curiosity. Genuine interest in patients as individuals—not just cases—builds strong relationships and boosts retention. Ask about their lives, like their hobbies or unique traits:

  • “Betty, where did you get those blue shoes?”
  • “Frank, why’s your group called Kiwanis?”

This authentic curiosity makes patients feel valued and fosters loyalty.

Test Your Team’s Curiosity

To embed this approach, routinely quiz your team during case management meetings about patients’ personal details, like a new patient’s favorite sport or where an active patient shops. This friendly exercise keeps everyone engaged and curious, strengthening patient relationships.

Stay Curious and Goal-Driven

A practice thrives on relationships, not just clinical skills or billing codes. By staying genuinely interested in patients, you’ll enhance retention and build a loyal community.

Key Points: Patients leave due to perceived indifference, not cost or outcomes. Empathy, driven by curiosity, is the solution. Test and encourage your team to stay interested in patients’ lives to improve retention.

Ed

References

#1 Rockefeller Corporation Study (1999) CustomerThink, Help-Desk-Migration.
#2 Temkin Group Study (2016)
#3 PwC Consumer Intelligence Series, Experience is Everything. (2018)

Multiple Appointment Scheduling Calendars -2025

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Multiple Appointment Scheduling Calendars are helpful for increasing your patient retention.  We take the work out of them by creating two different easy to use fully customizable forms.

Feel free to download them here.

Scheduling Calendars

Personal-Appointment-Calendar 2024(Customizable WORD Doc) (Portrait)

Appointment – Calendar 2024 (Customizable WORD Doc) (Landscape)

Personal-Appointment-Calendar 2025(Customizable WORD Doc) (Portrait)

Appointment – Calendar 2025(Customizable WORD Doc) (Landscape)

The Value of Creating a Practice Community

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Where everybody knows everybody else’s name

Do your patients consider your practice so cool that they want to hang out with you more?

Do they come in early just to soak in the vibes and chat with other patients?

Do you have a practice club?

There are sizable benefits to creating and sustaining your own practice community. The fact is you probably loosely have one already. It is a rich resource that, if better organized and cultivated, can improve patient retention and referrals.

People want to be part of something larger than themselves. This includes belonging to a group whose values they share. Edward Deci, Ph.D., says it is an intrinsic, innate motivation we all have.

A practice club, or organized community relations program, strengthens your connection with each patient. But in addition, it builds relationships between your patients and even non-patients who are supportive of your practice.

I grew up in a small farm town. We had a very busy barbershop. It was always full of men, smoking cigarettes and talking to the barbers – and each other – about the comings and goings of our small town. I think my dad dropped in at least every other day. The barbershop had created its own interactive and slightly exclusive club.

As a more organized example, the motorcycle company Harley-Davidson established the Harley Owners Group, nicknamed HOG. You must own a Harley motorcycle to belong, and then you are eligible to attend many events the company sponsors and receive discounts on all its products. I know a few HOG members, and they are loyal to the brand and share a bond with each other. And they are active, servicing their bikes and using Harley products.

Organizing Your Community

You can sponsor your own “rallies” and probably have. Patients attend, see you and your staff outside the office, and get a chance to talk. But even more, they can connect with other patients. This is how your practice network strengthens.

You can better organize your community by delegating someone to be your Community Services Coordinator for a few hours every month. They would plan and implement various events, with everyone on staff would participating.

In addition, they could start an online club, such as a private Facebook Group. Your patients would be invited to join, as well as local businesses who share your values.

In my experience, most community-building efforts rarely amount to much because there is no one in charge to keep the group energized. Events are “one and done,” with little follow-up. This contributes to the Practice Roller Coaster effect. They do work at generating referrals and improving retention, for a while, but the energy created ebbs away.

Authentic newsletters, events, phone calls, a social media group, success stories, and special bonuses help keep the community humming along.

Network Effects

Network Effects is an economic term. It simply means that the more people use a company’s product or service, the more valuable it becomes. The larger your network becomes, the better the service improves. And the better your services improve, the larger your network becomes.

It is momentum related. Think of a flywheel or pushing a car with a dead battery. (ugh). Once you get it going, the going gets easier.

From my favorite HOG advertisement:

“It’s a free country. Live like it.
Screw it, let’s ride.”

