Dr. Franson: Hello Remarkable, I’m here with, I don’t even know if I should introduce this guy, it’s Dr. Patrick Gentempo and I’m Dr. Stephen Franson. Thanks for joining us for our coffee break. In our coffee break passages, we get together and meet with some thought leaders. Obviously, you are one of the big dogs in our profession, and I love to be able to find out what you’re up to and share great ideas with my people. We’re going to spend about 5 minutes picking your brain. I know you got this kick ass new program that I’m excited about, and you’re excited about. I’ve seen the buttons, I should have my button on right now.
Grab the button. Isn’t it fantastic! We’re here in Caldem 2013 in Costa Mesa, we’ve had amazing weekend. Everybody’s sharing their big ideas. I wanted to grab Patrick and have him let us know what he’s up to. Talk to me a little about what’s going on.
Dr. Gentempo: If this is the Coffee Break, where’s the coffee?
Dr. Franson: I know…
Dr. Gentempo: I’m kidding.
Dr. Franson: We’ve had about four coffee breaks today, we are so wired. We’ve had so much coffee today, we decided to do it without the coffee on this one.
Dr. Gentempo: This might be the wine break.
Dr. Franson: That’s a great idea.
Dr. Gentempo: So what’s going on, we’re here talking here about how to control your life and energy with chemicals. No, the opposite of the chiropractic message. What’s going on is that chiropractic is great, it’s got lots of challenges and it’s got lots of opportunities and that’s the way it’s been since it started and probably will be for the next hundred years. In particular, do you want to give me direction…
Dr. Franson: Yeah, no I do. So I know you have this new initiative that you’re launching
Dr. Gentempo: Freeform
Dr. Franson: That is solving a very important problem. When people ask me what I’m doing with the Remarkable Practice I’m just flaunting our program itself solves another set of problems in people[inaudible]. We’re trying to solve this replacement problems we are seeing in chiropractics. I think that doctors in chiropractic today are just addicted to trying to find new patients and that has created its own sort of cottage industry that is taking full advantage of that.
Although I think new patients is critically important, it’s expanding our mission but replacement is a very unhealthy thing to see in practices. I think that retention is key, chiropractors do their best work when we’re seeing people over the longest period of time. In the Remarkable Practice our objective is to try to create the practice that allows the people the opportunity to stay for a long time and then because it is remarkable by definition they’re telling others and that generates more patients. I know you’re solving a very important problem that I’m seeing with my clients and with my people and that is the burden of insurance.
Dr. Gentempo: Yes. Freeform, this particular project is about ending insurance dependency in chiropractic. I think the number one death threat to the chiropractic profession right now is insurance dependency more than anything else I see going on. That is the thing that can pull the rug out, has pulled the rug out and really continues to be a weakness for us. It’s completely connected to what you just sited in so far as why you turn over new patients because basically they’re being managed on an allopathic model, which is what insurance is. It is limited medicare for limited conditions over a limited period of time then that’s over. They’re trained in the orientation to you to say that I have coverage for this care, coverage ends then this care ends. Those two things should have never been connected.
They have coverage for allopathic intervention, it’s good that they do but if what we are selling is something other than that then we have to design our practice models to reflect that. One of the big distinctions I would make is that a non insurance dependence practice, and I use that word instead of cash because cash means something else, which is okay, it’s good, it just means you bill no insurance, you accept no insurance, you’re not on any plans, you are 100% just people pay you, no third parties.
Dr. Franson: It falls under that definition, but it’s not synonymous.
Dr. Gentempo: It falls under that set, but what I’m talking about is kind of the inter step towards the cash practice, which is having at least 75% of what you collect come from patients and 25% insurance. If you utilize insurance it somewhat tactical manner in your business model, and you do it right, and you don’t confuse it with what the long term chiropractic care and benefits are, there’s a way to do that and there’s a way to do that right. At that point if you’re at 25% insurance, going to full cash is pretty easy.
Ultimately, if you understand nothing else about what we’re going to talk about you’re going to understand this non-insurance dependence practice isn’t a type of practice it is a standard of business for any type of practice and that’s the key. I don’t care if you have a [inaudible] practice, [inaudible] practice, or say I have a pediatric practice, I have injury practice, I have this I have that, I’m talking about the different types of practices they have and look at non-insurance dependence as another type of practice, and it’s not. It is a standard of business for any type of practice. Really the question you ask yourself is what are your business standards. What are you willing to do in sense of transacting and trading with your community as far as your services for revenue. For me, I think we have to raise those standards. There’s a package deal there and that’s why I think what you do is extraordinary ties in with talking about a Remarkable Practice is that if you’re saying in a nut shell what is the goal about, how do you create a non-insurance dependent practice, it is about bringing your A-game.
