The #1 Threat Killing Chiropractic Growth: How to Plug Your Patient Leaks Today

 Welcome to the Chiropractic Deep Dive. It’s a critical strategy session, and you know it’s part of the Successful Chiro Podcast, and we’re bringing this to you on behalf of five Star Management. That’s right. If you’re here, you’re looking for fast, uh, actionable knowledge, and today we are tackling what Dr.

Noel Lloyd has identified as probably the single biggest threat to practice success. We’re talking about patient leakage. Yeah. And when we say leakage, I mean we’re not just talking about a few last minute cancellations. Oh wow. This is about practices that are doing great things, bringing in new people, but they’re still just struggling to grow.

They can’t get that momentum because the back door is, you know, it’s just wide open. So let’s really define this leak, because it’s a very specific thing, isn’t it? It’s not the difficult patients we’re talking about. Exactly. Not at all. The leak is when you lose your great patients. I mean, these are the people who, they love chiropractic.

They came in, they got results, their life is better. They’re gardening again, walking the dog. Yes, all those things, playing with their grandkids, they totally get the value, but then. Somewhere between that initial decision and becoming, you know, a long-term patient, they just disappear.

Yeah. And the symptom of that, it’s not just that the numbers are flat, it’s that you can’t get the best results for people because they don’t stick around for the full correction. Precisely. And that’s why Dr. Lloyd’s approach is so, so smart. He basically created this, um, this thought frame using five key stats, just five.

Okay. And for each of those stats, he’s identified the top five fixes that, I mean, they solve like 90% of the problem. It’s genius. So these are the five big ones. New patients show ups, then there’s a kept appointment percentage or KAP, right. The re-exam index, which he calls the Rex index, uh, retention rate in the mode.

And then finally, PVA patient visit average. And for today, we’re gonna dive really deep into the fixes for just those first three, the show up, the KAP and the Rex index. Because if you can just plug those three holes, the other two start to fix themselves, they improve dramatically. So let’s get into it.

Okay. Let’s do it. So. Section one that new patients show up, right? Yeah. It’s all about systems, right? Yeah. This is the person who signs up maybe at a health fair or something. They make the appointment and then they just ghost you. Never walk in the door. It is so frustrating. I mean, you’ve spent the marketing dollars, the staff time.

All for nothing. Right. And the targets here are, they’re pretty aggressive. For a referral, you should be hitting like 96 to a hundred percent. Wow. But for, you know, a new person who doesn’t know you, you’re trying to get that number from maybe 50% up to 66, 70%. Okay. Now this first fix is, I gotta say it’s a bit counterintuitive.

Mm-hmm. ’cause I know a lot of docs worry about creating any kind of friction for a new patient. Yeah. But a participant on the call shared something radical. The reservation fee? Yes. This was a real jaw dropper. This practice implemented a $60. Uh, refundable reservation fee, $60 60, and the logic is just so simple.

If you show up that 60 bucks is either refunded or it’s a credit on your account, if you’re a no-show, you forfeit it. The immediate reaction I’m having, and I bet you are too, is. My staff would kill me. My patients would hate that. Mm. What was the feedback? Was there pushback? Well, the participant admitted that the staff was really hesitant.

At first. They were worried. It sounded too transactional, but here’s the kicker. They had almost zero pushback from patients. When the ca frames it as, Hey, we’re holding this very valuable time just for you. It sounds like a premium service, not a penalty. Right? In fact, they reported one day where they had 12 out of 12 new patients show up, 12 for 12.

It just creates instant accountability. That makes so much sense. It shifts it from a casual idea to a real commitment. Yeah. So what else did they tie into that first phone call? Booking ahead. This was critical. You don’t just book visit one. You book visit one and visit two. The report of findings right there on the first call.

Ah, so you establish that continuity from the get go. You do. It signals that their care plan starts now, not after some vague checkup. It’s a process. They also talked about a prescreening system. Uh, the WHW intake. What’s that about? This is where your front desk staff become leaders. WHW stands for what?

How long? What have you tried? So like a mini history on the phone? Exactly. The ca asks, you know, what’s going on? Shoulder pain, numbness. Oh, okay. How long has this been happening? 10 years. Wow. And what have you tried before? Physical therapy, injections. Now that. That sounds like a lot of work for a ca who’s already juggling a million things.

How do they manage that without getting totally overwhelmed? I mean, chasing down records sounds like a nightmare. See, that’s where the system comes in. It’s not just data gathering, it’s intelligence gathering. When the CA knows the patient had an MRI at say Mercy Hospital two years ago, they can call and get the report before the patient even comes in.

