Blog, Live Events December 30, 2021

The Business of Chiropractic Circa 2022

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Hi, I’m Dr. Mark Studin and welcome to today’s presentation. First. I’d like to thank ChiroSecure for giving me the forum and the opportunity to speak. It’s always an honor, and I very much appreciate it. Today’s conversation. Is going to be centered on the business of chiropractic. And even though I’m talking about what’s coming up in 2022, it really is applicable to January, February, March, April, may, June in any year 23, 24, 25.

But right now, certain things are happening that we’ve got to pay attention to because as one of my former mentors taught me 45 years ago, there was a business hand and a service hand. It’s the same person. You can’t let one influence the other, it’s not the church of chiropractic, but it’s also not a race to the bottom to see how little we could charge to compete with those other people charging less.

So it’s really about being the best of the best through clinical excellence and being paid a fair and equitable fee. Now, when we look at that, You all were all running small businesses. You all, you’re not running mom and pop shops now in a mom and pop status. It’s really a grocery store at the, and by the way, I don’t want to denigrate any business.

Okay. A local. Grocery store, not a chain with a local grocer or a candy store or butcher, some people do really well, but a lot of people say if I make 50, a hundred, 150,000, I am golden, but in a small business, according to the small business administrator, it’s defined by from revenue from one to $40 million.

That’s where we fall in small business. And we really should be in the one to $2 million range with a single practice. But listen, I consult offices in the 25 to $30 million range chiropractic practices. I consult offices who are barely paying their bills. So you’re running a small business. Y, but the problem is most of us consider or run our businesses like a mom and pop shop.

Now what’s a tell. Here’s a tell a mom and pop shop or run a paper. Checkbook. Do you run a paper checkbook? If you do, you’re very 1960s and 1970s, you need to be on a computer program. I use QuickBooks. It’s very important to have the power of information. You need to know things. So if you’re still on a checkbook, you’re very yesterday and you can’t run your business on a checkbook and that’s very important.

And one of the reasons that’s important is you need to know what your profit and loss is at any given time. Now what’s a profit and loss. I collect a hundred thousand dollars. I have $70,000 in expenses. My before tax profit is $30,000. Now, do I have any other tax write-offs against this now? What does this have to do with chiropractic?

The answer is the business hand and the service end. So you have to understand these things. You can’t say. My accountant comes and we’ll talk about accountants in just a minute. So you’ve got to have a full well that wasn’t meant to change what you could change. I banged the desk and said you need to understand what those profit losses are.

Prognosticate or plan ahead. And that’s critical. So when we look at the profit and losses within 15 seconds, you should, and this is from quick books, which I strongly recommend I’ve been using it since 1998. And every business that I’m in, okay. In every business and a check entry takes me about five seconds, including printing it.

Doesn’t take a little. I’ll be able to see what my net income is, and I’ll be able to see what my expenses are and I’ll be able to look at them and I could guide my business. And that’s very important because when you plan your tax deadline is not December 31st. And by the way, you might have until April 15th to file, but you’ve got to have everything in your checkbook by December 31st.

You know what? I start to plan January 1st. I start to plan January 1st because I need to know what’s going on now. And to do that, we have to look at an account and we’re going to go back a slide in just a moment, but we’re going to look at an account. Most people meet with your accountant once a month, occasionally once a quarter.

But I talked to him all the time. You don’t have an account and you have a, you have your turbo tax. All he does is take your bit your checkbook and feeds it into the computer plunks numbers. And you can do that yourself. You don’t need them. And then he fills out forms. You don’t need them behind every good business is a great idea.

I meet with my accountant every single month, starting in January every month. And we sit there because go back, let’s go back a slide because we sit there starting January 1st and we actually meet the end of every month, January 31st, we meet on or about and me go through the entire checkbook and we categorize everything that we do.

And at the end of January on January 31st, I say, okay, What do we need to put away? W what’s our profit looking like for this year? And I have a separate account and I’m putting money away in a tax account. So I don’t get caught short at the end of the year. Then we look at things like IRAs or retirement plans.

Then we look at tax shelters if I need those. And by the way, if you work with me, you’re going to need a tax shelter, because you’re going to make more money. You got to put it somewhere. Then in February, you meet again. And then in March, we meet again every month we’re needing new. I don’t really particularly.

