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REMARKABLE RETENTION MANUAL

"YOUR RETENTION IS A REFLECTION OF YOUR CLARITY."

CA Version

www.TheRemarkablePractice.com

CA Retention Manual

Copyright © 2015 The Remarkable Practice.

All Rights Reserved.

The Remarkable Practice CA Retention Manual and any accompanying materials may not be distributed by any means or reproduced in any form, in whole or in part,

without the written permission of the publisher.

© 2016 TRP www.TheRemarkablePractice.com 1

CA Retention Manual

Table of Contents

Office Terminology....................................………............................................ 612 Things Every CA Should Know .................................................................. 7

(Module 5)

New Patient and Report Flow Charts First 4 …………………………………………………………………………………………………….... 9Day 0-4 …………………………………………………………………………………………………... 10Day 4+……………………………………………………………………………………………………... 14First 28 months ……………………………………………………………………………………... 15

Remarkable Manuals: Retention .........................………................................. 5

The Big SevenOverview: Stop Patient Drop-Out ………………………………………………………...... 17

(Module 45)

The Patient ProcessDay 3 Flow Chart .......................................................................................... 19

Day 3 Check In ………………………………………………..……………………………......……. 20Break In /Letter System………………………………..…………………………….....………. 22

(Module 30, 31) Break-In/Mapping/Protocols Checklist ........................................................... 25Patient Flow Training Checklist ....................................................................... 26Office Policies: Sample .................................................................................... 27

Acknowledgement Sheet: Sample .................................................................. 29NP Schedule: Sample ...................................................................................... 30Day 3 Check Out / Scheduling (Mapping) ………………..…………………….…........ 31

(Module 33)

Product Confusion ...................................................................................... 35(DC Module 49)

Expectations & Agreements ....................................................................... 36(DC Module 57, CA Module 15)

Table Talk .................................................................................................... 37(DC Module 50)

Workshop (New Patient Orientation) ......................................................... 38(DC Module 74)

Progress Exam Check In ………………………………………………………………………….. 40


CA Retention Manual

© 2015 TRP

R4/5 Confirmation Call Script…………………………………………………………………. 58(Module 48)

R4 Appointments …………………………………………………………………………………... 59(Module 49)

R4 Check In ………………………………………………………………………………………….... 60R4 Check Out Script ……………………………………………………………………………….. 62R5/R6 Appointments …………………………………………………………………………….. 65

(Module 50)R5/R6 Check In …………………………………………………………………………………….. 66R5/R6 Check Out Script ………………………………………………………………………..... 68

Re-Reports & Re-Commitments

Team Building & MetricsTeam Building ............................................................................................. 72

(Module 6-7) Team Meeting ............................................................................................. 74

(Module 8) Team Training .............................................................................................. 75

(Module 9-10) Practice Energy ............................................................................................ 79

(Module 11)Vital Signs .................................................................................................... 80

(Module 37)NP Tracking Report ...................................................................................... 82

(Module 38)Weekly Performance Report ....................................................................... 84

(Module 39) Forensics Report .......................................................................................... 86

(Module 40) Troubleshooting Retention .......................................................................... 88

(Module 43) Troubleshooting Collections ........................................................................ 91

Progress Exam Questionnaires ................................................................... 41(Module 46)

BSE – Progress Exams ……………………………………………………………………………. 49(Module 47)

Core Consultation Schedule and Notes ....................................................... 53Flow ............................................................................................................. 55

(DC Module 56)Value Economy ............................................................................................ 56

(DC Module 58)


CA Retention Manual

Daily Checklist: Check In ......................................................................... 123Weekly Checklist: Check In ..................................................................... 124Daily Checklist: Check Out ...................................................................... 125Weekly Checklist: Check Out .................................................................. 126Marketing Checklist ................................................................................ 128CA Competency Checklist ....................................................................... 129

General CA Responsibilities Managing Patient Accounts .................................................................... 114Gifting Overview ..................................................................................... 115Progress Exam Gifting ............................................................................. 116Gifting: Patient of the Week ................................................................... 117Letters ..................................................................................................... 118Referral Thank You Letter Sample .......................................................... 119Testimonial Thank You Letter Sample .................................................... 120Inactive Letter Sample ............................................................................ 121

Opening the Shift

The Huddle ................................................................................................ 94The Exam List ............................................................................................ 96Voicemail .................................................................................................. 97

Running the ShiftManaging Flow .......................................................................................... 99Managing Patient Wait Time .................................................................. 100Too Early/Too Late/Not on Schedule Scripts .......................................... 101Arriving Patients ...................................................................................... 10220 Minute Phone Calls ............................................................................ 1033 Strike Rule ............................................................................................ 105Using the Telephone ............................................................................... 108

Closing the Shift

Confirmation Emails/Calls ...................................................................... 110Weekly Statistics .................................................................................... 111

Remarkable Shift Resources

Checklists


Remarkable Manuals

The Remarkable Practice has created a three-part series of Process and Procedure Manuals designed to help make your practice truly Remarkable!

Remarkable (adj): Worthy of mention; notable; extraordinary

There is a Remarkable Manual dedicated to each of the 3 Domains of your practice:

Part One: Remarkable AttractionPart Two: Remarkable ConversionPart Three: Remarkable Retention

There is a dedicated DC and CA version for each domain.

Inside this Remarkable Retention Manual, your team will find everything they need to be Remarkable: including the Procedural steps of each part of the TRP system, relevant scripts, forms, and references to the DC and CA Academy (see Module # for references) as well as the TRP Competency Check-Lists which serve as your "training syllabus" and training guide.

Welcome to your Remarkable Practice!

CA Retention Manual


CA Retention Manual

OFFICE TERMINOLOGY The team members and doctors of the office use certain terms and verbal concepts to describe office practices and procedures. This is a quick guide to help you understand what these terms mean, and where those terms are used.

OFFICE

CODE

OFFICE TERM PATIENT TERM MEANING

N New Patient Exam New Patient Exam

And Consultation Very 1st visit in office

1 R-1 Report of Findings Report after

New Patient Exam

2 R-2/3Recommendations

for Care

Chance to commit to care and

pay for care

4 R-4 4 Month Review Go over last 4 month’s progress

and recommit to care

5 R-5 End of Year Report Go over last year’s progress and

recommit to care

6 R-6 End of Year Report

Go over last year’s progress and

recommit to care (during

adjustment time – 3rd+ year)

E Progress Exam Progress Exam Bio-structural posture exam

R Progress Report Progress Report Primary Doctor reviews Progress

Exam Results with patient

PEQ PEQ Progress Exam

Questionnaire

Survey patients fill out at First 3

Progress Exams

X X-Ray X-Ray X-Rays need to be taken

S Scan Thermal Scan A temperature-based scan of the

spinal area

B Core Consult Core Consult Core strengthening exercises

H Shoulder Consult Shoulder Consult Instructions for exercising the

shoulders

T Traction Consult Traction Consult Instructions for home traction

O Orthotics Orthotics Fitting Patient gets fitted for orthotic

inserts for their shoes.

C Consultation Consultation The patient has a 15 minute

consultation with the doctor.

HMA HMA Health Made

Affordable Plan

The patient’s financial paperwork

for the year.

OSA OSA Originally Scheduled

Appointment


CA Retention Manual

12 Laws of Health Every CA Should Know(Module 5)

1. Are you designed to be healthy or sick?a. You are designed to be health.

2. Is your body smart or stupid?a. Your body is smart.

3. What is the most important system for staying healthy?a. Your nerve system - it is the master system.

4. What protects your nervous system?a. Your spine is your suit of armor.

5. Is your life stressful?a. Life is stressful - more stressful every year.

6. What is all of this stress doing to your body?a. Stress causes problems in the spine: a condition known as

subluxation.7. What is the real cause of health problems?

a. Subluxation causes health problems: dysfunction that can manifest as symptoms and conditions.

8. How is your nervous system functioning?a. How would you know? How do you know if you have

subluxation?9. What should you do if you have subluxation?

a. You should take action!10. When is the best time to deal with your health?

a. Today.11. If you don't tell them, who will?

a. We are on a mission.

12. Are you ready to make a difference?

If the answer is yes, then you are in the right place!


CA Retention Manual

New Patient & Report Flow Charts


CA Retention Manual

Promotional Activities: Screenings, Talks, Phone Calls

New Patient Consultation/Examination – Refer for X Ray

Report of Findings/Recommendations for Care/1st Adjustment

Break -In/2nd Adjustment

1st Regular Adjustment (in the flow)

Adjustments (3 X week)

Adjustment and 1st Progress Exam and 1st Questionnaire

Adjustment and 1st Progress Report

Adjustment and 1st Consultation

Adjustment (2 X week – per DC recommendation) (Consultation follow-up)

Adjustment and 2nd Progress Exam and 2nd Questionnaire

Adjustment and 2nd Progress Report

Adjustment and 2nd Consultation

Adjustment (2 X week)

Adjustment and Re-examination: R4 Exam and 3rd Questionnaire

Report with New Recommendations R4 (and New Financials: R5)

Day 0

Day 1

Day 2

Day 3

Day 4

Visit 5-11

Visit 12

Visit 13

Visit 14

Visit 15-23

Visit 24

Visit 25

Visit 26

Visit 26-35

Visit 36

Visit 40

First 4


CA Retention Manual

Day 0 - 4 Flow

Day 4

First Regularly Scheduled Adjustment

Day 3

Break In 2nd Adjustment

Day 2 Report of Findings

1st Adjustment Recommendations for

Care

Day 1

New Patient Consultation Chiropractic Exam

Refer for X-rays

Day 0

Screening New Patient Call In

New Patient Confirm. Call


CA Retention Manual

Staff Location

Check In

Office Tour

Meet & Greet

Pre-Consult

Consult / 5 Traumas

OPQRST

Postural Exam &

Thermal Scan

Chiro. / Gonstead

Exam

Segue & CTA X-rays

Check Out

Day

1

Flow

5 Mins.

5 Mins.

2 Min.

5 Mins.

5 Mins.

5 Mins.

5 Mins.

2 Mins.

10 Mins

5 Mins.

= 45 Minutes Total

Time

Front Desk

From Front Office to Consultation Room

Consultation Room

Consultation Room

Consultation Room

Consultation Room

BSE Station & Exam Room

Exam Room

Exam Room

Front Desk

Check In CA

Exam DC / Tech CA / Check In CA / Check Out CA

Exam DC

Exam DC

Tech CA / Exam DC

Tech CA / Exam DC

Tech CA / Exam DC

Exam DC

Exam DC

Check Out CA


CA Retention Manual

Check In Escort to

Report Ctr.

Group R1 Intro & Video

Outro Phases of

Subluxation

Individual R1 X-ray Review

Individual R2

Recs. for Care

Time

1st Adjustment

Group R2 Protocols

Group R3 Financials

Individual Break Out / Check Out

Day

2

Flow

2 Mins.

12 Min.

5 Mins.

3 Mins.

3 Mins.

3 Mins.

3 Mins.

6 Mins.

3 Mins

5 Mins.

= 45 Minutes Total

Time Staff Location

Check In CA

Exam DC / Tech CA / CICA / COCA

Exam DC / Reporting DC

Reporting DC

Reporting DC

Reporting DC

Reporting DC

Reporting DC / Exam DC / Tech CA / CICA / COCA

Exam DC / Reporting DC

Check Out CA

Front Desk

Relaxation Center to Consultation Center

Consultation Center

Adjustitorium

Adjustitorium

Adjustitorium

Adjustitorium

Adjustitorium / Relaxation Center

Consultation Room

Front Desk

Individual R1 Knee to Knee


CA Retention Manual

Check In

Walk Back

Break In

Letters / Flow

2nd Adjustment

Check Out

Day

3

Flow

1 Min.

1 Min.

6 Mins.

3 Mins.

3 Mins.

5 Mins.

= 19 Minutes Total

Time Staff Location

Check In CA




Primary DC

Check Out CA

Front Desk

Clinic

Consultation Room / Exam Room /Waiting Area / Front Desk

Relaxation Center

Adjustitorium

Front Desk


CA Retention Manual

Staff Location

1 Min.

5-15 Mins.

