PVA: How to Dissect Your Practice to Find Where the Problems Lie and Fix Them

US Chiropractic Directory

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 From the Desk of Mark Studin DC, FASBE(C), DAAPM, DAAMLP


PVA: Patient Visit Average

How to Dissect Your Practice to Find Where the Problems Lie and Fix Them
 

What you tell me as a consultant about your practice is usually inflammatory bravado. I have heard it all because I have also said it all. I have heard that, "I am a healer. I like to give my patients personalized attention. I would have more PI patients, but everyone in my community is on the take and I will not do that. I don’t believe in wellness care..." and every other excuse. Oh, I forgot, "My dog ate my homework!" Get the picture?
 

The only real metric is the hard numbers of your practice and the statistics they generate. Consultants nationally utilize the statistic of PVA as a prime indicator of how your practice is performing and the type of practice you have. PVA gives you statistical insight on how to fix problems related to the retention of patients. What most doctors do not realize is that your PVA is the bellwether for your success and the barometer for the future and it all starts on the first visit of the patient.
 

Patient Visit Average
 

Total number of Visits for 3 months 
______________________________ = PVA

Total # of New Patients for 3 months

　

PVA
 

5-15 Failing Practice
 

The practice is on survival. There is no report of findings as the patients do not understand why they are under your care. This doctor will be struggling to pay every bill and live month-to-month trying to figure out what to do next as chiropractic has failed him/her.

　

15-30 Pain Practice
 

The patients are coming under the medical model, if it hurts. There is still something wrong and they need to continue until their pain goes away. They will then stop without the underlying problems or the causes of their pain being corrected because the report of findings was absent or centered on their pain. This doctor will earn a salary and have just enough money to pay the bills and make a modest salary. There is enough here for the doctor to be motivated to try to grow and figure out what others know. I hear this from many 25-30 year practitioners who have hung in there trying to figure it out.

　

30-40 Corrective Care Practice

These patients understand that their pain is not the problem; they have been educated to the concept of corrective care. They understand that the doctor cannot correct the causes of the problems until their pain goes away because until the spasm let’s go, the structure can’t normalize. This is a practice that is close to stability. These doctors have a very healthy practice with a professional income. They are working hard on tweaking what they need to do to get the patients to keep all of their appointments so they can get to the next level, but they understand the big picture of reconstructing spines and can communicate it.

　

40-50 Rehabilitative/Stabilization Practice

These patients fully understand the above concepts and also have been educated on the concept of wellness. Their pain issues have been resolved and they like being better, not just feeling better. The doctor has successfully communicated the concepts of corrective care and wellness care to the patients. This practice is stable. These doctors have an affluent practice with expendable income. Their biggest challenges are to break barriers and go to the next level and usually look to add associates to their practices.

　

50+ Wellness Practice

These patients are fully educated on the concepts of wellness and have accepted it into their lifestyles. This practice is stable and will grow effortlessly because the patients will now tell everyone that they have found an answer to their health issues. These doctors have the least stress in practice because the patients fully understand the long-term benefits of chiropractic care. These doctors usually have associates and getting new patients is much easier because if you have an army of healthy patients, they become your referral source for their lifetime.

　

As long as your PVA is 30 or above, you are out of survival mode (providing your business model is efficient and you are collecting your fees) and you get to determine what services to deliver to your patients. Some doctors practice a pain model, while others focus on corrective/rehabilitative care and yet others strive towards a wellness model. With the exception of the pain model, it doesn’t matter what your choice of practice model is; that’s up to you.

The reason the pain model doesn’t work is simple. The problem isn’t the patient's pain; it’s the underlying instability and that is what you need to spend time with during the report of findings. The patient needs to understand that if the cause of the problem is corrected, then the pain will not only go away, it will stay away and his/her spine, shoulder, knee, etc. will not prematurely degenerate and he/she gets to keep that body part.

　

This is where a dedicated WRITTEN report of findings becomes critical to the success of your practice. Most of you do not do a report of findings more than 10 seconds long and that is unconscionable. Cardiologists, dermatologists, oncologists and every other medical specialist gives a written report of findings and the public already understands most medical care. In chiropractic, we are often not understood because we never had a "Marcus Welby MD," "ER," "Grey’s Anatomy," or any other show on TV to explain chiropractic to the population prior to entering our offices. That is your job and it is as important as your adjustment.

　

If patients do not understand their care and terminate care when the pain goes away without stabilizing the underlying cause, then soon enough, the pain will return and the joint will progressively degenerate. Subluxation degeneration will progress and over time the patient's spine will start to decay, like a cavity in a tooth. The only problem is unlike a tooth that can be replaced, you only have 1 spinal bone and it can’t be replaced. If you do not care for it, it will cause your patient’s body to malfunction and eventually cause more serious problems both structurally and systemically. Do your patients understand that? Have you taught them that? Have you showed them a poster? Have you had them sit in front of a DVD that has a 3rd party explain that concept?

Many doctors treat each patient differently based upon their financial class (personal injury-Medicare-managed care-cash). If a patient enters the office as a result of an accident and there is a PI case, then the doctor feels the patient is highly motivated and doesn’t need a lot of prodding or education to stay under care. This patient is motivated by money and will come in regularly. Other patients are in so much pain that the doctor feels that their pain is the motivator and they need not be educated as to why they are under care.

In both of these instances, the doctor couldn’t be more wrong. Research has shown that money will not motivate most patients to continue care nor will the fact that the patient is in pain. As soon as the pain eases, or in the case of the PI patient, as soon as the patient sees the doctor and his/her pain eases after an accident, the patient is usually gone if they are not educated as to why he/she is under care.

This is where you get to educate your patients and give them choices. The educational portion will be under another consultation. However, the choices are always the same:

1. Pain relief

2. Corrective care

3. Lifetime wellness

Your PVA will tell you what type of practice you currently have.
 

It doesn’t matter why the patient enters your office, the story is the same. Most, if not all, patients have pain for one reason or another and the etiology of the pain is not relevant. What is relevant is that to have a healthy practice you have to bring the patient from his/her pain to either reconstructive care or lifetime wellness care and that takes education. The education process starts with your reception area on the first visit and never ends. It occurs on each and every encounter with your patient either in or out of the office. In future consultations we will cover each aspect in minute detail.
 

To move up in the PVA scale is simply a function of education and choices. You have to educate your patients about the long-term benefits of chiropractic care. It starts with pain care, progresses into reconstructive care and offers the tremendous advantage of wellness care.
 

Some of you practice in the paradigm of subluxation care, while others have a model based on structural care. Both work and have a place in the chiropractic family. However, the minimum is reconstructive care. It doesn’t matter what your practice model is, if you do not reconstruct the spine and stabilize it, your patient’s spine will prematurely degenerate and you have the responsibility to educate your patient and help prevent that.
 

Statistics should all be graphed on paper to see the trends in the statistics. You need to see if your practice is either flat, on the upswing or on the downswing. There should never be any surprises in practice and with the statistics you are keeping, you should also be able to predict what your income will be in 30, 60 and 90 days. How can any business run without concrete information to prognosticate the future from a statistical standpoint? It’s time to run your practice like a real business!
 

Each week you should have a staff meeting to review these statistics with your staff so that everyone is on the same page. You need to build a team that runs on proven systems. Over the next few consultations we will be sharing some of those systems with you.