Yes. It’s maybe 15 minutes of ca time that saves the doctor 30 minutes in the exam room and it makes that new patient feel incredibly cared for. It just screams professionalism. That is a huge differentiator. Okay, so that leads to the final piece of the show up puzzle. The logistics, the triple confirmation, right?

This is where you mix automation with a human touch. It’s a sequence. An email goes out two business days before the visit. Okay? A text message goes out 24 hours before, and then the personal phone call the business day before, and there was a specific trick to that text message wasn’t there? There was.

It’s so simple, but it’s powerful. The template says, reply, yes to confirm or reply RS to reschedule. It forces an active choice. No more passive. Okay. You have to engage. You have to make that final pre-decision, and the ca backs it up on the phone call. They’re systematic. They set the standard, and boom, your new patient leak starts to plug up right from day one.

So we’ve gotten them in the door. The show up rate is solid, but now the real work begins. Let’s move to section two, fixing the kept appointments percentage or KAP. It’s all about the existing patients, right? Yeah. Mm-hmm. Post day two, exactly. These are the people who have committed, but now they’re starting to miss appointments, and Dr.

Lloyd’s target for KAP is 85%. A lot of practices hover around 80, 82, but that 85% is the gold standard. The fixes here seem to be all about removing friction and just proactively reinforcing their commitment 100%. And the first one is so simple. It’s the custom fit schedule, which is basically just good customer service.

It is it’s front desk leadership. If a patient is always 10 minutes late for their 5: 30 the CA doesn’t just sigh and write it down. They jump in and say, Hey, it seems like 5: 30 is tough. Would 5: 45 work better? Or maybe we could try a lunch appointment on Wednesdays. You’re solving the problem before it becomes a pattern of missed visits instead of waiting for them to fall off completely.

But sometimes, you know, life happens and they do fall outta compliance. That’s when you need the next fix, the DC intervention. The mini re report. Okay. Walk me through this. So the patient is flagged as being out of compliance. What happens next? First, this is never a punishment. It has to come from a place of real concern.

The ca flags the appointment maybe with a different color on the schedule as a one-on-one. A special visit, a special visit, and the patient is taken to a private area, a consult room, or a cubicle, and the doctor pulls up their x-rays. The visuals. The visuals are everything. You have their films, cervical, thoracic, lumbar, right up on the screen next to a picture of an ideal healthy spine.

And the doctor just reviews it. Look how far we’ve come, but look at the correction we still need to make. And then they ask the big question. They ask the big question. Are we still on the path to corrective care? It’s not an accusation, it’s a recommitment. It resells the entire value of the plan in about two minutes.

That’s brilliant. But for that to work, the CA has to be on top of the data. Oh, absolutely. Which brings us to the third fix. Running an out of compliance report every single week, the staff has to track frequencies. If a patient is on a twice a week schedule, they only showed up once in the last two weeks.

They get flagged. They get flagged. The system has to find the problem before the patient disappears entirely. You can’t rely on memory. It has to be a report and another huge system fix is about looking forward. Yeah. Mapping all appointments. Yes. This has to happen right after the report of findings.

During that financial conversation. If the plan is twice a week for 12 weeks, you don’t just say, call us to schedule. You schedule all 24 of those visits. Right then and there, you put them all in the calendar, all of them. And the key is how you frame it, the language you use. Gimme an example. How do you make that stick?

You anchor it to their existing life routines. The CA will say something like, okay, great. We’ll book you for 5: 30 on Mondays and Wednesdays. So that’s right after work for you and just before you have to pick the kids up from soccer practice. So it feels like part of their week, not an extra thing.

It becomes non-negotiable, just like going to the gym or going to work. It removes that daily decision of, should I go today? Hmm. And all of these systems, all these reports and scripts, they’re all held together by the fifth fix. Which is the doctor’s compassionate leadership. This is the foundation. Dr.

Lloyd was so clear about this. The doctor can’t show anger or frustration that their schedule is messed up. The message has to be pure, heartfelt concern. What’s the key phrase there? It’s something like this. You know, I’ve seen more really nice people. Who feel better stop coming and end up hurting themselves more by missing appointments than by almost anything else.

I’m just gonna ask you to try a little bit harder for your own sake. That’s powerful. It’s accountability wrapped in care, and that’s what builds the relationship that makes all the other systems work. Okay, so we’ve got ’em to show up. We’ve got ’em staying compliant, but now we hit what might be the most dangerous leak of all.