3 Mins.

1-6 Mins.

= 10 - 25 Minutes Total

Check In

Waiting

First Regular Adjustment

Check Out

Day

4 +

FlowTime

Check In CA

None

Adjusting Doctor

Check Out CA

Front Desk

Relaxation Center

Adjustitorium

Front Desk


CA Retention Manual


CA Retention Manual

The Big Seven


Stop Patient Drop-Out: The Big Seven Overview(Module 45)

Why, when, and where do patients drop out of care in your office? Answering these questions are the first step to stopping patient drop-out. Where in the process are they leaving?

Remember, Retention is a Reflection of your Clarity.

One valuable diagnostic tool is the Forensics Report. This tracks and shows visual representations of when and where patients are discontinuing. Combined with your PVA (Patient) and your Stick Rate, this will show you the trends in your practice, and reveal where you are losing clarity.

(The TRP Vital Signs Program, which includes the Forensics Report, gathers and organizes all your practice data. Using it will bring clarity around how your practice is doing - and where you need to improve. Look for Vital Signs at www.TheRemarkablePractice.com!)

Your patients drop out of care when they lose CLARITY around the VALUE OF CONTINUED CHIROPRACTIC CARE. That being said, you must constantly and deliberately be building greater CLARITY around their continued care. We have identified 7 Key Elements in the Patient Process that do just that. If these live in your systems as “MECHANISMS” – built into the Process itself – these happen AUTOMATICALLY. If these are missing or not done well – they create pitfalls and lead to patient drop-out. We call these the Big 7.

The Usual Suspects:7 Reasons Your Patients Drop Out

1. Value Economy2. Product Confusion3. Table Talk4. Workshop5. Progress Exams & Reports6. Flow7. Expectations

See the following pages for a deeper dive into each of these topics.

CA Retention Manual


CA Retention Manual

The Patient Process


CA Retention Manual0 4+ 2 1 3

Check In

Walk Back

Break In

Letters / Flow

2nd Adjustment

Check Out

Day 3

Flow



DAY 3: CHECK IN (Module 34)

Procedure:

Script:

Hi NAME! Good to see you again.

If you would please take a seat to my right I will let your doctor know that you are here.

The Break In appointment typically happens during normal adjusting hours. The appointment should last about 15-20 including the adjustment. The patient checks in and then is instructed to have a seat and wait for the doctor. The check in CA will then alert the exam DC that the patient is ready and, if necessary, pull a letter for the patient so they won’t have to wait too long to get adjusted after they meet with the doctor.

Do you have your Chiropractic Card? Great! You can check yourself in the same way as yesterday.

You’ll notice that your name came up in red. Normally your name will come up in a white box. When it comes up red it means you need to stop by Check Out before you leave.



DAY 3 CHECK IN CHECKLIST

⃝ Check In CA must be aware of when a patient is scheduled to come in to the office for a Break In ⃝ Greet patient by name ⃝ Introduce yourself if you haven’t met the patient before ⃝ Remind patient how to check in using swipe card

Swipe through reader with barcode facing patient

Name pops up on arrivals screen confirming check in

⃝ Explain Red Box

NAME, normally your name pops up in white

When name is pops up red please stop by check out before leaving

⃝ NAME, please have a seat and the doctor will be with you shortly

⃝ Alert DC that the patient is ready for Break In

For more on Day 3 Check In, see CA Academy Module 34.



BREAK IN /LETTER SYSTEM(Module 34-36)

Procedure:

Script:

The Break In should be done before the patient receives their adjustment. The staff member who is doing the Break In needs to prepare the paperwork and check if the patient has committed financially yet or not. The DC//NPC/CA should take notes on the patients scheduling and financial decisions during the Break In in order to convey this info to the Check Out CA.

Financial Discussion – Make sure to check if the patient is committed financially or not before starting the Break-In.

Hi NAME. Good to see you again. So you got your first adjustment yesterday…that’s great! In a few minutes I will send you in so the doctor can check how your spine responded to your first adjustment. But first we are going to go over your schedule, and review our office policies, which are like guardrails designed to help you get the most out of your care. And then I’ll show you how to use the letter system.

If the patient has not committed financially yet: I know you brought home your financial paperwork last night. Which option works best for you? (1x or 4 Monthly payments) Alright, the front desk will help you take care of that after your adjustment.

Schedule As your doctor (I) discussed with you, you need to be adjusted 3x a week during the first month of care. Now, I know you looked at the schedule at home. Which days and times have you decided on? If hasn’t decided – Are mornings or afternoons better?

After your first Progress Exam the doctor (I) will determine if you are holding your adjustments well and are ready to graduate to 2/x week. At that point which day would you prefer to drop? (suggest best option)

Care plan/3 Strike Rule I know that we have discussed how vital it is to maintain rhythm in your care. I would like to challenge you to make it your goal that you never miss or change your appointments. And if something happens where you do have to, make it your goal to make it up within 24 hours so you don’t interfere with your rhythm.



If you do change and miss your appointments you’ll lose your corrective momentum, and we can’t help you. So we have a three strike policy. This means that if you miss three appointments without making them up, we simply interpret that as your priorities with your care have changed, and we will freeze your care. I’m sure you understand that this is a partnership, and we cannot take this more seriously than you do.

Out of town dates? Do you have any dates coming up when you will be out of town? With vacations or work travel, let us know ahead of time if you’re going to have to disturb your rhythm, and we will add those missed appointments ahead of time to build up momentum before you leave and also catch you up when you get home.

If the patient is hesitant to set schedule up – I sense that you have some questions. Is it a question of your commitment to the care? What is your concern? Is there anything I can clarify for you?

Orientation Alright, so as the last step in your New Patient process, the doctor requires that you attend a Better Results Faster Orientation within the first two weeks of your care. I know you probably still have questions, and there are some things you’ll need to stop doing, and other things you’ll need to start doing in order to get the best results. At this Orientation, you will learn things about your health that you won’t hear anywhere else, and it’s a great opportunity to ask any questions you still have. After it, you, too, will be able to get better results faster. Patients often bring friends and family to the workshop. You’ll love it. We have the Orientation workshop on Tuesday at lunch or Wednesday evening… Since you are already scheduled on Tues/Wed, for your convenience let’s move that day’s adjustment to right before orientation so that it is easy for you.

Scheduling family members As I’m sure you’ve figured out, we are very committed to the health of the families in our community. So in the first two weeks of your report we will do a subluxation check-up for any members of your immediate family - at our expense. This includes a New Patient consultation, exams, x-rays if necessary, and a report of findings. Who would you like to schedule?

Letter system Okay great. Let’s head up front so I can give your schedule to the front desk and then I will show you how the letter system works and then get you adjusted.



From now on when you check in at the front desk you will receive your letter. You will notice that on the right are blue letters and pink on the left. You have a _____ letter today so that means you are on the _________ side. While you are waiting for your turn you will sit here in our relaxation center. Here you can always learn something about your health and relax for a few minutes so you can receive your best adjustment.

It is your turn when you are the next letter up on the peg and one of the changing rooms opens up. When that happens, hang your letter on the peg. Head into the empty changing room and lock the door behind you. Remove everything from the waist up (women – leave on bra and put on gown on with opening in the back). Have your swiping card out and press the button to let the doctor know you are ready.

So head on in and the doctor will be with you in a minute. When you are done stop by Check Out before you leave.

Procedure: The staff member who does the Break In needs to bring the patient’s schedule up to the Check Out CA and explain any financial and scheduling decisions the patient has made. This gives the COCA the opportunity to set up the patient’s schedule in the computer while the patient is being adjusted.

For more on the Break-In, see CA Academy Module 34.



BREAK IN / MAPPING / PROTOCOLS CHECKLIST

Break In Preparation

⃝ Discuss at huddle any relevant details and plans for Break In Who is doing break In

Where will Break In be done (Consult / Exam Room,Adjustitorium…)

Who is adjusting patient

⃝ Patient Checks In at Front Desk ⃝ CA explains Swipe In process – if red see Check out before leaving ⃝ CA sets aside a letter for patient ⃝ CA notifies DC that patient is ready ⃝ DC/Tech CA gathers Break In paperwork

Office Schedule

Office Policies

3 Strike Rule

New Patient Schedule⃝ DC/Tech CA greets patient and brings them to Consult / Exam room

Break In

⃝ Financial Discussion If patient has not committed yet DC asks patient about

financial decision

If no strong commitment - address any questions or concernsimmediately

⃝ Set up Patient Schedule

3 visits per week for approximately 5 weeks

Workshop

After Progress Exam which 2 days to keep scheduled?⃝ Office Policies

Importance of Care Plan / Maintaining OSA

Out of Town dates

Schedule workshop and invite family/friends

Scheduling family members for NP consultation⃝ 3 Strike Rule ⃝ Walk patient to front desk to explain letter system / office flow



PATIENT FLOW TRAINING CHECKLIST(Module 35)

⃝ Following Break In - Walk patient to Front Desk ⃝ From now on patient checks in and CA gives them a letter ⃝ If female patient has not committed financially – get loaner gown to use today ⃝ Explain Pink/Blue letters

2 DCs adjusting

Letters indicate which doctor you will be seeing⃝ Relaxation Area – prepare for best adjustment and learn something while you wait ⃝ Relax until you are next letter and a changing room opens up ⃝ Hang letter on peg ⃝ Go into empty changing room ⃝ Close and lock changing room door behind you ⃝ Prep to see DC

Men remove everything from waist up

Women wear gown with opening in the back

Remove all necklaces / long earrings

Press button when ready

You can leave your belongings in the changing room while you see the DC⃝ DC will open door changing room door when he is ready to see you ⃝ Once adjusted return to changing room and change back into clothes ⃝ For Women - Put gown in laundry basket ⃝ Stop by Check Out before leaving


Franson Family Chiropractic 100 Cummings Center Suite 101D

Beverly, MA 01915 (978) 927-8466 fax (978) 927-8486

www.fransonchiropractic.comwww.facebook.com/fransonfamilychiropractic

OFFICE POLICIES

CARE PLAN The doctor has designed a specific course of action to allow proper care. Appointments cannot be missed. If an appointment must be changed, reschedule later that day, or within 24 hours. (See 3 Strike Rule.)

WORKSHOP All new patients are required to attend the Foundations Workshop. This workshop covers essential information concerning your care, provides a forum for your questions, and is invaluable in achieving your health goals.

FINANCIAL It is your payment that allows us to continue providing high levels of professional care, maintain our facility, and to compensate our team. If for any reason you cannot keep your financial agreement, inform us immediately to avoid any misunderstanding. We will make every attempt to make affordable arrangements.

FAMILY We are absolutely committed to your family's health. The Franson Family Chiropractic Team recognizes that the children are the future. Because of this commitment, it is our highest priority that all individuals joining our practice have their children checked within 2 weeks of beginning care in our office. This spinal and nerve system checkup will be done at our expense.

REFERRALS The greatest honor a patient can give the doctor is the referral of their family or loved one. We promise to give them the same attention, care, and quality service that you receive. Thank you in advance!

Remember, healing and correction take time. If at any time in your care you have any confusion or concern with your body's responses, please arrange for a consultation with the doctor immediately. We want you to get the most from your chiropractic care.




Beverly, MA 01915 (978) 927-8466 fax (978) 927-8486


3 STRIKE RULE

Your compliance to the doctor’s recommended care plan is a key determining factor to the success of your case. As explained, rhythm is critical in maximizing the effectiveness of the corrective adjustments.

Your compliance to your outlined schedule of care is also the most obvious indicator of your commitment to your chiropractic care. Without your complete commitment, success in your case is not possible.

