Dr. Davis: After graduating from Life University, Dr. Josh Wagner created a very profitable practice from scratch in one of the most expensive neighborhoods in Manhattan, New York starting out with less than $5000. After his own success, Dr. Wagner began to teach other doctors his methods and he's created the perfect patient funnel system. Using growth and communication strategies not introduced yet in chiropractic, the perfect patient funnel system members are seeing increases in their practice with far less energy and expense.
Dr. Wagner coaches a number of upper cervical doctors in his methods and they have seen tremendous success as well. Welcome, Dr. Josh.
Dr. Wagner: Thanks for having me, Dr. Bill. I really appreciate being here and everyone is listening.
Dr. Davis: Awesome. Well, previously we talked on the blog and you shared some of your back story about starting your practice and discovering some methods that really helped you to be successful. I'm going to link to that in the interview for anybody who wants to go back and read it and because you did share a ton of value in that interview, but today I want to focus on a new topic and that's time-based DC care. And so, can you define what time-based care is?
Dr. Wagner: Absolutely and it's funny Bill. It's such a simple concept. It's one little tweak for chiropractors in changing how they recommend their care recommendations and plans to patients that makes all the difference in the world. Yet, because as chiropractors we're so ingrained in certain stats and numbers and how we've been taught. This is the way to practice. This is the way to practice. I find it often easier for non-chiropractors to understand the difference, which is oftentimes patients. And so, what I'm going to share with you literally will make it so much easier for both you to recommend and for patients to say yes, to understand to continue in your care, and to tell other people about you because there's less anxiety or any of the common objections that the patients have when it comes to receiving. They're oftentimes potentially longer than expected or more visits than expected care plan from a DC.
And so, here it is. When you recommend care, let's say a common DC may recommend six visits, 12 visits, 36 visits, 64 visits. I've seen as high as like 125 visit care plans over the course of the year.
Now, most of the lay public whether it's their fourth time to a chiropractor or their first time, they've been to other kinds of doctors. Their GP, their pediatrician, and their dentist whatever it is. And even for pretty intense conditions, they don't have to go back that many times to the doctor. Even like, let's say even something like cancer radiation. Yeah, it's a series of treatments but it's not like 125 or 65. So, what DC time-based care plans do is you can still recommend the same frequency. You can do the same amount of visits over the same amount of time as you feel is in the patient's best clinical need from your experience, for your clinic, for your technique. All you're going to do is when you present their recommendations is you're going to drop from saying, you're going to omit and not say the total number of visits in the care plan over that amount of time. You're going to let them know the frequency you'll start with. How long you're going to work together and that's it, and you're going to let them know.
As we progress, like let's say you know you're going to start seeing the person, the patient two times a week for the first four weeks or six weeks or you decide. You know that you know what your initial frequency is going to be. And then, you let them know, we're going to start off twice a week for the first four weeks and then as you progress – so you're already foreshadowing and planting the seed that they're going to get better. The frequency is going to change and adapt. You're not telling them what it's going to go to but it's just logical it's going to decrease from there. You're never going to let them know that it's going be definitely 36 visits over X amount of time. You're just going to let them know that you're going to work together until that time and at that point whatever you would have said anyway. Whatever results you expect to see, the difference that will make in their life, the clinical changes you expect and just by dropping the total visit number, you will see a dramatic difference in patient hesitation, reluctance, anxiety because the second you say anything more than about eight visits, this, like radar goes up in patients’ minds of like, ‘Wow! do I need that many visits? What will my husband think? How much is this going to cost? I've never been recommended to come this many times to a doctor before.’ People can understand a month, three months, more significant condition six months, but it's a lot harder for them to grasp the visit number. Just by dropping that, you remove an incredibly big barrier that has caused so much of the public to either not start chiropractic care or not continue because all they're thinking is how many more times they have to come back in the future.
And one of the best examples I could give to explain this is, I did Invisalign. If you're familiar with that, it's like the new way to properly align your teeth instead of braces. It is clear.
Dr. Davis: Right.
Dr. Wagner: Plastic.
Dr. Davis: Uhm.
Dr. Wagner: I even had braces, a typical thirteen-year-old and over the years shifted and my teeth weren't in perfect alignment and I met a renowned dentist in Manhattan. We became friends and he's like, ‘Josh, I'll hook you up. I'll give it to you for my cost but it's going to take, it’s going take a year and a half.’ I'm like, ‘okay I get it. Braces took three years. This will take a year and a half to two years. I get it.’ And that's pretty much all he told me. I didn't know at that point that I would have to go in for like checkups and visits. Like, things every two weeks and sitting in his waiting room for 40 minutes, and it was awful. If I ever knew that going into it, I never would have done the procedure straight up. Now, I know…
Dr. Davis: Right.