And also,

Seize your future,

Ed

Want to improve your community building? Schedule a call and we can look at options. To schedule, go here.

In the Sierra’s

Improve Patient Retention Through Onboarding and Gamification

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It all comes back to goals – helping patients achieve theirs.

Onboarding and Gamification. Now there are a couple of terms you didn’t hear way back in the last century of practice management.

While these terms are new, what they define have been used for years. I do think they more clearly express very useful procedures that can help fill up a practice and help more patients achieve their goals of better health.

Let’s take a look at each:

Onboarding

Onboarding refers to the process of bringing a new employee, or in this case, a new patient, “on board,” as on a boat. According to Merriam Webster, “companies want to onboard their clients and customers too—to get them fully fluent in their products and services, so that they can get the most out of them.”

Onboarding a new patient would include all the basic procedures you do over the first few days of care, including consultation, history, exam, imaging, financial arrangements, and explanation of the application of first services.

There are probably 8-10 essential actions you can take with every new patient, or returning patient, that will make their experience so exceptional that they eagerly continue with their care. However, like most offices, when you are busy, you may take a few shortcuts and only do the bare minimum of procedures to get by, vowing to complete them later.

But later rarely comes. Staff turnover, new regulations, and other disruptions all discard the best laid patient service procedures. Finally, only the very minimal is done.

I call this “Procedural Atrophy.” It happens. It is a “thing.” It happens to all of us. This is why checklists are so valuable. They remind us of all the steps that should be taken to produce the best outcome possible.

For many years, we have integrated a checklist for new patients on our New Patient Log.

When a new patient comes in for their first appointment, their name is manually written on a sheet. At each step along the way, the sheet is checked off as completed. This helps ensure that no step is missed in the onboarding process.

In some offices, we have even added columns for future visits, such as Progress Exam, Progress Report, Completed Care Program. We have then assigned a team member, usually someone in the therapy department, the role of Case Completion Coordinator. Their goal is to coordinate services to help ensure that each patient gets the care they want and need and completes their program. We also assign the Case Completion Coordinator statistics to help them monitor their effectiveness.

Retention is helping your patients achieve their goals of better health. The same would apply to any type of service business.

It is all about goals, yours and especially theirs.

I’d like to keep these newsletters as brief as possible, so next week we will cover how Gamification is yet another tool to help your patients achieve their health goals.

In the meantime, seek your future and stay true to your goals.

Ed

P.S. Reply to this email With Please send me the New Patient Log and Checklist if you would like a customizable Word copy of a sample New Patient Log and Checklist

PSS ALSO, get the Goal Driven Business plus 10 practice building tools –HERE!

Momentary Affluence — or Is the Tide Turning for True Health?

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Over the last few months, we have noticed that offices have continued to grow – some even breaking their previous records!

Why is this?

I have heard from doctors and office managers that patients may be hesitant to visit medical offices and prefer seeing chiropractors, acupuncturists, and other health-oriented offices instead. Are they just afraid of the COVID at medical centers, or are they truly seeking to improve their health and immune systems?

What have you heard?

I am going to guess that your practice is filling back up as well.  What should you do to augment your growth, sustain it, and even increase it?

RETENTION AND REFERRALS

You want to think about retention and then generating more referrals – from patients and from community members. Consider the following:

  1. First, don’t take this growth for granted. Each patient is unique and special and important. Provide world-class service and deliver world-class outcomes. In the end, this will ALWAYS be your #1 marketing tool.
  2. Educate. I can’t stress this enough. Please… Inform While You Perform. Factual information is one of the reasons patients see you. You are independent. Your strings are not pulled by Merck, Pfizer, or WHO. You can refer patients to information on your services, on Vitamin D, Zinc, and yes, Quercetin. They can trust you for the unedited and unspun truth about health.
  3. Communicate. Newsletters, workshops via Zoom, or in the office, outdoor events (staying in compliance with local ordinances – as you see fit!) – keep the conversation going. Maintain and improve the relationship with your patients.
  4. Capacity. Do you need another provider? Another team member? Don’t overextend yourself, but also, don’t stand in the way of your growth.
  5. Partner with other providers and businesses. Medical doctors are discovering that health solutions they have for COVID are being suppressed. The braver ones are speaking up. Doctors of all kinds, now more than ever, can share the same goal and help each other overcome similar challenges. Businesses as well, want practical solutions for their employees.
  6. Make a List. Make a list of patient retention and referral generation procedures that have worked for you and review them often. In upcoming newsletters, we will brush off some lists from our old Marketing Manager Systemsm that has hundreds of marketing procedures. You know many of them, but it always helps to be reminded!