Have to work with a CPA. CPAs are less apt to be aggressive in those, in the IRS code. I work with an enrolled agent and I’m not against the CPA, but I’m thrilled with my enrolled agent. I work with with an enrolled agent, which is a tax prepare first for many years that I morphed over to. We CPA fired him.

After two years, went back to an enrolled agent. And every month we meet and every month we review the books, you’ve got to know what’s going on. You have to know how you’re paying people. And by the way, if you have a 10 99 on your staff and they’re a provider, you’re not doing it. You’re it’s you can’t have a tenant in our.

It is almost impossible to have a 10 99 as a treating provider in your office, almost impossible. And every single accountant, a CPA, a tax lawyer says no. IRS is looking at insurance companies. The answer is no, but you’ve got to sit with your accountant every month. Non-degree. Every single month, not every quarter you send them stuff.

Oh, I talked to him on the phone. It doesn’t work like that. You’ve got to set everything up every month and review because how are you going to know in December, what this check you wrote in January was it was assigned to you have. You got to categorize everything. You’ve got to look at everything.

You’ve got to look at your corporations in a hole and just how you flow your money. It’s very important. So if you’re running a mom and pop business, you’re going to be on a paper checkbook. You’re going to meet with your accountant once a year, send them stuff every quarter and call them and ask questions.

I grew up. In a retail family who ran stores in New York city, our families, red pop mom and pop shops. And there was nothing wrong with that. We had a great life and I’m not denigrating that. We’re really aspire and functioning in the small business environment, one to $40 million. And if you want to grow your financial acumen, your ability to handle money must grow with you.

Because if you do not do that, you’re going to end up with less because I don’t care how much you make. I care how much you keep and you need to keep more using the tax code, working smarter, not harder. And understanding, oh, my account just came to me. Right now I’m recording this it’s the end of December.

He says, mark, you going to need some deduction, so go buy whatever you want. That’s related to your business. Go by. And I went out and spent a bunch of money to buy stuff, to get it in before the end of the year that’s called the tax write-off. So I’m looking at, or a tax shelter. I don’t care what you call it.

It’s legal. It’s not a gray area. It’s in the tax code and you use it to your advantage. Now these are just the basics and there’s so much more that I want to chat with you about. When I work with. Doctors. And I first sit with them, I say, okay, I’m going to come up with a strategic business plan till you’re a hundred years old, a hundred and people scratch their head and go seriously.

I said, yeah. I said, you’re going to work maybe until you’re 70, then between 70 and a hundred, you have to be able to live and function in that money. And you can’t do it on social media. So we have to look at how much you have saved. We have to look at the value of your homes are going to be paid for.

And if it is that’s, what’s going to be used to carry you from 70 to a hundred. Meaning if you have to go into an assisted living or a nursing home where you need an eight to live with you, where’s that money going to come from? Where are you going to live? You’re not going to have the fight. It’s 70 years old to schlep.

Okay. And I love chiropractic, but when you’re 30, 40, 50, 60, you’re in the pits. When you get in, you’re in your mid to late sixties and I’m turning 66 in a few weeks, you’re not going to have the fight that you had previously. So you’re going to need money to live. So I tell everyone, if you start at age 70, You’ll look at your home.

You’re not going to take that money. That’s going to carry you until you were a hundred years old. You need a place to live and it has to be paid for by that. Then you take all the money you saved up and divided by 360, meaning from 70 to 100 years. It’s 30 years, 12 months a year. It’s 360 months. So you’re going to take 360 installments out of your retirement out of all of your money.

I don’t care if you call it retirement, not a retirement, your liquid money, not your primary home. If you have real estate, you might want to consider, start turning that into cash in your sixties. So that by the time you hit, because it’s not a quick sell, you want to be able to use that. Until, you hit the pine box around a hundred years old and you could live, and that’s really important.

That’s strategic business planning, handling your life from beginning to end. Now, if we go and we look at practice, how are we going to plan for next. Do you want to be a personal injury practice? Do you want to deal with workers’ comp? Do you want to have a pediatric practice? Do you want to have a Medicare practice, a sports injury practice, or just a general practice with slip and falls and aches and pains.