Our team is completely committed to a successful process and outcome for you, therefore we will diligently support the maintenance of your adjustment schedule and outlined care plan.

If at any point in your care you need to reschedule an office visit, our team will work to reschedule you for the same day. If that is not possible, all efforts will be made to schedule you the next day.

ANY AND ALL SCHEDULED OFFICE VISITS THAT ARE MISSED MUST BE MADE UP.

If the doctor’s recommendations are that you are to be checked 3 times a week, then you must be checked 3 times that week. Make-up appointments may be done the next day (preferably), or added to the next week.

If 3 appointments are missed and are not “made-up”, we can only interpret this to mean that your commitment to your care has changed, and your care will be suspended.

We only want the best for our patients. We are completely committed to you and your health. Please recognize that adherence to your care plan is critical and address it as such.

Thank you in advance for your cooperation. You will be glad that you did!!

(See our scheduling and make-up policy for questions regarding sickness, vacation, and travel.)




Beverly, MA 01915 (978) 927-8466 fax (978) 927-8486


ACKNOWLEDGEMENT SHEET

Patient Name:

I have heard and understand the Recommendations for Care made by thedoctors of Franson Family Chiropractic in regards to my individual case. Ihave received a copy of the Recommendations for Care.

I have heard and understand the office policies of Franson FamilyChiropractic and have received a copy of the policies.

I have heard and understand the 3-Strike Rule of Franson Family Chiropracticand have received a copy of the policy.

Signature_____________________________________ Date___________

At Franson Family Chiropractic, we take pride in acknowledging our patients for their referrals and testimonials. Please give us your permission to use or post your name in our office. Thank you!

Signature_____________________________________ Date___________



New Patient Appointment Schedule Monday Tuesday Wednesday Thursday Friday

7:00 7:00 7:00

8:00

9:00 9:00 9:00

10:00 10:00 10:00

11:00 11:00

3:00 3:00

4:00

4:30 4:30

5:30

Please speak to the front desk or call the office at 978-927-8466 to schedule a New Patient exam.




DAY 3: CHECK-OUT

Procedure:

After the patient has been adjusted they will stop by Check Out to finish any last paperwork and make a payment if necessary.

Steps for R2 Check Out:

1. IF not Committed Yet: Take Payment for second adjustment and/orfirst payment of care plan

2. Enter HMA information [see the “Setting Up HMA Plan” section ofthis manual] – if patient makes commitment

3. Set up patient’s Map – See “Mapping New Patients” Section and print acopy for them to take home (see also CA Academy Module 36)

4. Stop manage reminders for monthly payments (or set up EFT), HMA [ifnot signed yet], and to schedule their R4

5. Have them sign the Acknowledgment Sheet indicating that we havegiven them a copy of all their paperwork to take home

6. After the patient has checked-out, give the patient folder to theOffice Manager to enter diagnosis codes/insurance information into thesystem.

7. Stop Manage R4 Gifting (R4 Gifting??) - on 4 month x-ray date

8. Stop Manage First Progress Exam Gifting – on the date the firstProgress Exam is scheduled

Script:

Explain MAP & Workshop

Here is a copy of your schedule. You will see in green the days that you are scheduled to be adjusted and they are listed below with the date and time. Every 12 visits you see a blue bar… this is a progress evaluation. It happens during your regular appointment and helps the doctor to track your progress. Here in pink is your Four Month X-ray. After your x-ray you will sit down with the doctor to discuss your progress



over the last four months. At that point he will be able to make recommendations going forward. I will challenge you to stick to your schedule as closely as possible in order to get the best results from your care. If you ever do need to change or miss an appointment please communicate with us ahead of time

Now, you indicated you’d be coming to the Better Results Faster Orientation on DATE. Is that right? Enter appointment in Platinum. Great! This orientation will help you get the most out of your care and you will learn things about your health that you won’t hear anywhere else. Who do you know that you would like to bring with you to the workshop? Great! Here are tickets for you and your guest(s) – please bring them with you on DAY. Write the date on the tickets.

Acknowledgment Sheet

Please sign here so we know we gave you copies of our office policies.

We like to acknowledge patients for referrals and commitment to their care. So we like to get your permission to recognize you publicly in our office. (If they don’t want to have their name used, make a note in their gray box.)

Informed Consent

This is our Informed Consent; it states that you understand and agree to your care in our office. Please sign and date at the bottom.

Financial

If the patient has not made their financial commitment yet:

• Which payment plan have you decided on?• The cost for today’s adjustment is $50 – please let me know next time

which payment plan you are choosing• How would you like to take care of that?• If they choose monthly, no EFT, add: We would like to challenge you

to make your payments in a timely manner; your responsibility in thismanner helps us to provide the best, most professional care possible.

Do you have any other questions for me? Alright, then we will see you on DATE for your next appointment. Don’t forget to ice as the doctor instructed. Have a great day!



DAY 3 CHECK OUT CHECKLIST

Before Check Out

⃝ Once DC/Tech CA has finished the Break In/Office Flow they will bring the Break In paperwork to the Check Out CA ⃝ DC/Tech CA will review patient’s decisions with the COCA

Financial

Scheduling

Workshop

Out of town dates

Scheduling family members

⃝ While patient is being adjusted COCA should set up patient’s schedule in Platinum

Make sure to add workshop, progress exams/reports, coreconsults, x-ray codes

Stop manage to Schedule R4 on date of x-rays

Stop manage PEQ and R4 gifting

⃝ Print Multiple Appointment Schedule for patient to give to patient during check

out

⃝ Once patient comes out of changing room they will go to COCA desk to check

out

Break In Check Out

⃝ Take payment if patient is still “Outstanding”

$50 if still deciding

o Add Payment Transaction

o Postpone HMA Stop Manager for next visit

Balance of 1x or 4x payment

o Add Payment Transaction

o Set up Plan Box

o Unclick Green Box

o Add “R1/2/3 Yes” or “R1/2/3 Out – Yes” Transaction

⃝ Explain Patient’s Schedule Printout to them



Days in green you have appointment

List of Day/Date/Time at bottom of page

Workshop on DATE

Blue bars are progress exams – extra few minutes during regular apt

Pink is 4 month x-rays

Get best results by keeping your regularly scheduled appts

⃝ Schedule family members – if applicable

Add to Platinum

Give NP Intake form to patient for their family member

Remind that apt will be at our expense if scheduled in the next 2 weeks

⃝ Patient signs acknowledgment sheet

⃝ NAME, unless you have any other questions we are all set. Have a great day!


Product Confusion (DC Module 49)

The first reason patients drop out of care is Product Confusion. This starts right from day one, and is usually not deliberate. But if the patient does not have a real understanding of your objectives and expectations for care, letting misconceptions remain, then:

You are selling one thing... and they are buying another.

When this is the case, what starts as confusion moves to frustration and disappointment, and results in drop-out. In order to prevent this, you must be clear from Day One about what you do.

This is not an "Or" conversation, it's an "And"conversation.

Listen to their wants and needs, welcoming them with open arms, AND show them what is possible and available to them. Help them understand that you will help them get what they WANT AND what they NEED. This is about getting back to function and activities – and then getting their health and life back!

Take them through the Four Agreements:1. First, they must own and agree on THE REAL PROBLEM - beyond their

symptoms (COMPLAINT), they must see how their health is impacting their life - THE REAL PROBLEM (LIFE EFFECT). And they must FEEL that you understand their problem -you must make the empathetic connection.

2. Second, they must own and agree on the GOALS - and see the implications of not getting their health back.

3. Third, they agree on THE PATH - your Recommendations for Care. They must see that you can help them get past their current problem - AND get back to LIFE.

4. Fourth, they must see that your solution is the path back to health, and the only way to get the life they really want.

Once you've taken them through this, and they see that chiropractic can help them get want they WANT- and what they NEED - they will

stick with you!

CA Retention Manual


Expectations & Agreements(DC Module 57)

The two most important things in forming lasting, healthy relationships are Transparent Expectations and Honest Agreements. This applies to relationships with patients just as much as anywhere else in life, and it starts at the beginning.

There are 3 major kinds of expectations that need to be addressed:• Short Term: immediate experience

o How adjustments feelo How they feelo Address symptoms

• Mid-Term: their roleo Partnershipo Done "with" you, not "for" youo Three Legged Stool of Results

• Long Term: chiropractic as a life strategyo Their futureo Healthy is normal

o Behavior - choices - matter!

Be the person who helps them reach their goals!

CA Retention Manual


Table Talk(DC Module 50)

In order to build a practice of lifelong chiropractic fans, your patients must truly understand the value of life-long chiropractic care. This puts you in the business of changing people's belief systems, which makes education your top job. The best place to do this is the adjustment table.

In order to build education into your system, define an office visit to include it. For example, and Office Visit includes:

1. Objective Assessment2. Corrective Adjustments3. Deliberate Education

Education is an intrinsic part of an Adjustment.

BJ Palmer said: "The key to practice success is simple: give, love, and serve."• Give: priceless care• Love: everyone• Serve: education - The money that they pay you is TUITION FOR THE

EDUCATION THEY WILL RECEIVE - and education that will change their health and their life forever.

Organize your education into a system built into the pattern of care in your office. For example, you will utilize a Table Talk curriculum that follows a twelve visit structure. The Twelve Things Every Patient Needs to Know - and they will never leave you. (See The Dirty Dozen talking points on the following pages.)

And remember: your patients are most available to learn in the beginning of their care! If you do the first 90 to 120 days well, you

will have patients for life!

CA Retention Manual


Remarkable Workshops: New Patient Orientation(DC Module 74)

Workshops are powerful tools to change your patients' lives forever. The Workshop, particularly the New Patient Orientation, contains the most important communication for your new patients. This is a top-down overview of a New Patient Orientation Workshop. (For more on workshops, see DC Academy Modules 51 - 53 and 73 - 74.)

Weekly New Patient OrientationPurpose:

1. Create Paradigm Shift2. Must Add Value3. Produce Referrals

#1: Paradigm Shift: Anatomy of a Break-througho Be Availableo Have Intentiono Recognize They Are Stucko Outside Force - Catalyst (You are the Catalyst!)o Break-Through

#2: Add Value: Better Results Faster o Speak to their Wantso Deliver on your Promiseo Promote with Certainty

#3: Recruit into the Mission: Create Your Ideal Practiceo New Patientso Referralso Greater Retention

5 Musts to Remarkable Workshops1. Must be important to YOU2. Must happen consistently3. Must be mandatory4. Must be compelling5. Must add VALUE

Who attends:• New Patients - & their guests• Existing Veteran Patients - & their guests• Your guests

Remember: always have something to invite people to!

For more on the New Patient Orientation, including the Better Results Faster sample PPT deck, see DC Academy Module 74.

CA Retention Manual


Check In

Waiting

First Regular Adjustment

Check Out

Day 4

Fl ow

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PEQ CHECK IN (Module 46)

Procedure: At Huddle, when exams are discussed, anyone who is scheduled for a progress exam should be checked to see if they also need a PEQ (PEQs are only done in the first four months of care). If so the DC should write the patient’s name on the appropriate PEQ and bring it to the front desk.

When the patient checks in, the CICA should explain that the patient is scheduled for a progress exam and give them the PEQ. Explain to the patient to fill out the PEQ and give it to the DC when they get adjusted.

Script:

Hi NAME. Congratulations! You have reached your first chiropractic milestone – your progress exam! The doctor would like some feedback about your care so while you are waiting please fill out this questionnaire. Hand them clipboard and pen and show them that the PEQ is double sided. You can give it to the doctor when you go in to get adjusted. The doctor will do the progress exam after you have been adjusted.

Here is your letter.