Dr. Wagner: Patients don't dread going to the chiropractor and they don't usually have to sit in, waiting for 40 minutes and it's not a bad experience. But it's the whole thing is, if I had factored that into my daily life and week and career, I never would have done it. And patients are thinking the same things in a lot of ways. So, there's an example where that dentist, he got me to get my teeth better. He got paid and he omitted one little thing and it's so much easier when chiropractors do it. And here's another huge benefit of time-based. It's the fact that as the DC, you're not pigeon-holing yourself into you have to deliver X amount of visits over the timeframe you recommended.
So, I know a very common care recommendation is 36 visits over three months. A lot of chiropractors are taught to do that just cut, cut whatever like standard care plan methodology. Now, here's what happens: at a certain time in that, most DC's during that process they realize, ‘you know, my patient they're doing great objectively, clinically, subjectively. They don't need to be coming in maybe two times or three times a week still at this point but this is what I signed up the patient for. This is the paperwork they filled out. This is what I told them. How it's going to be, and there's something off there in the relationship. Like, you know as the doctor they don't really need that frequency anymore. The patient doesn't want to be coming in because they know they're getting better. It doesn't make sense to them as much as you educate. And that causes a rift with a lot of doctors with the pre-set visit care plans recommended.
So, think about this scenario, let’s say you do 36 visits over three months and your fee is $1500. Now, you do a three-month care plan for $1500. So, it’s the same time length, and it’s the same investment but you don’t put a visit number associated with it. What doctors I worked with see, is that they may only see those patients 25 times, 29 times and the reason they’re seeing them less is because the patient is doing better. So, what happens is, the patient is happy because they’re doing well. They don’t have to come in as much. You’re making the same revenue and all of a sudden your profitability just skyrocketed because anywhere from seven to nine to 12 visits that you would have has to spend time and bend over a patient to get compensated for. You’re getting compensated for anyway without cheating, stealing, reaping off an insurance company or anything like that. The only reason you’re more profitable is because your patients are doing better and they’re happier. So, think about that from a standpoint of clinical integrity and authenticity with your recommendations and business profitability. It’s a win-win in every aspect and model.
Dr. Davis: Okay. Let me jump in doc. So, when you’re talking about let’s say, you make a recommendation for $2000. It’s going to take three months, and how do you break that down with the cost per visit? Right, because you’re going to have to have a defined cost for each visit. Let’s say that you only see them 20 times versus 30 times. I mean, do you change the cost per visit?
Dr. Wagner: Good question. Yes, good question Bill. Now, you’re diving into the specifics and this is where I’ll shed some light on this because this is where I work like personally with DC’s in the program or a lot more training. So, there is a difference obviously if you’re in network, out of network or completely cash. So, if you’re in network, this model in terms of the fees really only caters to – you can still drop the N number of visits when you’re recommending care but people can’t pre-pay in advance. You’re really restricted as in network to what you’re contracted to at the company. Same with if you’re out of network and it’s still a cash patient like they have high deductible but you’re submitting insurance claims or you’re submitting it to them. Obviously, you have to keep your fees the same rate that just legal contractual issues with insurance. For cash, you have a little more freedom. What I recommend is elevating your per visit fee, which makes the time-visit care plan more advantageous and more cost-effective to enter into.
So, let’s say someone sees your per visit fee and adds up their initial frequency times how many weeks or months your care plan maybe, adds up in their head or on paper, and they realized that’s a lot going to be a lot more than if they choose to take part in your time-based DC care plan or time-based patient savings plan. You make call it for them. That’s one aspect.
The second is, even though – so, this maybe an upper cervical audience and you may not be doing any other insurance-based codes or modalities. I get that but there’s plenty of other aspects you can incorporate into your care relationships. So, it could be videos you created like a video series for things the patient could be doing to benefit themselves outside of your practice. It could be email correspondence that you open up your patients to and put a price tag on it. It could be at home exercises and recommendations you give. It could be talks and presentations inside the practice that you invite people to. And now, instead of them being optional and free, now they’re still optional but they’re included as part of what they’ve paid for in their care plan. So, when anyone sees that, it’s like they invested in something, they give it a lot more credibility, weight and seriousness. So, there’s more chance people show up.
