So, the stage was set for abuse.  Many chiropractors advertised “NOOPE”– No Out of Pocket Expense in their ads.  They would waive deductibles and copays, bill office visits with multiple modalities (stim, traction, exercise, diathermy, ultrasound, etc.) and the insurance would typically pay around 80% of the bill, no questions asked.  Since chiropractic coverage was new, it would be several years before cost benefit analysis could be done.  In the meantime, chiropractors back then were “raking it in, getting over $100/visit.  Some retired early.

Well, insurance companies figured out what was happening.    There were no oversight/utilization review systems;  no best practices guidelines to determine appropriate covered services, and so on.  This environment was breeding abuse of the system (overtreatment) and restrictions started to make their way into chiropractic coverage.  Managed Care organizations like ASHP and ACN started to come on the scene, which severely reduced coverage for chiropractic services.

Now, as 2010 approaches, amidst the biggest recession since 1930, employers are still offering plans with chiropractic coverage, but with very high deductibles and limited visits.  Many major plans go through a chiropractic managed care company like ACN/Optum Health, offering a paltry reimbursement that hasn’t increased with inflation over the last 10 years (figure that one out).

And, cash practices are not as easy to run these days either.   Back in the 80′s, it was also much easier to sell prepaid plans and “maintenance” packages– often running $4,000- $6,000 per year.  The novelty of “bone on nerve” faded some time ago, and people just aren’t into it as they were back then.  Plus, chiropractors were warned that they could get into trouble for offering prepaid maintenance care packages, because it resembles acting like a health insurance company, and of course chiropractors don’t have the license to conduct that kind of business.   Lastly, the recession is definitely affecting cash practices as consumers don’t find chiropractic maintenance as a necessity, compared to things like mortgages, food, and utilities.

I wrote a book that addresses the changing nature of the chiropractic business model, and teaches you how to make your practice resistant to these adverse changes going on.  Go check it out, it can save you thousands of dollars and a lot of heartache.  The key for chiropractors is to manage costs, have laser sharp marketing, and hedge your business.

Twitter is microblogging.  The way to use it is, you create an account and choose to “follow” certain people.  This means you wish to receive their Twitter posts, or “tweets.”  People in turn follow you and receive your tweets.  You send messages (limited to 140 characters) to your followers at your leisure.   The message can be of anything on your mind, like what you are currently doing; a book you want to recommend to your followers, and so on.

Of course, there are those who  use Twitter as a marketing tool.   The idea is to first build up familiarity with your followers; earn their trust.  Give them some useful info sprinkled in with the mindless tweets (…I just shot a hole in one, hooray!…).  Then, as your relationship with your followers matures, tweet subtle solicitations, or tweets that identify the services you offer.   When feel that you have built up a comfortable relationship with your followers, you can start tweeting special offers.   Do this only when you’ve gone through the steps of establishing trust.  Never tweet a hard sell too early; it will turn off your followers and they will cut the cord.  As in all social media platforms like FaceBook and MySpace, overt advertising to your friends is frowned upon.  You have to build up to it.

So, should you as a chiropractor use Twitter to build up your business?  My recommendation is to first get your email marketing campaign set.   That should be your first priority.  Email has been around much longer; more people have an email account than a Twitter account, and in most cases their email application is already opened up on their computer (whereas they have to log onto Twitter to touch base with their followers).  When that’s done, give Twitter a shot.  What’s nice about Twitter is that you don’t have to worry about your messages getting sent to the spam folder, because people chose to follow you.

My feeling is that the jury is still out on Twitter.  There may be a “tech backlash” against social media platforms as they tend to consume a lot of personal time.  We’ll see.

Dan Perez, DC

But before you throw out the baby with the bathwater, I want to tell you that despite the negativity of commercial email, it can still be of great use to you.  All you have to do is to stick by these fundamental rules:

1.  You have to ask your patients/ prospective patients for their email address, and tell them how you will use their email.  Taking their email from the new patient intake form (if you have this field) is not enough.  The patient must “opt in” to your email list, on their own (after you tell them the benefits of doing so, of course).

2.  You have to provide useful, pertinent content; not a bunch of fluff.  Think about the level of content that YOU would want to receive.  Since we’re chiropractors, examples would include instructions on how to stretch properly, the proper way to set up your workstation to minimize strain, and how to apply ice and heat to a new injury.  Go the extra step and include video in your emails.  Now that’s great content.

3.  You need to make unsubscribing easy.  If the patient wishes to no longer receive your emails for one reason or another, you need to have an unsubscribe link at the bottom of each email message.

And in order to make it all work, you’ll need an email marketing software that will handle all the email subscriptions, email delivery, and unsubscribes.  There are several to choose from; the one I use is GetResponse.  GetResponse is web based, and is a monthly subscription of about $15.00 a month.  You can set up multiple campaigns.  So far, I am really excited about its easy to navigate, user-friendly interface.  The learning curve is quite short.  Check it out!

Dan