Dr. Franson: Right.
Dr. Gentempo: It’s about you can’t be lazy and do it. Now you can get lazy with insurance and say I’m just going to keep charging the system and get my limited visits and get insurance companies to pay me and maybe I don’t have focus so much on education. I’ve actually had that feedback too, "God doesn’t it get exhausting because if you’re not going to take insurance, you gotta really work hard to educate people." I’m like yeah, that’s what it’s all about.
Dr. Franson: But to get to redirect some the energy that you’re spending pulling your hair out with the insurance companies.
Dr. Gentempo: Of course, listen if you look at education as drudgery, you gotta get a check up from the neck up right. You should be excited about the opportunity to educate people. It could be… Have you had this experience: you’re dead tired, it’s the end of a long day, it’s maybe 12 o’clock at night, you’re hanging with friends. You feel like you’re just drowsy, you want to go to sleep and somebody brings up something that is exciting
Dr. Franson: Hot topic.
Dr. Gentempo: For me if it was the philosophy of chiropractic, then next thing you know I’m so full energized, or I could be someone who wants to talk about vaccines, I’m fully energized.
Dr. Franson: It’s 2 am before you know it.
Dr. Gentempo: Exactly right, and you’re gone! When the idea or the opportunity to educate somebody about chiropractic about health about [inaudible] about all those things that’s the stuff you get your juice flowing. What drains you is saying "crap I gotta fill out another report."
Dr. Franson: Right
Dr. Gentempo: Now I gotta this claim denial, they want more documentation. I gotta post payment audit. That’s stuff will drain the heck out of you.
Dr. Franson: It’s not coffee, but it’s gonna do it. Cheers.
Dr. Gentempo: Cheers.
Dr. Franson: Thank you. This is, I have personal experience with this obviously. I love the fact that you’re solving this pain, because I went through this pain, and I’ve been in practice for 16 plus years. The first, I think, 8 years we participated in the insurance thing. We really did our best to try to walk that tight rope between having integrity around our recommendations are there yet at the same time trying to make sure the patients can take advantage of what ever insurance opportunity was there.
The financial benefits of that, all that, even inside of it very principal, very structured, great education, communication type of practice yet we still had some insurance going on, and I think we probably at one point at 700 a week we decided 80 % of headaches come from 20% of our cases and those the ones on insurance. I made out. I remember it was at one point, our goal, the goal in revenues, we wanted to go to 1000 a week that was the big thing at the time. I knew we couldn’t do that, it was one of the things that were, that was holding us back from being able to do that. We decided that we couldn’t just simply divorce ourselves from this pre-existing agreement that we had with our patients and restructure it. We knew it needed to be a process.
The process was very deliberate, and we educated our patients in the difference between the allopathic model, and the wellness model. It was really a focus education on this actually what the insurance company tells doctors, gives the paperwork we get back from the doctors, highlighting what they don’t cover for. I got my practice pissed of at the insurance industry. I taught workshops about it, to heavy philosophical workshops and it was a 90 day movement and by then end of it I was like you know what, I knew everyone was pissed off, "That’s it, we’re all done. Whose with me?" Everyone was like "yeah!" So it wasn’t just an overnight transition.
Dr. Gentempo: It isn’t.
Dr. Franson: I know you got a system now that’s teaching us.
Dr. Gentempo: Exactly.
Dr. Franson: Talk to me about it.
Dr. Gentempo: Just to be clear, we don’t recommend cold turkey. I see people get to the "I’m mad as hell, and I’m not going to take it anymore" mode, and I’ve seen cold turkey it ain’t pretty. You want to have a structure process through the conversion. What we have identified, myself and my partner Dr. Troy Dukewitz, is a seven step process. There is literally seven steps of conversion that you go through that deals with the varying parts of your practice. Starts with first knowing reality, which is very very critical. We have a 157 question questionnaire that digs into aspects of your practice that you’re not even thinking about right now. In order to change reality you have to know it.
One of the premise we offer it from is that all suffering starts from one’s unwillingness to admit reality. That’s the old Buddhist saying right. Even thought you might not want to look, and its human nature not want to look at the stuff.
Dr. Franson: The crevices.
