Ronda Nelson: Well hello friends, and welcome back to The Clinical Entrepreneur Podcast. I am your host, Ronda Nelson, back for another week of some pretty awesome clinical tips and insight. This is one of my most favorite things to do is to just hop on here with you every week and share what I think are key strategies for practitioners, wellness practitioners specifically, who want to grow and scale their practices. We often get stuck in the rut of fee-for-service. We show up, we see patients, we generate revenue, we pay our overhead, there’s some leftover for us, and then we do the same thing every day. That can easily lead to burnout or dissatisfaction. We get bored because we’re wired to always want to do something else. Like what else do we want to do? We’re always thinking like business owners, “What can I do to serve better and improve the bottom line of our practices?” And that’s what it’s all about.
Ronda Nelson: Today we’re talking about how we can generate additional income in your practice outside of that fee-for-service. If we can’t generate other revenue streams coming in, you and I are never going to be able to take a vacation. We will be thinking about how many visits it will take to pay for the vacation, for the time we’re out of office, for our staff, and we never end up taking a vacation because of it. We need to take the financial pressure off of the fee-for-service model and place it on recurring revenue or additional income streams.
I want you to just keep an open mind and think, “Wow. That idea might work,” or it might be another one you’ll say, “Nope, not my style,” and that’s okay. But let’s see if I can throw out a few things here to help you be able to generate that additional revenue. So, first of all, I want to set the stage here. We want to talk about fee-for-service. One thing that fee-for-service does or does not do is it puts a ceiling on our income because there are only so many hours you can work in a day and there’s only so much you can charge for your appointment. That’s it. So, we have to charge what the market will support. We typically know if you have insurance, there’s extremely poor reimbursement and it’s getting worse by the week. Insurance is definitely a way to make you work harder and go out of business sooner because you’re working harder to try and keep up with the paperwork. Having to pay a biller and then getting terrible reimbursements from the insurance company is why I am a strong advocate for moving away from insurance and into a full cash practice.
And then in the meantime, your overhead could go up. You may have to move to a new building or you may have to hire another team member but your reimbursements aren’t changing. So, overall, your capacity to grow is limited, and that’s what we want to get away from. The patients want more of you and they’re not satisfied with just what the insurance will pay for. They want more help but what’s the cost? The cost to you, the cost to your practice, the cost to your overhead? There are three basic criteria when thinking about additional revenue streams. Number one, it’s okay when you’re thinking about creating an additional revenue stream that it takes you more time upfront to put it together to organize it. I’m talking about freeing up your time and allowing you to have more revenue but I want you to remember that it takes time to put something new together, just like it takes time to learn a new skill. An initial investment of time is one of the criteria because what we don’t want is additional revenue that requires more of your time. That’s what we’re trying to fix.
Secondly, they should be in large part able to be managed by your staff. Not entirely because you may need to have some say about the content or whatever it is that you’re doing, but you should not be managing it, your team should be. And if you are listening and you are a solo practitioner, a solopreneur, then there are so many places where you can get help. Even if it’s just two hours a week, you can pay a virtual assistant $20 to $30 an hour and can pay them for two hours a week to execute this. If you set it up correctly, you should still be able to make money. And the last kind of criteria is if you can put the thing on autopilot so that it just kind of does its own thing and it doesn’t require your time after that initial set up or your staff’s time.
Let’s look at the five ways that I think are pretty easy to get more revenue but please, don’t try all of these at once. Number one, monthly membership. The reason I love a monthly membership is that it’s very easy to set up. Generally speaking, you’re going to provide one service a month and you might do it at a slight discount or maybe not. Let’s just say that you’re a chiropractor and you have an adjustment. Your fee for an adjustment is $55, so you charge $55 for the person to walk in the door, get an adjustment, and walk out of the door. There’s nothing else involved with that. If you wanted to do a membership, you would do a membership for one or two adjustments a month. Pick one treatment and set your fee higher. In my example, instead of having a monthly single one-off visit that is $55, you instead set your single fee at $65.