These are things you need to decide about what you want to do, but how do you make that business? How do you make that decision? The first thing you need to do is you need to stay updated in the industries. You have to stay updated because most chiropractic business models are upside down and mine was for years.

Let’s see, it was in the mid eighties. We were in, in the insurance. Hey, day, one day I woke up, I went to. And I have 30 canceling. That’s not true. All my patients came in and 30% of my practice. When the bills were sent in and the next billing cycle paid was zero because we went from the old fashioned in plans to managed care plans.

And I wasn’t in my state organizations hierarchy because it was nepotism at its worst. And I wasn’t on those panels. And the next thing I knew, I wasn’t getting paid on 30% and I had to let go of all 30% of those patients. And it was all my goodness. How come? I didn’t know. I got caught by surprise. If you’re dealing in any of the genres of healthcare, any, you have to understand.

What’s happening in that genre of healthcare, what’s happening with personal injury, what’s happening with workers’ comp? What are the laws about treating children? What about Medicare and the rules? What about sports injury people? How are we going to get them paid for? Because it’s the business. Are we going to go to cash?

We’re going to look at all of these different things and are we staying. Of the current information. You’ve got to know what’s going on in today’s marketplace and the keyword is marketplace, and I’m going to start using business words. Okay. Market share is incredible, but gaining a market share when you’re losing.

It’s not a place to be in the marketplace. For instance, in workers’ comp, if they decide you’re only going to get eight visits, you could treat them for a hundred visits. You might have to go to court. After those eight visits, you’re going to lose money if you’re dealing in and just sports injuries or slip and falls of people coming in with back or neck pain And you’re dealing with managed care.

Okay. A lot of these managed care companies, they’ll give you six visits. And after that, they’re going to torture you. And they’re only going to pay you 32 bucks for six visits. Guess what? You’re going to go out of business. So if you think that you want to run a cash practice, but you’re competing with these franchises, the next thing you know, it’s a race to the bottom.

I’m going to do a $20 evaluation. I’m going to get $16 a visit. Guess what? You’re not going to be able to afford your rent or your mortgage or your. It’s a race to the bottom. It’s a silly place to be. It’s just a silly place to be. So when we make the business decision, we look on the left side of the scale.

Do you want to make more money or less money? So on the left side of the scale is managed care. Medicare worker’s comp. Okay. Okay. So you’re going to be looking at less money because you’re getting paid less per visit. And there’s nothing wrong with those things. Listen for many years I saw 650 visits a week and I was cash and managed care predominantly.

And I did great until I broke my. From adjusting patients, both shoulders operated on hand surgery on both sides. My hip was just replaced. You can’t do that volume for that period of time, but then I look at personal injury and what happened when I looked really hard. I fell in love and look on the left side.

I am passionate about trauma care, passionate about, I love treating trauma cases. The, everything is new. When people come in what’s wrong, let’s figure. It became a jigsaw puzzle to me. And at the same time I found out. And if you look at that graph of. That’s been, and that’s my research. I’ve done it every other year, since 2011.

Right now I’m just finishing up 2021. These are all published in the American chiropractor magazine, which is an index journal, but why should I work for 40, 50 or $60 a visit when I can work between two and $400 a visit doing the exact same thing? Does it make sense to do the same thing on the same page?

And make so much less to me, it didn’t make sense. It didn’t make sense at all. I’m a numbers guy, so you’re collecting 60 bucks a visit and you’re seeing 150 patients a week for 52 weeks a year. You’re collecting $468,000. That’s not a bad amount of change, but say you’re collecting 200 visit times.

150 visits a week, times 52 weeks a year. Now you’re making 1,000,500 and $60,000 on the same number of patients doing the same services over the so much more documentation in personal injury. Guess what folks, that’s a fallacy, because if you think you’re going to document different from a cash patient from a PI case, that’s the slippery slope to lose in your license.

Everyone has to have the same level of documentation. If you’re not, you’re pandering to the plaintiff’s attorney. Don’t ask me, ask a licensure board. They’ll tell you. And by the way, who has a higher level of scrutiny, personal injury or cash patients? The answer was cash patients because what a PI patient gets angry, who do they complain to the insurance company and often.