Dr. Gentempo: Yeah, crevices. You gotta get in there. That first step is a big one, knowing reality. The second step is the head space conversion, because its head first all else follows. Most people want to skip to step four, which is the procedural conversion. "Okay how do I change the consultation now, how do I change finance, how to put these packages together?" All the important procedures, but it’s not the procedure that gets the results, it’s who the person is doing the procedure. It’s your head space first. We have to know what is your philosophy with chiropractic, what is your purpose or your practice, what’s your goal for every patient that comes in. Real important what is your philosophy of money. These are all questions that have to be answered by you in a meaningful way so that you organize all this and once you have that down, then the next step is to go to your team. Now your head is right go to your team, covert your team. Very critical.
After you convert your team, now it’s time to start converting the procedures in the office to align with this. Its like phase in, you honor the commitments you have, but you start phasing off of those and bringing in this new process.
Dr. Franson: And every new patient is a new client.
Dr. Gentempo: Every new patient is the new start. The old ones you honor. Then there’s an assessment, if you’re a participating provider in any carriers, which ones do you let go right away. Start moving them…
Dr. Franson: Get rid of the bad stuff
Dr. Gentempo: Get rid of the bad stuff, exactly. Then once you have that done, then you have your financial conversion which gets into now the whole financial dynamics of the practice. Because it is a financial maker to a large degree, greater revenue comes from how do you collect it, what the distribution of that revenue is, overhead considerations, all that stuff has to come in to play. So you have to look at that financial, what kind of packages are you going to offer your patients. There is no right or wrong here, there’re tons of ways to do it but you have to pick a way and you got to make it so once you do that then it’s the educational conversion.
Now that you are set up, the only way to succeed in a non-insurance dependent practice is to educate like crazy. That’s what you’ve been talking about, it’s totally critical. That to me is the fun part, I love educating people. Lastly…
Dr. Franson: That’s not just a step in the check list. We’re talking about its cultural, it’s the DNA of the practice. We talk about Remarkable, you’ve gotta to, that means that people are talking about you outside of the clinic. Give them the story, they have to have a story to tell about you outside of the clinic. Give them the story, they have to have a story to tell about you and it has to be bigger than, you know…
Dr. Gentempo: It’s got to be [inaudible] com pellant, there’s ways about it. It’s kind of what I’ve said, and I’ll probably [inaudible], you know people talk about their purpose and their mission statements, these aren’t words on paper, and these aren’t corporate exercises. It had to be a state of mind, if it’s not a state of mind then it doesn’t work.
After the education conversion, then the final stage is the marketing conversion. Now you bring in the right people. The only way to market is I’m on the list, I’ll be on your insurance list, you’ll pay me I’ll put you on my list. As compare to, you know what, there is this entire range of marketing that chiropractics could and should do that is low cost, very effective, and targets the right kind of people to bring them in. The big mistake we make in that realm is: Oh since everybody can benefit from chiropractic care we just market to anybody and everybody. It doesn’t work that way, what are you passionate about? What is… Who is your ideal patient? That’s who you oughta be speaking to, and I’m not here to moralize. I don’t know if that is kids, families, sports athletes, injuries, you know what ever it is you are passionate about is fine, but know what that is and go after it.
Dr. Franson: That’s right.
Dr. Gentempo: I can tell you some of the things practices I know collect 2-3 millions a year cash are narrow focused practice, ADHD practices, Autism practice. One guy has an Autism practice, well over 3 million dollars in collections. He has a four month waiting list to get into that practice. Now does he see some people in the process that not have autism? Sure. But what does he speak to what is he known for what is he get into? He’s narrowed, it’s kind of like solving the riddle, he’s got the specific community that he speaks to because that is where his passion is.
Dr. Franson: He’s a sniper.
Dr. Gentempo: Yeah. He’s sniper and that’s what you need to be if you, in my mind, if you want to have people hear your message.
Dr. Franson: Awesome, excellent. All right folks, so you heard me say it a million times, bottom line is we are moving away from this medical model, the medical insurance model. Don’t try to play a game, which you can’t possibly win. Do not sell one product and try deliver another. At the end of the day it starts from day one, you gotta be able to tell the story, and always remember that they absolutely need you. People can’t afford everything that they want, but they can afford anything that they want. Patrick, help us all to untangle the quagmire that is the insurance lie, and helps tell the truth about chiropractic.
Thank you so much…
Dr. Gentempo: Right on, my pleasure
Dr. Franson: … for everything you do on behalf of all of us in Chiropractic. You are an extraordinary man.
Dr. Gentempo: And so are you sir. Should I tell them where they can get information.
Dr. Franson: Oh yeah please do.
Dr. Gentempo: Go to freeformchiro.com that easy. Check it out, we have a lot of videos and other stuff that you can look at that I think will be helpful for you. This is a movement that’s gotta happen. I appreciate the spirit you are bringing, and the leadership that you show, and the future is very bright if you know how to wear the right sunglasses.