Progress Exam # 1 - Questionnaire Name: _________________________

Date: __________________________

Primary Doctor: _________________

1. What are your Health Goals at this point in your care?

Correct symptoms / Body Signals _______________________

Improve function of body systems _______________________

Reach potential / optimal health _______________________

2. Have we done a good job explaining the objective of your care plan? In other words, do you feel that you understand why you are getting adjusted?

Yes

No

3. Has the doctor fully explained the cause of your problem? In other words, do you understand your problem (Subluxation)?

Yes

No

4. If you have/had a symptom, do you understand the difference between the symptom and the problem (Subluxation)?

Yes

No

5. What Phase of Subluxation are you in?

Phase 1

Phase 2

Phase 3

6. How long has this problem been in your spine? _________ years

7. Do you understand the doctor’s recommendation for your care?

Yes

No

8. How often (per week) are you scheduled to be adjusted at this point?

____ / per week



9. Have you been following the doctor’s recommendations (keeping your adjustmentschedule)?

Yes

No

10. How could we help you maximize your results and reach your goals?_______________________________________________________________________________________________________________________________________________________________________________________________________________

11. Have your family members had a Spine and Nerve System Check-Up yet?

Yes

No

12. Have you attended the Foundations Workshop yet?

Yes

No

13. Have you utilized the Workshop Video Lending Library yet?

Yes

No

14. We have a series of consultations scheduled for you in the near future as a part of yourcare. They include consultations on specific exercises, posture and stretching, etc. Arethere particular topics that you are interested in learning more about?

Diet / Weight-Loss

Energy

Stress

Sleeping

Immune System

Raising Healthy Children

Others_______________________________________________________________________________________________________________________________________



Progress Exam #2 - Questionnaire

1. Do you know the 3 “Legs” of “The 3 Legged Stool of Correction”?

Nutrition

Sleep Patterns

Adjustments

Laughter

Breaking Bad Habits

Exercise

2. Do you know the doctor’s recommendations for your care? How many times per weekare you supposed to be scheduled to get checked and adjusted?

_________ times / week

3. Do you understand the importance of keeping your Originally Scheduled Appointments?Do you understand the value of RHYTHM?

Yes

No

4. How are you doing with keeping your scheduled appointments? Maintaining yourcorrective rhythm?

Grade yourself: A B C D F

5. Do you know what bad habits create or promote your subluxation pattern?

Yes

No

I have questions – please help

6. How are you doing with breaking your bad habits?


Name: ______________________________

Date: ______________________________

Primary Doctor: ______________________



7. Do you know what exercises you should be doing to support your adjustments?

Yes

No

8. How are you doing with your exercises?


9. How do you feel your health and life are improving? Are your expectations being met?_______________________________________________________________________________________________________________________________________________________________________________________________________________

10. What could you do to get even better results and reach your goals?_______________________________________________________________________________________________________________________________________________________________________________________________________________

11. What can we do to help you get better results and reach your goals?_______________________________________________________________________________________________________________________________________________________________________________________________________________



Progress Exam #3 Questionnaire

12. Do you know the doctor’s recommendations for your care? How many times per weekare you supposed to be scheduled to get checked and adjusted?

_________ visits / week

13. How are you doing with keeping your scheduled appointments? Keeping your rhythm?


14. Do you know what bad habits create or promote your subluxation pattern?

Yes

No

I have questions – please help

15. How are you doing with breaking your bad habits?


16. Do you know what exercises you should be doing to support your adjustments?

Yes

No

17. How are you doing with your exercises?


18. Have you been taking advantage of our available consultations?

Yes

No

19. Have you been following through with what you are learning?

Yes

No

Name: ______________________________

Date: _______________________________

Primary Doctor: ______________________



20. What determines how often you should be adjusted?

Pick 2:

Your goals

The weather

How well you hold your adjustments

Random chance

No idea

21. What influences how well you hold your adjustments?

Pick all that apply:

Your commitment to keeping your appointments (Rhythm)

Breaking the bad habits that cause subluxation

Adding specific exercises that strengthen the spine

22. How do you feel your care is going? Are your expectations being met?_______________________________________________________________________________________________________________________________________________________________________________________________________________

23. What could you do to get even better results and reach your goals?_______________________________________________________________________________________________________________________________________________________________________________________________________________

24. What can we do to help you get better results and reach your goals?_______________________________________________________________________________________________________________________________________________________________________________________________________________




PROGRESS EXAMS & QUESTIONNAIRES (PEQ) CHECKLIST

⃝ At huddle discuss patients that are scheduled for Progress Exams during the shift

⃝ Write down which patients need PEQs 1, 2, 3 (Only in first 4 months of care)

⃝ Set aside the correct number of PEQs so they are readily available during the shift

When PEQ patient checks in:

⃝ Greet by Name

⃝ You are due for a Progress Exam today

⃝ The DC would like some feedback

⃝ Please fill out PEQ while you are waiting

⃝ Give PEQ to the DC when you go in to get adjusted

⃝ We will do Progress Exam after your adjustment

Perform Progress Exam:

⃝ Reminder, we are looking at posture as an indicator of nerve irritation

⃝ Looking at posture and weight balance

⃝ Tells us 3 things:

How you are responding to care

Where we should focus going forward

How well you are holding your adjustments – how often you need to beadjusted

⃝ Take 3 Photos

Head and shoulders – AP (facing forward)

Full length Lateral (from the side)

Full length – PA (Facing away from camera)

⃝ Patient steps up on balances

⃝ Unlock scales and let them settle

⃝ Simultaneously lock both balances

⃝ Write down weight numbers from each scale

⃝ DC will review this with you at your next visit



After Progress Exam:

⃝ Add Progress Exam Transaction to patient’s electronic file

⃝ Upload Progress Exam Photos to electronic file

⃝ In patient’s electonic file - click Black Box on (black box should be filled in) to

let the DC know the photos are ready to be reviewed

⃝ For patients in First Four Months - Make sure the patient in scheduled for a

Progress Report at their next visit



BSE - Progress Exam (Module 47)

Procedure:

Patients in their first 16 months of care will have a Progress Exam (Posture and Bi-Lateral Weight Study) every twelve visits. During the first four months of care, the visit after a Progress Exam the Primary Doctor will do a Progress Report with the patient. During this report the DC will review the exam results and let the patient know how their spine is responding to their care.

To perform the progress exam the Exam DC/Tech CA finds the patient in the waiting area and gives them the appropriate Progress Exam Questionnaire (PEQ) to fill out. Once the patient is done with the PEQ the DC/CA should review it briefly and then perform the Progress Exam. If the patient indicated on the PEQ that they have concerns or questions about their care the DC should address the questions immediately.

See the Appendix at the end of the manual for Progress Exam Questionnaire samples.

Insights:

Progress Exams: Hawthorne Effect

Patients want to be measured. People simply “do better” when they know that they are being watched and measured – this is known as the Hawthorne Effect. People are motivated by measurement…as long as:

1. They know that they are being measured – and what is being measured2. They know how to influence their outcomes (control)3. They get good feedback (see Progress Reports)

Script:

Good morning/afternoon, PATIENT NAME, before you get adjusted today we are

going to be doing a Progress Exam for you. If 1st PE: Congratulations – This is an exciting milestone…

I see that you have filled out your questionnaire, thank you. That’s great. We will review that together…



(DC or CA) Review the PEQ with the patient at the Bio-structural Exam Center (BSE); semi-privately. Address any blanks, questions or comments that the patient makes.

Any and all feedback is critical and valuable. These questionnaires are a vital component in communication between patients and our Teams. Make sure to commend the patient for their effort, candor, etc…and then highlight the information that you wish the Adjusting Doctor to review. Discuss any and all notable feedback to the doctors – positive or otherwise.

Every 12 visits we will perform a Progress Exam to objectively measure how you are responding to your care. These are important clinical milestones.

We will do two simple but powerful tests:

1. A postural evaluation2. ..and a bilateral weight scale (or “balance”) check-up…OK?

As you know, your posture tells us a great deal about your health. You already understand that: Your posture is the window to your spine.

And it makes sense to you that a healthy body is well-balanced. Yes? This means that your eyes should be level with your shoulders, your shoulders level with your hips, and your hips level with the ground. Yes?

Your body is smart, if you have nerve irritation in your spine your body will lean away from it.

This creates two things we can measure:

1. postural shifts away from normal2. …and an imbalance in how your body carries its weight from side to side.

Does that make sense?

Great! So, to start, please stand facing me. Look straight ahead with your feet shoulder width apart and your hands relaxed at your sides. Take AP photo of upper torso and head.

Okay now, please turn to your left to face the blue wall. Take a full length lateral picture.



Verbalize your Objective Findings. This perspective gives us information about the health and mechanics of

your spinal curve system – “your body’s spring system”

You have significant Forward Head Posture…

This is usually a sign of a reduction or loss of your healthy cervical curve…

You have rounded shoulders – or Kyphosis

…and sway back – or a loss of your healthy lower spine curve…

Tell the patient what you see:

Make concise, direct, confident statements. Be systematic and consistent – top to bottom. Remember, this is a different tone – this is not a New Patient. We are trying to communicate the fact that their future adjustments / recommendations are always based on objective findings, not solely on “how they are feeling.” This is a delicate balance.

Examples:

Looking at your posture – you have a left head tilt and your headand neck are shifted to the left

…a high left shoulder

…your pelvis is rotated forward on the right

…and you have a high right hip

“I will take pictures of your posture for the doctor’s review.”

Now, please turn to the left again to face the (white) wall. Step on the balances (scales) in front of you, with one foot centered in each balance. Look straight ahead with your hands at your sides.

Call the scales “balances”, not scales. People hate scales and being weighed.

Now, let’s take a photo of your posture from this angle.

Take a full length PA picture.

Once you have taken the third picture lock out the “balances” to assess balance.


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As you know, a healthy body is balanced – it carries its weight evenly… Please hold still while I unlock the balances until they settle. Keep looking straight ahead, you are doing great. Don’t move. You’re doing great. Keep looking at the wall…

Keep talking to them until it is time for them to step off the scales.

You can step off the balances now.

Read the scales… You are carrying ### pounds on the right leg and ### pounds onthe left leg. That is a ### pound imbalance.

Avoid explaining the findings (reporting) to the patient. Do not dodge or avoid questions; simply explain that the doctor will be giving them a Progress Report on their next visit.

After Progress Exam:

NAME, this is how we use this information:

First, this data tells us how your body is responding to your adjustmentsrelative to our expectations when you first started.

Second, it gives us direction as to where we should focus for your next set of 12 adjustments.

And finally, it shows us how well you are holding your adjustments - this is what determines your frequency.

The doctor will give you feedback on this during your Progress Report in an upcoming visit. Please confirm that date when you check out today.

Now let’s get you adjusted…

Pre-View and Future Pace the Progress Report This script teaches the patient “what is important” – the Objective findings will be repeated during the subsequent Progress Report. Repetition is the mother of mastery.

Procedure:

Take patient into Adjustitorium or Relaxation Center (hot seats). Give the Progress Exam Questionnaire to the patient’s primary doctor to review before the patient’s next adjustment. Make sure the Exam photos and data is entered into the patient’s file immediately.

CA Retention Manual


Core Consult Schedule and Notes

Category Consult Date Scheduled

Date Completed

Completed By - Name Notes

Intro / Overview 3 Legged Stool

Lumbar Level 1: Stand Ups

Level 2: Chair Touch

Level 3: Air Squats

Level 4: Overhead Squats

Level 5: Weighted OH Squats

Level 6: Single Arm OH Squats

Cervical Bad Habits

Traction

Life Extension

Vitruvian Man

Thoracic Bad Habits

Planking

Supermans

Push-Ups

OverHead Squats

Shoulders Bands

Kettlebells

OH Squats

Bulletproof Shoulder Routine

Joint Mobility

Ice

Kettle Bell Arm Bars

Turkish Get-Ups

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Swings

OH Squats

Self Care Foam Rolling

Pain Balls

Stretching

Stick Work

Joint Mobility

Icing Tips

Diet Style Nutritional Journal

Videos (15/15, Infl. Nation, Fuel)

Consult

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Flow(DC Module 56)

"Flow" is when all sources of practice friction are eliminated or reduced. When friction is present, it is harder to be - and stay - your patient. But when the practice flows, the energy is incredible.