Sure company doesn’t care. That’s just about money with them. But if you complained to a licensure board about a cash patient, because that’s the only place patients have to complain, they are mandated by law to do an investigation on you. You’re screwed, you will get investigated and the license, your board is much less.

Listen, you don’t want to be investigated by anyone. And I can sit and talk about documentation and pitfalls. I have relationships with the attorneys from a lot of the insurance companies. I read federal cases against chiropractors all day long. I know what’s going on out there, but the hardest doctors to defend are those who run cash practice.

Who actually have to answer to licensure boards, it’s held, so you just have to do it right. And you need the same level of documentation. It doesn’t matter, but here’s the thing with personal injury. Now, listen, I’ve been in a cash environment. I don’t like to do that. I love personal injury. I’ve been in workers’ comp.

I’ve never lost so money as much as dealing with workers’ comp. Cause we did it well. We educated the patient. We played by the rules. What worker’s comp is stacked against you because workers’ comp is run by the state. It’s rarely privately funded. But it, and so therefore all the rules are set against you.

We have, I’ve never written off so much money, millions of my career because of workers comp, how to train them, how to pay for them. So it’s just not a place I would choose to be. So it’s really important. You understand the rules of every single game but in personal injury, There are two things that are required documentation and that’s important documentation.

This is the number one thing I hear from lawyers. The medical primaries and the Kairos don’t go back one. Now the medical primaries and the Kairos don’t know how to write reports, it’s killing us. You know what they don’t want. They don’t want your referrals because then they’re saddled with. And you’re sitting there talking about being a healer and subluxation.

You’re not talking about what you found was far as documentation, and they’re losing money with ortho neuro as a neurosurgeon, but they’re losing more with you. If you are not educated properly, you need an education. The second thing you need is credentials, or the. When dealing with personal injury, it’s documentation and credentials.

And by the way, there is no one or two magic items. What, and I get this a lot when doctors call me to consult for me to consult for them, what’s the most important thing I have to know in personal injury. And I said, there is no most important thing. There are so many small pieces of the puzzle. So many, for instance, if you writing a report from an on an x-ray.

The lateral cervical reveal, foraminal, encroachment, and C4. Five lawyers just want to work with you because you didn’t write. I personally reviewed the lateral cervical, and now they could consider that hearsay because it could be read by a radiologist. So there are so many little things, little facets, but as far as credentials go in, the knowledge comes with it.

I put up on this screen, six sample credentials, trauma quality. Primary spike air qualified MRI interpretation, review, qualified expert, witness and documentation qualified evaluation of management, qualified interprofessional hospital. Qualified. There are so many. Academic levels of recognition that you could get that a real, these are all approved through Cleveland university, Kansas city, college of chiropractic.

They’re all approved through chiropractic academia. These are formal credentials. Lawyers need this to work with you. And then if you want to kick it up a notch, we finally, after seven. I have worked with the state university of New York at Buffalo Jacobs school of medicine and biomedical science is the office of good thing and medical education in a joint partnership with Cleveland university, Kansas city.

They now certified a fellowship in primary spine care. You want to work with. You want to have collaborating relationships with orthos, neuroses, and neurosurgeons. You want to work in urgent care centers. You want to be considered in a hospital. This is the credential that will unlock most of those doors because you’re a fellow certified by a medical school.

It’s just, it’s about credentials at the highest level. Okay. This is what lawyers clamor for. As an example, I had a doctor in Illinois. This is just out about six weeks right now. She joined the fellowship and honor CV. She wrote fellow candidate, primary spine care through SUNY Buffalo medical school, SUNY state, university of New York.

She spoke to a neurosurgeon and the neurosurgeon. She said that the neurosurgeon. She had told the neurosurgeon, I have the case to refer to you. And I like to have cases refer back. And the nurse surgeon said, listen, I don’t really work with chiropractors. I work with physiatrists and ortho and neuro.

I don’t really work with chiropractors. Please understand that she goes, but I want you to know that right now, I’m going to fellowship program through the state university of New York of Buffalo school of medicine. He goes, send me as many cards as you. ’cause I love chiropractic. I just haven’t found a chiropractor who was credentialed enough.