So, what I’m seeing is outside of just your actual adjustment, you can start incorporating other things into this care relationship that the patient sees as part of the financial investment. And that what comes into play to document it legally and ethically in terms of insurance where if two people paid the same amount for their three months of care, two months of care but got different number of chiropractic adjustments, you can still keep the documented receipt fee the same and the buffer would be the other aspects you included in the relationship and put on the receipt that aren’t insurance billable.
Does that clear up your question?
Dr. Davis: Yeah. I understand what you’re saying.
Dr. Wagner: It gets a little complicated with the out of network when you’re going to be billing insurance or the patient is going to be to either knocked out the deductible or get reimbursed but that’s where you have to keep obviously your adjustment fee universal but you can start adding other things into the relationship as to the reason – maybe you’re 20 adjustments on paper for the insurance company equaled $800 yet they paid you a $1000. The other $200 came in through whatever you choose to incorporate in that relationship. Maybe it’s the lay lectures. Maybe it’s the email correspondence. Maybe it’s the video series you created for them. Stuff that isn’t applicable in the insurance world that’s going to be causing any issues.
Dr. Davis: Right. And so, okay… well majority of upper cervical offices are cash. And so, in a cash world…
Dr. Wagner: So, that’s the easiest model to do this in.
Dr. Davis: You’d find this to be the easiest way to do this?
Dr. Wagner: Oh, absolutely because you have no constraints by the insurance company. I mean, you have no constraints and no issues either by the insurance company or the seeds the insurance company puts into the patients’ minds with whether it’s EOBs or there benefit call or any of that. So, being a straight cash-based practice is the best model to do time-based care.
And also, remember this – let’s say your original care plans were the proverbial 36 visits over three months, which I don’t endorse and I don’t agree with. I just say that as an example.
Dr. Davis: Right.
Dr. Wagner: If you switch that to now just doing three months for the same price, your new patients are in no way shape or form going to think, ‘oh well, I’m entitled to 36 visits or that’s what my cap is.’ They have no idea. Remember, they’re coming straight from lay world. They have no idea. So, they’re not going to be comparing the 23 or 27 or 31 visits to an expected 36 visits. You see what I mean?
Dr. Davis: Right.
Dr. Wagner: I know also not to be comparing with their friends or other patients. Well, how many visits did you get over the three-month period. They’re not going to be comparing that either. That’s what happens in DC’s minds.
Dr. Davis: Got you. Okay. You found that by focusing on time, taking out a number of – because I understand what you’re saying that big number. Whatever that total number is could be intimidating…
Dr. Wagner: Exactly.
Dr. Davis: …it could definitely turn someone off. And so, talk about real world examples of people that have integrated this and the changes they found either in their acceptance of care plans or profitability or whatever. If can share me some examples.
Dr. Wagner: Yes. I mean I’m not going to say DCs names. You can go on perfectpatientfunnel.com and see testimonials.
Dr. Davis: Sure.
Dr. Wagner: …but it can, like most DCs are a little hesitant and nervous even though all of these is dropping a visit number in your words you’re saying and on the piece of paper that you show someone the care plan and immediately. It’s like their new patients and their patients show them how easy it is because, okay indeed just like you’re trying to work it out in your head right now. When the patient just like, ‘okay, that makes sense. Can we start now?’ Like it’s the patients that convince the DCs how easy this model works as soon as they just take the step and offer it, and that’s everything from new patient care acceptance, rate increasing to retention increasing like they’re not billing earlier during their plan or asking for money back or any of that. And in terms of investment, you can do the same investment options. You can do prepaid. You can do breaking into installments. Or you can still offer a per visit rate. And I recommend raising your per visit rate so the plan rate is more attractive and there’s more incentive for the patient to choose it.
So, everything from new patient care acceptance going up, retention going up and referrals because referrals are always based on the experience. And if people are hesitant like people might be feeling better with your care but if they’re hesitant in the process to get there like, ‘Do I really need to be coming two or three times a week for four whole months?’ They’re going to be hesitant to refer people into the same model even if they think the model can help their best friend. So, it’s all based on the experience.
Dr. Davis: Right.
Dr. Wagner: So, by taking that hesitancy or that weirdness out of the care recommendation, you open up a lot more ability and accessibility for patients to feel more comfortable referring to their friends into a situation and recommendations that makes more sense to them.
Dr. Davis: Right. I understand what you're saying.