Here are "The Crazy 8." These are the most common rubs in a practice, and are crazy reasons to lose patients.

The Crazy Eight• #1 Location: Be particular.

o Choose a location that is already in the flow of your ideal patient's lifestyle.

o Choose your neighbors wisely.o Pay attention to traffic and parking - make sure it's easy for

your patients to get in and out.• #2 Hours/Schedule: Start early, finish late.

o Be open outside of normal work hours.o Think about utilizing a split schedule: mix full days with half

days.o Make sure you separate regular adjusting and special

appointment times, so you can fully focus on each.o Keep regular adjustments the priority; put reports and special

appointment blocks during less popular times. (See sample schedule on next page.)

• #3 Your Team: Ambassadors of Retention.o The team's communication and energy make it easier for

patients to keep on their schedule.o Good customer service!

• #4 Floor Plan: Your floor plan should increase flow, not inhibit it.o Create an intuitive space.o Fast/Slow: put "faster" elements, such as the Front Desk, in the

front of the office, and the "slower" elements, such as consultations/examinations, in the back.

• #5/6/8 New Patient Process/Regular Patient Process/Table Talk: see elsewhere in manual!

• #7 Wait Time: Time is money!o Keep integrity around blocked schedule.o Make a 7-15 minute wait time your goal, so the regular visit is

no more than 30 minutes.o Build value for the wait time - use it for teaching, and train the

patients to appreciate the time to relax before their adjustment.

CA Retention Manual


Value Economy(DC Module 58)

As mentioned before, your retention is a reflection of your clarity. It's a reflection of your clarity around What You Do, Why You Do It, and How You Do It, and, perhaps most importantly, around the VALUE chiropractic adds to your patients' life.

You see, all human beings have four limited resources: Time, Energy, Focus, and Money. And ALL our decisions are made based on how we spend - or don't spend - one or more of these four. We ask "what's in it for me?" Or, "Is it valuable t me?"

As you know, chiropractic offers tremendous value. It also requires ALL FOUR of the consumer's resources. So when new patients do not convert, it's a VALUE issue. When current patients don't re-commit, it's a VALUE issue.

It's not a MONEY issue, it's a VALUE issue.

So in order to drive retention, you MUST understand the concept of VALUE.

There are Four Stages of Value:1. Creating Value

a. Your Patient Education Processb. First Step: Shift their Belief System

2. Delivering Valuea. Systems Executionb. Meet Patient Expectations

3. Adding Valuea. Patients' Perceptionb. "Why do you get adjusted?"c. Answer: "My chiropractor is the EXPERT on my healthcare team who

checks my spine and nerve system regularly for any interference in the flow of information that keeps my body healthy and healing. ... Why?Who checks your spine and nerve system?"

4. Capturing Valuea. Financial Transactionb. Getting Paid for your Services

CA Retention Manual


CA Retention Manual

Re-Reports &

Re-Commitments


CA Retention Manual

R4/R5 CONFIRMATION CALL (Module 48)

Procedure:

Check-In is responsible for contacting all R4/R5 patients on the day prior to the report, as a way of reminding the patient and confirming that they have all of the details.

If the patient has an e-mail address in Platinum they will automatically get an appointment reminder when the daily appointment reminder e-mail goes out (See “Platinum E-mail” section). These patients do not need a confirmation call.

Patients who do not have an e-mail address in Platinum need to be called to remind them of their appointment.

NOTE: Remember to use the terms “Four Month Review” and “Annual Review” when naming the reports to the patients, rather than the office language of “R4” or “R5”.

Script:

Hi, NAME, this is NAME from Franson Family Chiropractic. I am calling to remind you that you are scheduled for your TYPE OF REPORT with Dr. NAME tomorrow, DAY AND DATE, at TIME.

This visit will begin promptly at TIME, so the doctor has asked that you arrive about 5 minutes early.

Please make every effort to keep the appointment. But if for some reason you can’t make it, please call us here at the office to reschedule. Our number is 978-927-8466.

We hope you have a healthy, happy day, and look forward to seeing for your REPORT tomorrow at TIME!

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R4 APPOINTMENTS (Module 49)

At the end of the first four months of care, each patient will have another x-ray and scan. They are then scheduled for a special consultation time with the doctor. The Four Month Review [R4] is an opportunity for the patient to review their pre- and post- x-rays with the doctor, to see the progress they have made, and to get recommendations from the doctor for their next 12 months of care. Patients also get new financial paperwork at the R4.

Arriving R4 Appointments:

• Greet the patient as they enter.• Explain to the patient how Report Time works.

o If the patient is the first report of Report Time, wait for the last of

the adjustments to finish, then send them in next.

o If they are second or later in the order of reports, ask the patient to

have a seat in the Activation Center [Hot Seats], and that you will let

them know when they can enter a room to begin their report.

• Call the doctor to alert them to the patient’s arrival.

Closing R4 Appointments:

• When the doctor is finished with each report, he/she will callCheck-Out and communicate any clinical and financial decisions. At thatpoint it is your responsibility to send in the next report.

• Print out the appropriate HMA to discuss with the patiento If they pay set up Plan Box

o If they take the paperwork home stop manage them for their HMA

o and turn on their Green Box

• Add and remove appointments as necessary to complete their schedule.• Make sure they are scheduled for a Progress Exam every 12th visit,

and for an x-ray three weeks before their new Plan End Date.• Stop Manage them to set up their R5 on the same date that the 12

month x-ray is scheduled• Enter R4 transaction and any payment transactions in the patient’s file.



R4 CHECK IN

Procedure:

Greet the patient as they enter. Ask them to have a seat in the relaxation area. Let the doctor know that the patient has arrived. If the DC is ready to see the R4 send them into a changing room and let them know to get ready just like they do for a normal adjustment.

Script:

Hi, PATIENT NAME! We have been expecting you for your Four Month Review at TIME. Go ahead and swipe your card to check in. Great! If you would now take a seat to my right I will let the doctor know you are here.



R4 CHECK IN CHECKLIST

Before Shift:

⃝ Discuss at huddle which reports are scheduled during the shift and who is doing the report ⃝ Print out all HMAs for patients scheduled for R4/5/6 today

Print 1 copy on green paper and one copy on white paper

R4 – Print 52 plan (unless the DC specifies that the patient will

be going to 26 plan)

R5/6 – Print Wellness (or 26 plan when DC requests)

During Shift:

⃝ Be aware of when reports are due to check in

⃝ Greet patient by name

⃝ NAME, we have been expecting you for REPORT TYPE

⃝ Please check in like normal

⃝ Have a seat to my right and I will let the doctor know that you are here

⃝ Beep DC and let them know that the patient is checked in and how

many adjustments they have left before report time



R4 CHECK OUT

Script:

NAME, you had your Four Month Review today. The doctor has given you recommendations for ONE TIME PER WEEK going forward.

You have been scheduled for DAY and DAY at TIME and it seems like that has been working out well for you. Which would be the best day for you to keep - going forward? Great! Complete schedule and print MAP for patient.

-OR- It seems like you have had a hard time making your appointments on DAY. Is there a different time that would be better for you? Reschedule and print MAP for patient.

We also have a new financial plan for you. This new plan, based on the doctor’s recommendations, is for 1 visit per week for the next 12 months of care. You see listed here what is included in the plan. The retail cost of the care is… But, in recognition of your commitment to your health, we’ll be extending a discount to you.

We have two payment options available…

a. … You can make a down payment of $XX, followed by twelve monthly payments of $XX. The total cost for this option is $XX, giving you the greatest savings, of $XX.

b. … The other option is to make twelve equal monthly installments. The total cost for this option is $XX…. And the cost per month is $XX… The savings here is $XX.

Which option works best for you? We’ll set up an Electronic Funds Transfer on the

5th, 10th, 15th, or 20th of each month for the monthly installments.

Once they’re set up: Our patients’ payments for their care allow us to keep our doors open and to offer excellent care. If, for any reason, you can’t keep your financial agreement with us, please let us know as soon as possible.

And you will notice two paragraphs at the bottom of the page. The first paragraph simply states that everything the doctor has recommended for you today is included. The second paragraph states that if you had to discontinue care for whatever reason we would reimburse you whatever you haven’t used yet. We want to guarantee that our patients are happy here and that there is never any risk involved.



I will also review our office policies with you.

Care Plan As the doctor has explained, to get the best results it is important to maintain the rhythm of your care. We challenge you to make it your goal to never miss an appointment. But if you do have to miss an appointment please let us know as soon as possible. Missed appointments should be made up within 24 hours. If this is not possible they MUST be made up within 7 days. Missed appointments will not be added to the end of the plan to extend the dates.

If you will be away for 3 weeks or more, again, please let us know in advance so we can take you off the schedule. Plan dates will be extended only if the absence is 3 weeks or more and we are notified in advance.

Family We would like to remind you of our commitment to FAMILY wellness care. It is our highest priority to check the whole family. For the next two weeks we are offering a new patient consultation to any of your family members at our expense.

Signature: If you would please sign here indicating that you have heard and understand our office policies. There is also a copy for your records in the paperwork that we gave you last time/are giving you now.

Close If patient was compliant with their schedule: You’ve been doing a great job with your schedule, NAME, and have made great progress over the last four months. We’re excited to watch you continue your progress!

See you next week!



R4 CHECK OUT CHECKLIST Before Shift:

⃝ Print out HMAs for all R4/5/6 scheduled during the shift

⃝ Print out all HMAs for patients scheduled for R4/5/6 today


R4 – Print 52 plan (unless DC specifies that the patient will be going to26 plan)


Report Check Out:

⃝ DC will call the front desk when report is finished

⃝ DC will inform the front desk of the results of the report

Patient’s adjustment frequency

Financial plan

Any special consults/recommendations

⃝ Patient proceeds to front desk after report

⃝ MAP patient based on DC’s recommendations

⃝ Review HMA with patient

⃝ If R4 Check Out

Clarify that the new plan is for 12 months not 4

Review 2 paragraphs at bottom of HMA – everything is included and if you

discontinue we will refund you anything you haven’t used yet

⃝ NAME, Which option would you like to take advantage of?

Take payment or Stop Manage for payment at next visit

Add R4/5/6 OUT or YES Transactions

Click on Green box if not paid

Set up plan box, if paid

⃝ Review Office Policies form on third page of HMA with patient

Care Plan

Missed Appointments

Family NP Exams

⃝ Have them sign Office Policies sheet

⃝ Schedule any requested consults



R5 APPOINTMENTS (Module 50)

At the end of a patient’s plan year, another set of x-rays or a scan will be taken and a special report time will be scheduled with the doctor. The Annual Review [R5] is another opportunity for the patient to re-commit to a new year of care to continue their corrective progress.

After 3 years of care a patient’s end of year report can be done during their regular appointment time. This appointment is still coded as a 5 but we call it an R6.

Arriving R5 Appointments: • Greet the patient as they enter.• Ask the patient to have a seat in the Activation Center and tell them you

will let them know when they can enter the room with the doctor to begintheir report.

• Call the doctor to alert them to the patient’s arrival.

Closing R5 Appointments:

• When the patient comes out from their R5, you will need their new greenHMA (Health Made Affordable) form so they may financially recommit tocare. The appropriate financial amount should be circled.

• Ask the patient what payment option they are choosing.o If the patient wants to use the 12 month payment plan, they need to sign

up for EFT.• If the patient is not ready to make a commitment now, make a copy of the HMA

form for them to take home and review. Place the green HMA form in the HMAbin in alphabetical order by last name.