If your regular’s one-off fee is $65 for a treatment when you create a membership that has one treatment a month for $49, how much more appealing is that? Sign me up. If I can come in once a month for $49, then if I come in two to three, or four times a month it’s still $49. I know that patient is going to pay for that recurring membership. You really know that your fee is actually $55 and you’re discounting it to $49. That’s what I consider a slight discount, but that $6 change isn’t going to make a big enough psychological impact to make them want to do that. Instead, you want to up your normal single one-off fee, make it a little higher than everybody else in the area, and then do the membership. Works every time. Worked for me. I’m in one with my chiropractor here in Las Vegas, and I love it. But the trick is that you have got to get your prices up and say, “We’re going to have to have a price change. The individual price is going to go to this but if you’re in the monthly membership, it’s this.” And they will all choose the monthly membership because it just automatically bills to their credit card. They don’t have to think about it.
Another one you can do is you can do a membership that is just like curated recipes. You source those recipes once and use them all year. In fact, you can even ask your front desk staff to do this or hire college students and say, “I want paleo recipes. We don’t want any of this. Look for these ingredients.” Set the criteria and set the price point at $9.99 a month. Patients will go for that every day of the week if someone will give them good, healthy recipes, especially from you, the practitioner, because you’re the one they trust. So, recipe memberships are great, especially when they come from practitioners.
Number two is a DIY course. I always pick on menopausal women because I am one. But you know that when I, as your ideal patient, walk in the door, you think, “Oh, I wish she knew about how her hormones worked. It would make the conversation that I’m going about to have with her so much easier.” Boom, there it is. What I love to do is do a DIY course that I might be able to take from you for $29 or $39, very inexpensive, and the patient can actually learn more about what’s happening in their body before they come in. I don’t give them the whole secret like dosing or the types of supplements or anything like that. But you can do a video recorded lesson about removing body care products or looking for possible hormone contaminations with face products because that can lead to a disruption of hormones in menopausal women. Do you see how you could address the different components of what my struggles are? And you’re giving me a little bit of a roadmap so that I know where to go on my own. But what often happens is they’ll get to the end of your $29, $39 course, and all of a sudden, that patient calls back and says, “Doc, I took your course and I loved it, but I really want you to help me finish this off.” I think that’s a wonderful way to serve the people that you wouldn’t otherwise be able to serve because of a financial limitation. Or you could do a short kind of a course that you can market as a prep or an intro for free so that you can get them in the door. The downside to DIY courses is they do take a little bit more time to prepare but can have really great reach.
The third thing you can do is hiring secondary staff, meaning you can bring in a massage therapist or health coach and have a multidisciplinary type of clinic. Or if you did bring in another practitioner that has the same skill as you and you just cochaired, they can start to generate that revenue for your practice. And now you’ve got income coming in that’s greater than what is going out to pay for that staff. You can get a health coach, patient coordinator, or patient support coordinator to do the HSR and just set that up, and that then becomes recurring revenue. Think about other services or other people that you can bring in that serve your ideal population, your patient population, but also create that recurring revenue.
The fourth one is group visits and although they do take a little bit more time to set up, it is probably the most profitable way for you to leverage your time. Let’s think about this in the context of liver purification. For example, if you were going to do a 21-day liver purification, you could invite all your patients to participate with you, do a weekly call with everyone participating, and send out daily emails about what they might be experiencing during the course of their purification. That right there is a perfect example of a group visit or a group activity. All of these people that are in your liver detox are not only paying for the supplements, but you’re charging them maybe $200 to be in the challenge with you. Well, if you had 10 people in the challenge, you now have not only the profit margin that’s in your supplements, but you also have that margin that they’ve paid to actually be in the challenge and to have that coaching with you. Now, just with 10 people, you made $2,000 and it took you three phone calls, or three Zoom meetings. You’re going to meet with them before it starts, once in the middle, and once at the end or however you want to set it up. So, you take that $2,000 that you just made and you divide that by the time that you spend in that group coaching call with them. Maybe you only have a 30-minute call. Your dollar per hour, my friend, just went through the roof. You can do any kind of a group. It’s almost like a challenge, but you can set that up and it really does allow you to scale up your dollars, your fee-for-service, and the time that you’re devoting.