Dr. Wagner: Oh and here’s another because you asked like what are the differences doctors are seeing? So, when you're not visit-based in terms of your revenue but you’re time-based, that also makes your schedule a lot easier. So a lot of doctors will practice for three hours on Saturday morning or all day Friday because the more visits they see equals their revenue and profitability.
Dr. Davis: Right.
Dr. Wagner: Now, when your time-based, it's not based on the number of visits you see a week or a day or a month. It's completely based on just how much money is coming in, which a lot of is based on the new patients coming to you but you don't have to feel like you need to be in on Saturday mornings to see 10, 20, 30 more visits for that extra revenue and income. And I completely endorsed doing the Monday through Thursday full-time model and having full three-day weekends, and this non-attachment to the visit numbers gives you that ability to condense your week and not work on the days where you'd rather be with your spouse or your kids or just doing your hobbies on a weekend.
Dr. Davis: Right. Okay. Now, when it comes to the actual schedule because I know there's a lot of doc's out there. I'm trying to think of what would be the questions that doctors would have in their minds about doing this and maybe some of their hesitations? And so, I know some of the issues that are centered around discounting in certain states and what not, can you talk about how that may be in fact – because my understanding is that in most states, you can give free visits, right? But discounting visits compared to what someone else’s is paying may be a problem. So, can you talk about that?
Dr. Wagner: Yeah. I don't really have much on that. I would say that would happen almost in the opposite model. So, let's say someone paid for the equivalent of what 20 visits. These were just hypothetical numbers and you saw them 24 times. You'd either have to discount each visit to make it fit into the 20 visits or give them like four free visits. Whereas, that never really happens in time-based because you're going to be basing your fees off of whatever your current. Like, whatever your current visit number plans are. You don't have to switch your fees up. You can keep at the same fee and if anything patients are going to be using less visits.
So, really you're going to be profiting more than feeling like you have to discount your visits or give away free visits and that's where in terms of a patient receipt or adding up like, ‘hey Doc, can I get an itemized receipt.’ That's where you'll add in other aspects of the care relationship and services that you provide to patients, which still means t could be a 100% straight upper cervical, and that's what makes up the difference between X number of visits equal $1500 but they paid two thousand. Here's where the other five hundred came in of investment.
Dr. Davis: Got you. Okay.
Dr. Wagner: When it comes to… I don't want to cut that off. Like, then there are what is it like ChiroHealth USA. There other services where I believe if you're a member of those, you can play around with your visit fees and have different tiers of pricing based on maybe different patient models. I've never used that but I think that's another way to make sure you're doing everything completely aligned.
Dr. Davis: Right. So, you’re in practice now, right? You're still currently practicing.
Dr. Wagner: I’m still practicing. I really don't see new patients anymore. I just see existing patients.
Dr. Davis: Okay. Yeah. If we took an example, so you said that you have a fee that’s associated with your pay per visit versus the fee that's associated with the time-based care. And so, and you said you mentioned that the fee for the per visit was higher than the visit for the time-based care. So, how was that work as far as, because you said not discounting your individual fees.
Dr. Wagner: Good question. So, if someone wants to not do your time-based care. So, there's not two different fees for, like the adjustment fee. There's your adjustment fee if they want to pay a visit per visit type of basis or there's your time-based care plan fee.
Dr. Davis: Okay.
Dr. Wagner: So, it's not like, oh a fee if you're doing it this way is $70 an adjustment and a fee for an adjustment if you're doing it this way is $50.
Dr. Davis: I see.
Dr. Wagner: It's straight. If someone wants to pay just visit per visit, which I always endorse giving that ability, you have one fee. What I recommend is to entice people to take advantage of the time-based plan is to raise your fees where you still feel congruent. If someone's paying you that fee, it's most likely because they're really only looking to utilize your care for a handful of visits at most. It's the kind of people, there's a certain percentage of people you're never going convince. They just want to see if and how quickly you can get them out of pain and they want to get away from you.
Dr. Davis: Right.
Dr. Wagner: So, raise your per visit fee. Cater to that person where if someone really is only going come in to you once, two, three times and then bail, even though you're recommending more. That at least you feel like you are compensated and you weren't ripped off by the patient, and so set your per visit fee cater to that scenario. And then, your time-based care, let's say it's a three-month plan or five-month plan or six-month plan can be more catered to however many visits you expect they're going use over that based on your original faith.
Dr. Davis: Got you.