• If the patient is ready to make a commitment now, have them sign the HMAform. Then you sign as the witness. Put the form in the “File Me bin” forprocessing.o Collect the one-time payment, or the first payment for the HMA.

o Record the payment.

o Set up EFT or Stop Manage for monthly payments

• Record an R5-Yes, R5-No, or R5-Out transaction.• Set up the patient’s Schedule for the next year• Schedule the patient for a Thermal Scan at 6 months and an x-ray or scan

three weeks before the new Plan End Date.• Print out a new Multiple Appointment Schedule for the patient.



R5 CHECK IN

Procedure:

Greet the patient as they enter. Ask the patient to have a seat in the relaxation area and let the doctor know that the patient has arrived.

Script:

Hi, PATIENT NAME! We have been expecting you for your report at TIME. Go ahead and swipe your card to check in. Great! If you would now take a seat to my right I will let the doctor know you are here.

R6 CHECK IN

Procedure:

Greet the patient as they enter. Let them know they have a report, and give them a letter like normal.

Script:

Hi, PATIENT NAME! You are scheduled for your annual report today. Go ahead and swipe your card to check in, and go in like normal. The doctor will review your scan when you get your adjustment. Then please stop by Check-Out before you leave.



R5/6 CHECK IN CHECKLIST

Before Shift:

⃝ Discuss at huddle which reports are scheduled during the shift and who is doing the report ⃝ Print out all HMAs for patients scheduled for R4/5/6 today (Check-Out)


R4 – Print 52 plan (unless the DC specifies that the patient will be going

to 26 plan)


During Shift:

⃝ Be aware of when reports are due to check in

⃝ Greet patient by name

⃝ NAME, we have been expecting you for REPORT TYPE

⃝ Please check in like normal

R5:

⃝ Have a seat to my right

⃝ I will let the doctor know that you are here

⃝ Beep DC and let them know that the patient is checked in and how many

adjustments that have left before report time

R6:

⃝ Give them a letter

⃝ Ask them to stop by Check-Out before they leave



R5/6 CHECK OUT

Script:

NAME, you had your annual review today. The doctor has recommended that you continue at one time per week/every other week. Would you like to keep DAY at TIME? It seems like that has been working well for you.

Okay, give me just a moment to complete your schedule. Print Map. Here is a copy of your schedule to take that home with you.

Here is a copy of your new financial paperwork for the next 12 months. You will see here at the top everything that is included in this plan and the retail cost of the care which is $XXX.

R5, add: In recognition of your commitment to your health, we are graduating you to Wellness care! This includes an even deeper discount to the cost as a way of recognizing your commitment to your health.

For payment, we offer twelve monthly installments. We’ll set you up for automatic

payments, running on the 5th, 10th, 15th, or 20th of each month. Your monthly charge will be $XX, for a yearly total of $XXX. This gives you a savings off retail of $XX.For the payments, which card would you like us to charge? Great!

If they are not ready to commit: Okay, if you need time to think about it I can give you a copy of this form to take with you and you can let me know next time what you would like to do.

Once they set up their EFT:

Could you please sign the HMA form for me? Would you like a copy of this form for your records?

I will also review our office policies with you.

Financial

Your payments for your care allow us to keep our doors open and to offer excellent care. If, for any reason, you can’t keep your financial agreement with us, please let us know as soon as possible.


0 3 2 1 4+

Care Plan As the doctor has explained, to get the best results it is important to maintain the rhythm of your care. We would like to challenge you to make it your goal to never miss an appointment. But if you do have to miss an appointment please let us know as soon as possible. Missed appointments should be made up within 24 hours. If this is not possible they MUST be made up within 7 days. Missed appointments will not be added to the end of the plan to extend the dates.

If you will be away for 3 weeks or more, again, please let us know in advance so we can take you off the schedule. Plan dates will be extended only if the absence is 3 weeks or more and we are notified in advance.

Family We would like to remind you of our commitment to FAMILY wellness care. It is our highest priority to check the whole family. For the next two weeks we are offering a new patient consultation to any of your family members at our expense.

Signature If you would please sign here indicating that you have heard and understand our office policies. There is also a copy for your records in the paperwork that we gave you last time/are giving you now.

Close Do you have any other questions for me? Okay, then we will see you DAY at TIME. Have a great day!

CA Retention Manual



R5/6 CHECK OUT CHECKLIST

Before Shift: ⃝ Print out HMAs for all R4/5/6 scheduled during the shift

⃝ Print out all HMAs for patients scheduled for R4/5/6 today


R4 – Print 52 plan (unless DC specifies that the patient will be going to26 plan)


Report Check Out: ⃝ DC will call the front desk when report is finished

⃝ DC will inform the front desk of the results of the report

Patient’s adjustment frequency

Financial plan

Any special consults/recommendations

⃝ Patient proceeds to front desk after report

⃝ MAP patient based on DCs recommendations

⃝ Review HMA with patient

⃝ If R4 Check Out

Clarify that the new plan is for 12 months not 4

Review 2 paragraphs at bottom of HMA – everything is included and if

you discontinue we will refund you anything you haven’t used yet

⃝ NAME, Which option would you like to take advantage of?

Take payment or Stop Manage for payment at next visit

Add R4/5/6 OUT or YES Transactions

Click on Green box if not paid

Set up plan box, if paid

⃝ Review Office Policies form on third page of HMA with patient

Care Plan

Missed Appointments

Family NP Exams

⃝ Have them sign Office Policies sheet

⃝ Schedule any requested consults


CA Retention Manual

Team Building

& Metrics


CA Retention Manual

Team Building(Module 6-7)

Your team will have greater influence over your practice’s sustainable growth than any other individual factor. If you have to choose between A+ Systems, A+ Chiropractors, or an A+ Team: choose the A+ Team. Your On-Purpose Team will help you build, serve, and expand your practice. The right team is absolutely critical.

The Remarkable Team: Positions, Roles, and Goals

Front Desk CA: The Champion of Patient Process

Check In CA: Boss of Today Face of the Practice Big Smile, Positive Energy Great with People Friendly, and able to say No with a smile

Master of the Schedule Know who is on Schedule What they’re doing What time

Master of the Systems Where each patient and team member is How long each process takes Direct everyone, patients and team members

Check Out CA: Boss of Tomorrowo Guardian of Policies

Protect, Promote, Enforce office policies Guardrails designed to protect patient’s experience Understand patient process

o Huge Value for Care Kind and empathetic Commitment to practice Mission Financial plans and agreements

o Shapes the Future Scheduling and Mapping Patients Workshop Attendance and guests Family check-ups


Back Office CA: The Guardian of Patient Procedures• Office Manager

o Oversees teamo Runs Schedules, meetings, trainingso General Administrative tasks

• Business Managero Accountso Insuranceo Book Keeping

• Marketing Managero Internalo External

• Floor CA/Tech CA: Boss of the Flooro Admin Liaison between Front and Backo Clinical Liaison between Patient and Doctoro Patient Advocate

• New Patient Concierge: First Class Serviceo Attached to New Patientso Guide and Guardian of NPo Clinical to Admin to Close

CA Retention Manual


CA Retention Manual

Team Meeting(Module 8)

Your Team Meeting is a weekly mechanism that protects the connection, organization, and communication of your team, and serves as a backbone to your practice success.

The purpose of the Team Meeting is to create an environment of connection, communication, and support. Team Meetings should be structured. They should happen at the same time, every week, have a reliable structure, and carry a specific tone. Keep it professional and purposeful, and whenever you can, fun!

Give each Team Member responsibilities to report on, so that they can come prepared for the meeting. Then go around the table, giving each Team Member a chance to share.

Team Meeting is your Family Dinner.


CA Retention Manual

Team Training(Module 9-10)

Why Team Training?The purpose of Team Trainings is to build Skill, Certainty, and Clarity.

Trainings, like meetings, are scheduled at a consistent time each week. They have a structure, and a tone. Each Team Training has a specific focus - and culminates in everyone practicing the parts they play with the patients.

We train like lives depend on it - because they DO!

Process vs. Procedure

• Process refers to the patient experience; it's everything that they see, hear, and feel.

• Procedures are the underpinnings that are invisible to the patient.• Process Training involves role-playing. The entire team gets to

participate in every aspect of the patient experience, so that they understand the continuity in patient communication.

• Procedure Training is more how-two and check-list oriented.

Heart, Head, Hands, Feet

The three most important attributes of your training system are: Structure, Culture, and Preparation.


• Topic: Introduce• Context: where the topic is in the patient process• Communications Objective• Patient Take-Away• Demonstrate• Delivery: discuss this as a team

o Stateo Cadence & speedo Posture & body languageo Emphasis

Training Structure: Week Two• First Half: Individual Performance/Role Play (of previous topic)• Warm-Up, Review:

o Communication Objective?o Patient Take-Away?

• Performance and Feedbacko Delivery

State/Energy Cadence/Speed Emphasis/Pause Over-all Feel

• High Points• Need Training... "3 Strokes for Every Poke"• Second half: Demo & Teaching of next topic

Remember E=MC2!Keep your trainings focused and productive, and always high energy and fun. Never lose sight of what you - and your team - have to offer to your community.

Train like lives depend on it - because they DO!

CA Retention Manual

Team Training, continued

Training Structure: Week One


TEAM TRAININGS

Why we Train:

• We train like lives depend on it…because they do.”• We train because it drives all metrics: results, referrals, conversions, retention, collections, etc…• We train because humans are innately driven to seek mastery• We train because our teams thrive in an environment that demands excellence• We train because we have been given a Sacred Trust• We train because it makes everything else easier• We train because we will be too busy to ad-‐lib• We train because it is the only way to find out exactly how good we can be….

Team Trainings are….

• Not meetings• Part of our schedule• Always happen• Set the intensity of our office and influence• Reflect our commitment to serve• Challenging, supportive, respectful and fun

Team Training Structure:

• Topic: “A Step on The Path”

• Done in the chronology of a New Patient Experience

• Doctor and Team are aware of upcoming focus / topic and are equipped with Script and / orprocedure ahead of time (week previous) -‐ they are told to come prepared

• Doctor and Team show-‐up prepared (learn script and procedure steps)

• Doctor role-‐plays (show them how to do it perfectly)

• Discuss key points:

o Objective (what are we trying to accomplish?)

o Take away (what are we trying to communicate?)

o State (what is the appropriate state of delivery? Ex: ROF vs. Workshop)

CA Retention Manual


o Delivery (how to deliver…cadence, pace, emphasis…)

o Content (what to say / script)

• Next week: Team Role-‐Plays (performance)

• Critique (from everyone – be supportive – use frame work above…)

o Ex: “Your state was great, serious but loving…your pace was a little fast…”

• Hug, high-‐five and look for ways to encourage one another

• Review next training topic.

First 14 Topics: New Patient Chronology (2 weeks on each)

1. New Patient Phone Call

2. Greeting NP and Paperwork / Intake

3. NP Office Tour

4. Meet Doctor / Tech Staff and Pre-‐Consultation

5. Consultation*

6. Segue (transition from Consultation to Examination – Policies – agreement)

7. Examination

8. X Ray

9. Check-‐Out

10. Report of Findings/Recommendations for Care (ROF/REC) Check-‐In

11. ROF/REC Check-‐Out

12. “Break-‐In” Check-‐In

13. “Break-‐In” and First Regular Office Visit

14. “Break-‐In” Check-‐Out

CA Retention Manual


CA Retention Manual

Practice Energy(Module 11)

E=MC2

Your practice is a reflection of your energy.

Energy & Enthusiasm = Money x Crucial Communications

M: MoneyMoney is good! It is important to your team, and is a good motivator. Compensate your team in such a way as to motivate, incentivize, and reward great people, great behavior, and great outcomes.