You can also take your marketing a step further…

IT’S NOT WHAT YOU SELL, IT IS WHAT YOU STAND FOR

As a more aggressive approach, you may want to be more vocal in promoting better health in all its aspects, from what we eat, breathe, to the kind of health care we seek.  In this regard you could take on the role of Health Rebel, or even Health Outlaw!

Your unique selling principle (USP) should include your noble purposes that sets you apart from comparable alternatives.  Consumers are looking for businesses that take responsibility for social and environmental issues. And, according to several studies*, this is especially true for the younger generation – Generation X – those born in the 1990s. Speaking out for better health in your community and against toxic pollutants, for example, is not only a noble purpose but – if genuine, has practical marketing benefits.

There really are two sides in our health culture – one for optimal natural health of the planet and of our bodies, and the other as advertised by corporations.

Your community is bombarded with thousands of advertising messages each day, many of them promoting drugs and COVID hysteria fears.  Advertising is a form of population control, which is an advanced science, and which may be used increasingly to motivate your community to consume more vaccines, including for COVID.  Yale University, as reported by Mercola, is testing advertising messages to shame, embarrass, anger, and otherwise motivate people to take the vaccines.

And the campaign has already started. According to USA today, it is patriotic to get vaccinated.

And it is not just the push for vaccines. Corporate medicine has been discrediting natural health remedies, including chiropractic, nutritional supplements, and certain medical practices such as chelation for years.  And outside of health care, we can see advertisements for the cancer-causing Roundup (with glyphosate), “foods” with toxic ingredients (e.g. aspartame), and the suppression of information about mercury, hexavalent chromium (as in the movie Erin Brockovich), and other toxins currently in our drinking water.

This is really your time. This is a contest for health independence from corporate tyrants that have set up laws to escape liability for their actions.  But those of you in the chiropractic profession are used to the fray. Now, you are not alone. Other doctors are also experiencing suppression and personal and professional retaliation and are joining the fight.

The sales of organic food and supplements continue to increase. And based upon your practice returning to pre-COVID levels, the tide just may be shifting towards true health.

But only with all of our help.

Helping you to help more people,

 

Ed Petty, and all of us at Petty, Michel, and Associates

Chiropractic Health Never Takes a Holiday

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AUTHOR NOTE:  The links below are now working…. if you have a problem accessing, please contact Linda at 262-749-0221.

This is a busy season, isn’t it?

But, usually a productive one. Although there are the usual complaints, in the big picture I think we all do very well. For the most part, we accomplish many good deeds during this time.

First, there is the Spirit of Christmas – which is always a good thing. Regardless of how devout you are to Christ’s birth, different religions and different cultures recognize this time in their own way. We are all maybe just a bit nicer to each other, or at least called upon to think about having more compassion for each other.  Tragedies also remind us of this.   In my opinion, the Spirit of Christmas transcends all religions.

Then, there are the reunions. Family and friends get together. Hectic? Usually. Messy? Often. Sometimes agitating? Yes.  But still, it is a time for meeting together and talking and eating and sharing. And loving.

Did I say eating? Yes. That is usually yummy good, as long as we do not over indulge in too much or too bad food.

 NOW TO A PRACTICAL PRACTICE MANAGEMENT SUGGESTION: Don’t’ forget to politely remind your patients – “This is NOT a time to fall off the Wagon of Health!”

Health Doesn’t Take a Holiday

Embrace this time. Have fellowship, share kindnesses – and have yourselves a Merry Little Christmas. But maintain your health and insist your patients do as well.

Keep them to their appointments and schedule them through January.

The links below direct you to pdf posters for examples.   They say: “Health Never Takes a Holiday.” You can place these on your front desk and in your adjusting rooms to remind patients to keep to their schedules and to get scheduled if needed.