The re-exam index. The rex index, this is when they quit before their first re-exam. It’s just a devastating failure point because if a patient quits before you can objectively measure their progress, it is almost impossible for them to become a lifetime wellness patient. ’cause they don’t have the proof, they don’t have the data.

There’s no bridge from corrective care to wellness. So tracking this Rex Index is non-negotiable. So what are the fixes? The first one is all about communication. Forecast the re-exam using table talk. Yes, this is the doctor’s job during every single adjustment. You are constantly subtly preparing the patient for what’s next.

You’re connecting today’s relief with tomorrow’s goal. So you might say something like you’d say to, uh, an older patient, Hey, remember just two weeks ago when you couldn’t even bend over to plant your tulips without that shooting pain? Now look at you. I think you’re gonna be a fantastic candidate for our wellness program

once we see these structural changes on your re-exam. You’re always pointing them to that next milestone. Now, the participants on the call pointed to a specific danger zone, right between visit six and eight. They called it the mode. What’s so special about that period? The mode is where the pain is mostly gone, maybe 70, 80% better, and the patient’s internal story changes.

It goes from, I have to fix this pain to, well, I feel fine now, so why am I still coming and spending this money? The initial motivation is gone. It’s gone, and if you haven’t built the case for structural correction, they’re gone too, which means the fix has to be aimed directly at that psychological shift, shifting the conversation at the mode.

Precisely around visit six, the whole team starts proactively answering the questions they know the patient is thinking. The doctor will say, you know, you’re gonna be driving to your appointment soon. Feeling perfectly fine. Do you remember from your report why it’s so important we continue to strengthen and stabilize the spine even after the pain is gone?

You’re constantly reinforcing the day two conversation constantly, and one participant put it so well, he said, if a patient quits before their re-exam, that is never the patient’s fault. It is a failure of leadership. That’s the core of it, isn’t it? Lead don’t chase. That’s the whole philosophy. The purpose of the re-exam, the timeline, what to expect.

It all has to be so clearly pre-framed on day one and day two that the patient understands. It would be, I mean, absolutely foolish to quit before that measurement. And there was a really practical scheduling fix for this too, right? For practices with limited hours, oh, this was brilliant. Practicality for bumps in the road, if your office is only open, say three days a week, your care plans should only be for two visits a week.

Wait, why is that? That sounds counterintuitive because life happens. If you schedule them for three visits a week and their kid gets sick or they have a work emergency, they immediately fall behind schedule and they get frustrated. They get frustrated. The re-exam date gets pushed back and they feel like they’re failing.

But if you schedule them for two visits, you’ve built in a buffer, they can miss a day and still be on track. They feel successful. That’s so smart. You’re managing their psychology, not just their spine. Which I guess leads to the final fix. Building that teaching muscle with the DCCA book club. It’s so fundamental.

The whole team Doctors Cas, everyone meets once a week to review books on leadership. On teaching. On communication. Yeah. They’re learning how to lead people through a complex process. They’re becoming better guides, and I think that gets to Dr. Lloyd’s biggest point about the whole industry. It really does.

I mean, your practice doesn’t have the marketing budget of a big pharmaceutical company. You can’t educate the entire public. So all of that responsibility for teaching, for leading, it falls on the DC and the team inside the four walls of that office. Your implementation of these systems is directly tied to your retention.

Wow, that was a phenomenal deep dive. So we covered the three big leaks, the show rate, which you could fix with that reservation fee and solid pre-screening, the KAP percentage, which you manage with DC interventions and those compliance reports. And finally, the REX index by leading the patient, passed that tricky pain relief.

You know, the theme from this whole session was just so clear. Success in this profession isn’t about working harder, it’s about systemizing smarter. You’re either leading the patient with these clear systematic steps, or you’re just constantly chasing them. So that brings us to our final thought for you to take away.

Given that it’s all on you and your team to be great educators and leaders, what is the one system, just one that you’re gonna implement today will be that $60 reservation fee, the out of compliance report. Or maybe just perfecting that appointment mapping script and this deep dive, which was all about making your practice systems just thrive, was brought to you by Five Star Management, your chiropractic consulting company. To get started on building these exact systems in your own practice,

the ones that really do turn happy patients into lifetime patients, we really encourage you to book a free call with Dr. George Birnbach. The link is right there for you in the show notes. And don’t miss our next deep dive. We are always analyzing the absolute best strategies in the profession.

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