C2: Crucial CommunicationsThere are two categories of relationships you can have with your team:

1. Transactional2. Relational

Of these two, Relational is better! Transactional relationships are built on money, contracts, etc. They are typically expensive, and have limited sustainability. Relational teams are built on Vision, Purpose, Mission, and Leadership, and Crucial Communications.


The Vital Signs Program is a collection of excel spreadsheets, charts, and graphs created as a tool to help you run your practice. Various reports may be generated weekly, monthly, quarterly and annually to better visualize your practice goals and achievements.

Your stats should be entered every week – either at the end of your week or the beginning of the week for the previous week’s stats.

We recommend having your Vital Signs ready for your Monday Team Meetings. The Vital Signs Reports can provide excellent structure to your weekly meetings. Involve each team member in this process and assign specific statistics to the correlating positions in your office. (Example: The Check-Out CA” is responsible for collections. The Check-In CA is responsible for compliance.) Each team member is responsible to “report and comment” on the respective stats at each meeting. This creates great accountability and ownership around positional responsibilities. It also keeps everyone engaged for more energetic team meetings.

The first step in your Vital Signs program is to learn to record and track the required information. You must be able to record and track the following:

Number of New Patients and how they were referred to your practice (Source)

Number of Report of Findings (ROF or R1) Number of Recommendation Reports (REC or R2/3) and their outcomes Number of Re–Reports and Re-Recommendations (R5) and their

outcomes Number of Appointments: scheduled, missed, and walk-ins Number of Inactive Patients or patients who have dropped out of care Collections

CA Retention Manual

Vital Signs(Module 37)

The Weekly Summary Report has multiple tabs listed along the bottom of the spreadsheet. They are as follows:

NP Tracking Report Weekly Stats Outstanding RECs Outstanding Re-Reports Weekly Performance Monthly Performance

• Inside Conversions Chart• Outside Conversions Chart• Patient Visits Chart• Collections Breakdown• Collections by Provider Chart


The only tabs that require data entry are the NP Tracking Report; Weekly Stats; Outstanding RECs and Re-Reports; and Collections Breakdown. All the other charts and monthly reports will be automatically generated for you based on your weekly data.

You should save your Vital Signs Weekly Summary Reports every month. For example, create a folder on your desktop called “2017 Stats” and keep every month in the folder. Once you have been using Vital Signs for a while, you will find it easy to compare your stats month to month, quarter to quarter and year to year.

CA Retention Manual


NP (NEW PATIENT) TRACKING REPORT

The NP Tracking Report records every person that has scheduled for an examination in your office – everyone that has asked for your help. The Report follows their first critical days in your practice and records their status at every step. This is vital to ensure that no one “falls through the cracks”. These are the delicate “Eggs” that must be gently guided through and “handed-off” between Team members at each step in your New Patient Process.

To use the NP Tracking Report, you must simply input the information for everyone that has scheduled an examination in your practice and the respective dates. You will record the patient name; referral or source; and dates of exams and reports. Finally, you will track the outcome of the reports with a date as to when they committed to care (yes); did not commit to care (no); or if they are still undecided or outstanding.

The crucial point here is to be clear as to your definition of “yes” or committed to care. In our practice, a patient is only a “yes” once they have made their financial commitment. If they have verbally committed and have scheduled out their first four months of care, but have not yet paid for their care, they are an “outstanding”.

Now your practice may have a different method of recording a new patient conversion. Maybe you accept insurance or you have patients that “pay as they go”. You need to determine your practice policy as to what defines a committed new patient. It may be that they schedule out their next 12 visits and are then considered a new patient conversion. The important thing is to stay consistent in how you record them. Be clear and consistent with your policies!

To quickly determine a patient’s status, each patient is color coded based on where they are in the process. The Color Code Key is as follows:

Orange = Patient Still In Process – ex. Reports are scheduled White = No NP Exam – The patient never came in for their new patient examination Yellow = NP Exam, No Reports – The patient had their exam but did not have reports Blue = R1 No – The patient received their Report of Findings but not their Recommendations Red = R2/3 Outstanding – The patient is undecided or outstanding Green = R2/3 Yes – The patient has committed to care – KNOW WHAT THAT MEANS! Gray = R2/3 No – The patient did not commit to care

Vital Signs: NP Report(Module 38)

CA Retention Manual


CA Retention Manual

Each week, all scheduled new patient exams should be entered into this spreadsheet. The report should be updated weekly. Any patient color coded “orange” or “in process” on one week should be followed through the cycle of reports and updated accordingly. Any outstanding reports, color coded “red”, should be updated weekly and they should stay “red” until they become a “yes” or a “no”.

Follow-up with any patient color coded “white” or “yellow”. These are people that have asked for your help. Do you your best to get them back into your office to get the care they need.

Every week you and your team should use the New Patient Tracking report to discuss the “eggs” in your practice. Make sure everyone is accounted for and all cycles are closed. Don’t let anyone miss out on the opportunity for greater health and wellness.

This Report should be kept as a running report for the year. The total counts are automatically recorded at the end of the sheet and can provide a great deal of information for your practice.

You may also sort on your data to reveal trends in your referral source. If you are recording which patient referred someone, you could sort on the names and see which patients are referring the most in your practice. Make sure to gift them for their support!

You could sort on the events column and look for all the new patients that scheduled from a specific health screening or event. Were the majority of new patients from a particular screening color coded green? If so, that was a worthwhile event! If they were all white or gray, it may not be a screening you want to do again the following year. Use the New Patient Tracking Report to help analyze your return on investment for your outside activities.

The best practices in the world use Vital Signs – or some type of meaningful metric tracking program…let’s make sure that you are too!

Remember: You are in the business of saving lives – and when business is good –

everybody wins.


The weekly summary is separate tabs that are automatically calculated by the data on the weekly stats tab. No additional information is required other than to type in the month and year.

This Weekly Performance Report provides key indicators to your practice's health: PVA or Patient Visit Average is your Retention which is automatically

calculated for you as your total monthly patient visits divided by your total number of conversions. This indicates how long a patient stays in your practice or the average number of adjustments per patient in your practice.

Prospect Value is automatically calculated each month as your total collections divided by your number of new patient reports. This is an indication of the financial value of a prospective new patient. In other words, what is every new patient scheduled worth to your clinic? This number is used to help determine your marketing budget.

Case Lifetime Value reflects the average financial value of a patient over the course of their care. Of all your patients that convert and commit to care, what is the average case worth to your practice over the lifetime of the patient.

INSIDE AND OUTSIDE MONTHLY CONVERSIONS PIE CHARTS

These pie charts are separate tabs on the spreadsheet and are automatically calculated by the data on the weekly stats tab. No additional information is required other than to type in the new month. This is a great visual tool to see your new patient conversion percentages from both inside referrals and outside sources. (Note: the charts are automatically modified as data is entered into the spreadsheet. Do not be concerned by the look of the charts prior to data being entered.)

PATIENT VISITS CHART

This bar graph is a separate tab on the weekly spreadsheet and is automatically calculated by the data on the weekly stats tab. As long as you have entered a PV Goal on your weekly stats tab, you will get a graphical representation of your PV in comparison to your goal. No additional information is required other than to type in the new month.

CA Retention Manual

Weekly Performance Report(Module 39)


COLLECTIONS BREAKDOWN

The Weekly Collections Breakdown tab is designed to track the source of Collections by Provider. This is usually applicable only if you have a multi-doctor clinic. However, you may want to use this sheet to record cash and insurance collections. You may also use it to record collections from supplements or other therapies. This is just a tool that you may choose to use to breakdown your collections. It is not linked to your Weekly Stats information.

COLLECTIONS BY PROVIDER CHART

This pie chart will be automatically generated if you use the Collections Breakdown sheet. The categories will be determined by the categories you have chosen to track. It will give a pie chart with each doctor’s collections or simply show cash versus insurance. You may decide what collections categories (if any) that you want to track.

CA Retention Manual


CA Retention Manual

Forensics Report(Module 40)

The Forensics Report is an extension of the New Patient Tracking Report. However, it goes one step further and records when patients have dropped out of care. Remember, as part of your weekly stats you should be recording your weekly Inactives. The key points to remember here are:

Define: “Converted Patient” – when are they a “Yes”

Define: “Inactive Patient” – date a patient discontinues care (date of last visit)

Is there a tracking / response system in place? (ex: missed appointments, phone calls, letters?)

You are already entering your new patient data into the NP Tracking Report. To generate the Forensics Report, it is simply a matter of copying and pasting the data each week into the Forensics Report.

Your New Patient Tracking data should be kept for the entire year. However, you can keep The Forensics Report running for several years of data in order to get a better/bigger picture of trends in your practice.

Entering the data is easy.

The spreadsheet has 4 tabs. You will only enter data into the first tab, the Data Table. You may simply copy and paste your new patient tracking data into the Forensics Report. Only copy the cells from the name to the beginning of the note section in columns A through M.

The columns on the far right are protected as they have complex formulas that allow dates to calculate at the 3, 4, 12 and 16 month marks – but only if the patient was a converted patient that does not have an inactive date. The dates will fill in automatically for you. You DO NOT need to enter any data.

The only other data that needs to be entered is an Inactive date if the patient goes inactive.

Again, you need to determine when that happens in your practice – be honest, objective and accurate…otherwise the information is not representative of reality – and therefore useless.


CA Retention Manual

The remaining tabs on the spreadsheet are charts and graphs that will automatically generate.

Totals –this gives a numeric count and percentages for:o Total NP examso Total Reportso Total Conversionso Total that Did Not Commit to Careo Patients that have “stuck around” to the 3, 4, 12 and 16 month marks

Stick Rate (A Retention Metric)

o A graphical representation of how long the patients “stick around”

Inactives by Month

o When patients are dropping out of care


CA Retention Manual

Troubleshooting Retention(Module 43)

Troubleshooting Patient Volume (PV)

Patient Volume is the Holy Grail of Chiropractic Stats: what does your PV say about your clinic?

Here's how you find your Total Patient Volume (TPV):Kept Patient Visits (KPV)

PLUSWalk-In/Call-In Visits (WPV)

EQUALSTotal Patient Visits (TPV)

Three Indicators of Practice Health, and what they Represent• Patient Volume: the Impact you are having on your Community• Collections: the Value that you, your team, and your patients have for your

care• New Patients: the ultimate success of your practice

If your PV is stuck, you need to look at your entire practice to find the blockages - the interference - wherever they are in your processes, procedures, and systems.

Trouble Shooting Compliance (Kept Visit Average)

Compliance indicates whether your patients are understanding and following your recommendations for their care. It reveals:

• Patient Commitment• Team's Ability to Convey Value• Clear Policies

Compliance is highly predictive of RETENTION.

Compliance Percentage Breakdown:• 87% and + = Growth Zone• 82% - 86% = Stagnant Zone• Below 82% = Breakdown Zone

If you are struggling with Compliance, here are some suggestions:• Create Value for Adjustment Rhythm, especially during Recommendations• Have a Written Compliance Policy - and enforce it!• Call Patients on 1st Missed Visit: let them know that you noticed, and you

care!• Tracking & Alert System: train your team!


Trouble Shooting Patient Visit Average (PVA)

Patient Visit Average represents the average number of adjustments your patients get in a lifetime relationship with your practice. It is a direct reflection of your RETENTION.

Remember, retention is key, because chiropractic care over a lifetime• Drives Better Clinical Outcomes for the Patients• Drives Practice Success and Growth• Drives Fulfillment for the DC & the Team

Total Monthly Patient VolumeDIVIDED BY

Total Monthly New Patient Commitments EQUALS

PVA

And your goal? As Big As Possible!

Your Retention is a Reflection of your CLARITY

Retention reflects • Your Clarity• Your Team's Clarity• Your Patients' Clarity

Retention reflects clarity in• What you do• Why you do it• HOW you do it

If your Retention is poor, check your practice against the Big Seven! Ensure that:• The Big Seven Practices EXIST• They are being EXECUTED• You & Your Team are COMPETENT• Your Patients are PARTICIPATING

CA Retention Manual


CA Retention Manual

Trouble Shooting Re-Conversion/Re-Sign/Re-Commitment

The ultimate goal is not simply Conversion, it's Re-Conversion. It's for a patient who's already experience your care and your team's service to say: yes, I'm staying here! So how do you build a practice full of Re-Commitments?