Clients may go to their members’ site and pull down the same files as customizable Word posters. There is a link for that below.

If you are not a client and want a Word file, just let us know.  We will get you one.

Use them if you want, or make your own.

Also, just for fun there is a link to a poem adapted from “The Night Before Christmas”: “Twas the Day Before Christmas.” Not sure who wrote and would like to know for attribution.

Now, if you think about it, what is the most important element to real health care?

… (thinking)….

Getting adjusted? Eating right? Exercising right? Yes, all these and more.

But even more fundamental is doing them. And to do them, you need to schedule them. This is why I place such an importance on the dynamic nature of the Front Desk. If patients are not scheduled, they don’t come in, and nothing else can happen.  Too obvious, but often overlooked or under stressed.

In the real world, the best guarantee for chiropractic health is the SCHEDULE.

From all of us at PM&A

Have yourself a merry little Christmas, and
May your hearts be light …

–Ed

Health Never Takes a Holiday (PDF)

Health Never Takes a Holiday-2(PDF)

Links to the members site for the fully customizable version of Health Never Takes a Holiday. (You will need to enter your user name and password.)

Health Never Takes a Holiday (DOC)

Health Never Takes a Holiday-2 (DOC)

Chiropractic Christmas Poem – “Twas The Day Before Christmas”

 

 

 

Where Are All Your Patients?

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Where Are All  Your Chiropractic Patients?

What would your daily volume of visits be like if ½ of all the NPs you have ever seen still came in to see you once every month? Or even every other month.

Let’s take a look: say you have been in business for 10 years. Each month during these years you averaged just 10 new patients per month. (Pretty low, I know.) That would total 10 x 12 months = 120 new patients per year and in ten years that would be 1,200 new patients.  If half of them saw you every two months, that would be 600 patient visits every two months, or 300 visits per month.

How would that be? Pretty nice, right? And do you think they would refer more family and friends if they saw you more regularly?

Aside from whether you recommend wellness care or not, it would make sense to retain your patients on some kind of schedule simply as a sound marketing strategy. From an economical point of view, both in terms of time and expense, it is much more cost effective to take care of existing patients than to promote for and process new patients.

Some Chiropractic offices we work with have a visit average, or a retention rate of 20. (This is calculated by dividing office visits by actual new patients.) And for some, the Patient Visit average is 50 – or more. This means that the patients come in an average of 50 times.  Very few of their patients drop out of care.

How can your office achieve a visit average of 50 or more?

We will go over at least 8 practice procedures to help your office increase its patient retention on our next webinar this Thursday, August 23 at 12:30.  (Office managers, marketing coordinators, and doctors should attend.) Go here to register: Register Now

Here is the first tip: Patients come to you for only two reasons – results and good feelings.

You have to deliver the results equal to or better than their expectations. (Frankly, compared to the medical and pharmaceutical alternatives, you have an unfair advantage!) But even if you miss here and there, what is amazing is that they will stick with you if you – and your office team – make them feel good!  I will go over examples of this in the webinar.

As an example in the world of management consulting, I was asked once to help one seminar company, years ago, provide private consultations to their clients. The seminar speaker was busy and asked me to help. He was very popular and charismatic. I agreed and saw about four of his clients.  I gave each what I considered to be relevant and practical advice for their unique situations. But what struck me was that the majority of the doctors I saw had declining numbers: their practices were getting worse by objective measurement. However, they all loved the seminar speaker and his program!  I didn’t understand it at first until I realized that he made them feel good.

So, get results on your patients. But, at every patient encounter with every team member in your office, make sure the patient walks away feeling better than they did before the encounter.

I will explain more about this in the webinar but it is something you can work on now with your staff. When the patient calls, are the front desk staff truly interested, or are they too busy with their computers? On their 6th visit, is the doctor genuinely interested in the patient as a special person, or just as another “case” to see before lunch.

Review these “moments of truth” with your team. You can practice and roll play and even tape record different types of patient encounters.  You will be amazed at how, sometimes, you sound hurried, disinterested, or less than friendly.

We all get so busy that we can lose the moment – and just that one moment with that patient can make all the difference.  It has been called “Present Time Consciousness.”  But it is really just paying attention.

That moment you have with that patient is unique and you will never have it again.

Make the best of it.