Lastly, VIP treatments. This kind of goes along with the monthly membership, but not really. I love to call it a VIP package or a VIP membership. You can even call it a VIP elite if you want. Now, here are some of the things that you could include in this. Package your services together for three or six months, or even a year, almost like a concierge type practice where you pay X amount of dollars a month or you pay X number of dollars for the whole year and this is what you get. You can include a certain number of monthly visits or a yearly check-in if that’s how you want to structure it. You can set them up to be individual or family. That just means that it might be one-on-one with an individual or seeing the whole family. You could include lab testing if you wanted and it’s important, I believe, to get a good comprehensive blood panel on your patients at least once a year. You could give them a little bit of a supplement credit that’s included almost like a discount, but you’re just giving them a credit for a certain number of supplements. You could set it up that you meet with them monthly, quarterly, or whatever feels right to you as far as having that real VIP experience. And then you might have a back-end portal and one of the lovely platforms that I really appreciate the work they’ve put into it is Practice Better. If you’re a virtual practitioner, you may know of Practice Better. If not, Practice Better would work great for a VIP elite type package. It depends on the price you want to charge but you could include scans each month, or a massage each month. But build all of that in and then make sure you’ve got a nice profit margin in there and then you’re going to roll out the red carpet and make them feel like they are the bomb in your world.
Now, let me go back over those 5 ways just because I know this was a huge knowledge information dump. Number one, monthly membership where you’re just including a service and they just pay every month for that one service. Number two, you could do like an intro course or a DIY course for someone who can’t afford it, where you’re laying out your plan and you’re kind of telling them what to do but you’re not giving them the keys to the office. Third, you can hire health coaches or other people to support you so that you are promoting them and they are bringing people in, and then there’s that a profit margin on that. So as they’re working, you’re still making income, your business is making income, but you may not have to be. The next one, number four, is group visits. And then the last one is that VIP treatment where you’re really going to roll out the red carpet for more of a concierge-type service.
Now, here are your action steps. Number one, keep an open mind and be creative. Number two, choose one that will be the easiest to implement. And honestly, I really do think that the monthly membership is probably the easiest. Don’t overcomplicate it. Next, layout your plan. If you have an office manager, a spouse, a friend, someone that you can sit down with and say, “Okay. Here’s what I’m thinking this is going to look like.” Play with it a little bit. Make sure that it feels right to you. It’s okay if you have to change it as you go if you find out it’s not working, that’s okay.
Without these additional revenue sources or streams coming in, you and I are tied to that fee-for-service. There would always be a ceiling to your income and that’s what I want you to get away from.
Ronda Nelson: That’s it for this week’s episode of The Clinical Entrepreneur podcast. If you loved this information, I would love it if you would rate and review this podcast on Apple or iTunes or wherever you are listening, and then make sure that you subscribe so that you always get these in your inbox. This is actually Episode #46, so we have 45 other awesome episodes that you can go look at. Head to RondaNelson.com/Podcast. And on that note, if you’re feeling a little overwhelmed, which I don’t blame you, but if you are and you need a little help kind of sorting through or sifting through those ideas, I am more than happy to help. All you have to do is go to RondaNelson.com/Strategy and schedule a free 15-minute call. You and I will hop on the phone and I’ll help you get unstuck. You can choose what revenue model will work the best for you and I’ll give you some tips and pointers before you head off and get moving. We’ll work through all the details and I’ll help you get a game plan to get started. That is it for this week’s Clinical Entrepreneur Podcast and thank you again so much for joining me. I appreciate you more than you know. Until next time. Take care, my friend. It’s time to go run your business like a boss.