We had another doctor in Cedar park, Texas who met with an orthopedic surgeon and said the same. The ortho only gave him five minutes to kiss his ring five minutes. He wanted his referrals, the ortho wanted the Kairos referrals. They spend 45 minutes in the room. You know what they talked about. They talked about slice acquisition sequences on MRI and the Kira said, listen, I am credentialed through the state university of New York at Buffalo school of medicine for MRI review interpretation for qualification, and he’s credentialed through the school.

The guy got 150 referrals from that ortho that year, go back then one slide. So if you look at each of these credentials, even though Cleveland recognizes the qualification, every single course is approved through the state university of New York of Buffalo school of medicine. These are things that are unlocking the.

They’re just unlocking the doors that we have. And I do have to share with you it’s it just works. I can tell you right now that our average doctor gets between 25 and I’m sorry. I apologize. Between 15 and 25 new cases per month, mostly pie. We’ve been doing it for years. That’s the average doctor. And that’s in 49 states.

It just works, but what’s the plan. How do you do all this stuff? Here’s what we do. First, we start with helping you build an infrastructure. Then we get your documentation down. You’ve got to be compliant. Documentation is about two things, reputation and compliance. If your documentation is hard. You’re using paper, documentation, check boxes.

You’re not putting in past medical history, review of systems, height, weight, blood pressure, pulse, all the things your licensure board requires. What real doctors do? Your reputation is trash lawyers. Aren’t going to work with it. And then these probably most definitely will not work. They’re going to consider, more than a technician, like a PT, but once we get your documentation sound, then we work with getting you credentials.

Those are your tools. We’re going to get your coursework, formal coursework recognized through both medical and chiropractic academia. Then you’re going to go to, and you’re going to start building some relationships. And in those relationships, we teach you how to start getting referrals. Then you become the solution to the.

Once you become the solution to the case and you do it enough, you make, you morph over to the inverted pyramid and you become the solution to the practice. Once you become a solution for the medical or legal practice, your credit peer relationships, or you’re an expert, then you start teaching that the lawyers in the MDs, and then you get their exclusive referrals.

And then you. Your advocate for inclusion. I’m meeting in a week from tomorrow with a hospital. They reached out to me because I was the solution for a medical primary care who happens to be the head of the internal medicine department in a hospital. And he found that I was a fellow through Sony state university of New York.

It’s Buffalo. And what did he do? He sent me up with the COO of the hospital. We’re working with another hospital in a. We’re going to hospital urgent cares. It doesn’t matter. They’re going to run after you, as long as you position your self properly. That’s really the goal folks. You’ve got to position yourself and that’s the goal.

So listen in 2022, and by the way, I’ve just scratched the surface. So if you want to learn more, go to teach You can call me, you can email me, but really it’s about setting up a strategy. For your office, you need a strategic business plan. It’s not a race to the bottom, just because this franchise charges $16 for a visit.

It doesn’t mean you have to charge $15 a visit. It doesn’t mean that at all, just because they’re cutting corners on an evaluation, doesn’t mean you have to cut cortisone and evaluation because it’s going to end up potentially costing you your license. Or being taken down by the insurance carriers in a Rico federal claim against you because you billed carriers and you didn’t complete the elements.

You didn’t put a time element and you didn’t put it, whatever the point is that you have to do it, it’s not a race to the bottom. It’s a race to the top and an erase of the. Become credentialed. The more credentials you have, the more patients you’ll see and the more money you’re going to keep, the more money you’re going to make.

Now you need to work with the right accounts and have the right business system set up. So you get to keep more money because really that’s what it’s about. So listen, I’d like to thank everyone every. For giving me the opportunity to share this. If you’d like to talk about your practice at any point in time, listen, I welcome your phone call.

My, my phone number was up here on the screen a moment ago. Here it is. I welcome a phone call, an email I’d love to chat with you if it helps chiropractic at any level, which you can tell me the chiropractor, I am happy to work with you. I’d also like to say that in the next presentation, Mike Miscoe is coming on, he has just used an attorney who is just a champion in defending chiropractors against allegations.

He’s wonderful. So I’d like to share with you to come in. And again, I’d like to thank ChiroSecure for giving me the opportunity to speak. Listen, I look forward to seeing you the next time. Thank you everyone. Have a great.