Dr. Wagner: But again it's not like if they're doing the time-based, it's suddenly a different purpose at few price.
Dr. Davis: Right.
Dr. Wagner: They can say, ‘sure doc I'll do your three-month plan. We'll start off at twice a week but I'm going to pay per visit.’ Well then, they're on the purpose of fee.
Dr. Davis: Right. So, I've heard this talked about. It's essentially it's a case fee. Right?
Dr. Wagner: Yeah exactly, because it's not a membership fee.
Dr. Davis: Right.
Dr. Wagner: This is not like a $179 a month come as much as you want. Absolutely not. This is, you are in control of their schedule, their frequency. So, that's a great way to put it, it's a case fee not a monthly fee or a membership fee. Even though you may break a six-month plan into six installments, it's not a monthly come as you go type of fee.
Dr. Davis: Got you.
Dr. Wagner: Yeah.
Dr. Davis: So, this is your best recommendation for their particular situation, based on their x-rays, based on their exam results…
Dr. Wagner: Exactly.
Dr. Davis: …based on everything that you know. This is what they need.
Dr. Wagner: Exactly, for the results we’re looking for.
Dr. Davis: And this is how much it costs.
Dr. Wagner: Yeah and this is what's included. So, instead of saying 36 visits, you're going to say the chiropractic adjustments starting off at two times a week frequency for at least the first two, three, four, six weeks whatever it is for you clinically. And then include everything else you can. Put a monetary value in, in what you're providing to them. And even for upper cervical straight chiropractors, you could think of other stuff that you're providing value to your patients that even though you may not bill insurance or patient may not pay you outright for it, you can include that, and it's again increasing the perception and the value of the relationship you're creating with that patient in their case.
Dr. Davis: Got you.
Dr. Wagner: Yeah.
Dr. Davis: Yup. I get that completely. And so, then once they finish their case or their time-based care and they then convert to a wellness or a maintenance, how would you recommend handling that?
Dr. Wagner: Very similarly. So, you can create time-based for maintenance and wellness and just to give you an example, a new patient 3-month or 6-month case fee isn't going to be the same case fee as a wellness patient 3-month or 6-month wellness period of time. Obviously, they're not going to be using as much. So, that's really the easy part and Doc's after their initial care with a patient assuming the patient's doing really well and getting into more of a maintenance or wellness approach, you could either continue on a per visit fee basis, a wellness time-based plan, but that's the easy part. That's just, hey, picking what's congruent for you over a certain amount of time and what fee is that based on how often you think you're going to see the patient.
Dr. Davis: Perfect. Perfect. All right, so Dr. Josh I appreciate you bringing value again for our audience and want you to have a chance to talk more about what you're doing for doctors with the perfect patient funnel system, and also just how people can get a hold of you if they're interested in learning more.
Dr. Wagner: Yeah, absolutely. So, perfectpatientfunnel.com is the website. Literally, what I shared on this interview with you is one video in module 1 of 10 modules and 70 plus videos on practice strategies that after being a practice management junkie for 10 years and devouring everything I could in the profession, and realizing 98% of it was the same just through different personalities. I went outside the realms, found what actually works in healthcare and business for not just practice profitability but peace of mind because profits without peace of mind is not worth it. Put that into my practice, saw at work, started sharing it with colleagues across the country, saw it worked for them, realizing it wasn't just me, my personality, my technique, any of that, and that's when I felt the passion to share that with the profession.
So, what I pride myself on really is patient-centered, new patient communication that gets an easier yes, retention and referrals, and that can be applied to a per visit-based model. It doesn't have to be for time-based care. I share a lot of that on a free presentation at perfectpatientfunnel.com. It's a featured presentation right at the top. In an hour, I'll share with you patient-centered communication, more on time-based care as well as strategic marketing.
So, that's where I share with chiropractors worldwide. Look at the testimonials. See what fits you. Send me a message if you have a question. I'm happy to get on the phone, but that's where my passion is, is just giving chiropractors new strategies in clearly a new era of chiropractic for more growth and more ease.
Dr. Davis: Awesome. Awesome. Well, thank you doc. Again perfectpatientfunnel.com, you can find this information also at the show notes if you go to uppercervicalmarketing.com/podcast. We'll have that link there for you as well.
Again, thank you so much Dr. Josh. I appreciate your time today.
Dr. Wagner: Cool! Thank you Dr. Bill and thank you for the service you are providing to chiropractors as well.
Dr. Davis: Absolutely.
Dr. Wagner. Be well.
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