Ground Rules:• Re-Conversion Starts on Day 1• Re-Exam is THEIR Report Card (not yours)• Expectations & Agreements

o Your Role as Chiropractor Educate Adjust Hold Accountable

o Their Role as Patient: Three Legged Stool Rhythm Habits Exercise

This is a relationship. And it develops just like one. Think of it this way:1. Day 1 = First Date2. Day 2 = Second Date3. Conversion = Engagement4. Re-Conversion = Marriage5. Subsequent Re-Conversions: Anniversaries

Trouble Shooting Inactives

Your practice has three doors: Front, Side, and Back.• Front Door = Attraction Issues• Back Door = Conversion Issues• Side Door = Retention Issues

It is hard to see patients discontinue their care. But if clarity is lost, and patients lose focus on the value of their continued care, they will step out the side door and be gone.

Track when and where in the patient process patients are leaving. This is what the Forensics Report is for! And your Stick Rate tells you:

• Where are your patients dropping out?• Where do you need to plug holes in your bucket?• Where do you and your Team need to focus your training or fix a system?

And again: check the Big Seven!


CA Retention Manual

Troubleshooting Collections(Module 44)

Collections are the transactional manifestation of the VALUE that you are delivering. Here are some ways to troubleshoot your Collections.

Trouble Shooting Practice Revenues (Collections)• Find the Problem:

o Productivity Issueo Systems Issue - are your systems set well?o Training Issue - are your team and patients trained well?o Execution Issue - are systems being executed well?o Integrity Issue

Patient - are patients out of integrity with their plans?• Culture• Expectations & Agreements• Policies

Team• Train! (Culture, Expectations & Agreements, Policies)• Train: Customer Service, Objection Management• Special Circumstances

Doctor• Limiting Belief?• Money Blueprint?• Poverty Complex?

• Business Model Issue:o Recommendations - visit by visit, or care plans?o Payment Plans - retail charge for services, or discounted pre-paid

plans?o Collection Visit Average

Focus on delivering value; money follows value.

Trouble Shooting CVA• Standard: $35 - $50 per office visit• Pricing/Charges for Services• Care Plans

o Don't give away care & services: charge what what they receiveo Representative of actual care

• Policies around over/under service• Payment Plans

o Commitment to care plano Pre-Pay Incentiveso Capped Fee - Savings!o Multiple Family Members - Savings!


CA Retention Manual

Remarkable Shift

Resources


CA Retention Manual

Opening The Shift


CA Retention Manual

THE HUDDLE

Each shift in our office begins with a Huddle. The team gathers together to discuss the various aspects of the upcoming shift, such as New Patient Exams, Reports, Scans, X-Rays, etc.

Check In CA begins Huddle by reading the date and all of the promotional info on the huddle sheet, including the current Patient of the Week, the Family of the Month, and the Chiro Kid of the Month, upcoming promotions, foundations/advanced workshops, and the Book of the Month. This serves as reminder to the team to continue to promote events from their various positions throughout the office.

The Exam DC then reads the Exam List (See Printing Exam List) and all the reports from the Huddle Sheet.

Sample Huddle Sheet


CA Retention Manual

MAKING THE HUDDLE SHEET

The Check In CA is responsible for creating a Huddle Sheet for the following day and making all of the confirmation calls / e-mails for the following days’ reports/consults (see “Confirmation Calls/E-mails”). Included on the Huddle Sheet are any New Patient Exams, R1/ROF, Break-In, R4/Four Month Review, Annual Reports, Progress Exams, Consults, and Workshop attendees. Also, Huddle Sheets for days that end with a Better Results Faster should include the names of those attending, and the number of guests.

The Huddle Sheet also serves as a list of all the confirmation calls that must be made for the next day. All Consults, New Patients, R1/ROF, R4, and R5 (not R6s) coded appointments must be called or e-mailed to confirm their next day’s appointment.

Preparing the Huddle Sheet for Tomorrow:

The Huddle Sheet Document should live in a shared folder. Open the file and begin by deleting old info out of the huddle sheet. To add tomorrow’s special appointments bring up tomorrows appointment schedule. In time order add all appropriate appointments to the huddle sheet (see list above). 4 month X-rays also need to be added. Be sure to check all of the doctors’ schedules who are adjusting the next day to make

sure nothing is omitted. Color code all the appointments on the Huddle sheet for ease of reading. For NPs and R1/ROFs make sure that the referral source is listed in the last box (see

sample Huddle Sheet above). For R2/Break Ins the last box should have the name of the report’s spouse or parent. For Consults the last box should contain the topic of the consult. All other reports you may leave the last box blank. At the end of the shift double check that nothing has changed in the schedule before

printing the huddle sheet for tomorrow. Print a copy for each member of the team.


CA Retention Manual

PRINTING EXAM LIST

Check In CA is responsible for printing the Exam List before Huddle everyday. The Exam List is a list of all appointments with a special code.The Exam list is then read at Huddle to make sure everyone is informed of upcoming exams and special appointments. This is gives the team an opportunity to plan ahead for the day and make sure everyone is on the same page about who is doing what.

Platinum Pro Tip: To Print the Exam List follow these steps: Type “R” – or click Appointment button in task bar Type “P” or click Professionals in the menu Press ESC to select all Professionals Type “L” or select Appointments with a code from the menu Select “By time” Accept today’s date Hit Enter to confirm time that shows up automatically Press ESC to select all Codes F6 to print


CA Retention Manual

CHECKING VOICEMAIL

It is Check-Out’s responsibility to check the voicemail before each shift. All patients who leave a voicemail message should be called back before the shift starts! Here is a list of the various duties involved in the voicemail responsibility.

Retrieve Phone Messages

• Check all boxes, one at a time• Flip over today's Huddle sheet, and write on the back• Write down all messages, including:

• Time of call, patient/caller name, specifics of message• When finished, erase each message, unless you need to keep it for someone else to

hear

Return calls to all patients who left messages:

Try cell phone or work phone first. Do not call home number before 8 a.m. unless the patient has called in that morning.

If a patient has cancelled an appointment: • Type reason in Missed Appointment Ledger (Platinum: R,Q) or delete depending on

whether the appointment was for today or a future date [see “CancelingAppointments section of this manual]

• If you are canceling an appointment for a New Patient, R1 or R2 on a future date DONOT DELETE THE APPOINTMENT - instead enter a note in the Missed AppointmentLedger (Platinum: R,Q) in order to allow for the tracking of the statistics

Distribute Phone messages to the Team.

• Write any messages for team members on the appropriate message pads.• Make sure you write CLEARLY so they can read the message.• Make sure you include the date.• Put your initials on each message slip.

• Place messages for DC’s and Techs in their boxes in Dr.’s office in back.• Place messages for Office Manager on desk in Manager’s Office.


CA Retention Manual

Running The Shift


CA Retention Manual

MANAGING THE FLOW

The Check-In CA is the Boss of Today. It is your responsibility to make sure that the office flows properly during normal adjusting hours, report times, and any other special appointment times. Think of yourself as the driver of a bus: you can’t leave the wheel, and you must be aware of your surroundings at all times!

The Check-Out CA is the Boss of Tomorrow. It is your responsibility to ensure that every patient is mapped out for their appointments appropriately and to manage their accounts. You need to keep everyone in integrity concerning their schedule and financial arrangements.

Here is a list of things for the Check in CA to keep in mind as you manage the flow of the office:

Notifying Doctors of who their last 2 patients are before report time, lunch time, and close.

This allows the doctor to prepare themselves mentally for the transition from adjusting time to report time.

Keeping the doctors on schedule!

This involves making sure that patients haven’t been allowed to enter late or as a walk in during a time when the doctor is booked solid already, and making sure the patients in the Hot Seats move through the process quickly and efficiently.

Notifying the Tech CA and Associate DC of Progress Exams, Scans, X-rays

The Tech CA and or Associate DC typically watch the arrival list and note any patients requiring Progress Exams, Scans or X-rays. The Check-In CA’s job is to communicate to the patient that they are going to receive a Progress Exam, Scan or X-ray, or reschedule it if the Tech CA and Associate doctor are both unavailable.

Notifying the Associate Doctor of New Patients

If a New Patient arrives, check them in according to the scripting available in the scripting section of this manual, enter the patient’s information into their computer file, and then pass the clipboard with the patient’s registration form off to the Associate doctor.


CA Retention Manual

MANAGING PATIENT WAIT TIME Patients are scheduled for appointments in fifteen minute increments. During their R2/3 they are asked not to arrive early or late, but to arrive right on time. But with daily changes in traffic patterns and normal life struggles, people tend to arrive early, late, and somewhere in-between for their appointments. The Check-In CA needs to monitor patient arrivals and use the following strategies to manage patient wait-time.

Always be aware of the patient’s assigned appointment time. Patients need to be “arrived” in the order of their appointments. A patient with a 7:30 am appointment should not be sent in to see the doctor before a patient with a 7:15 appointment (there might be exceptions, so be sure to treat each situation separately).

Too Early and Too Late

Use the following timetable as a template by which to determine the order to arrive patients. (8:00 has been chosen as a random example time for illustration purposes.)

• If a patient arrives before 7:55, they are EARLY for their 8:00appointment time. Ask them to wait in the front hotseats, and givethem a letter as soon as all of the 7:45 appointments have arrived andchecked in. If more than one patient arrives early, be sure to hand outletters in the order they arrived.

• If a patient arrives between 7:55 and 8:10, they are on time.• If a patient arrives after 8:10, they are late. When they arrive, tell them

that you had them on the schedule for 8:00. Depending on patient flow,there are various options:o Talk to them about the need to be on time and the need to call

ahead if they know they are going to be running late.o Ask them to see a different doctor other than the one they were

scheduled to see, if that doctor has immediate availability.o Ask them to wait in the front hot seats until the next slot the doctor

has available.

Walk-In Appointments

Patients who arrive without an appointment need to wait for open spots in the schedule, if they are available. Simply because a patient arrives and wants an adjustment does not necessarily mean the doctor has room for them on their schedule. Offer the nearest available appointment time to the patient, and kindly explain the reason for the wait.


CA Retention Manual

TOO EARLY / LATE / NOT ON THE SCHEDULE

Procedure:

If a current patient arrives in the office outside of their scheduled appointment time the Check In CA must address this issue with the patient. Take a look at the schedule to determine whether or not there is an opening in the schedule for them. Then use the appropriate script (see below) to discuss the situation with the patient.

Script:

Scenario 1 – There is an immediate opening with one of the DCs

Hi, PATIENT NAME. We were expecting you at DATE/TIME/YESTERDAY/TOMORROW.

I am able to fit you in with Dr. NAME right now. However, in the future if you need to come Early/Late/ Off of schedule I ask that you please call the office to let me know ahead of time. I want to make sure you don’t come all the way down here to find that we can’t get you in to see the doctor.

Scenario 2 – There is an available appointment in the near future with one of the DCs

Hi, PATIENT NAME. Hi, PATIENT NAME. We were expecting you at DATE / TIME / YESTERDAY / TOMORROW...

I do have an opening with Dr. NAME in 15, 30… minutes. Would you like to wait?Okay, then please have a seat and I will let you know when you can check in.

Scenario 3 – There are no available appointments in the next 30 + minutes

Hi, PATIENT NAME. Hi, PATIENT NAME. We were expecting you at DATE / TIME / YESTERDAY / TOMORROW.

I don’t have any openings right now but I can take a look at the schedule later today/this week to find another time to come in. And in the future I would just ask that if you need to come Early/Late/ Off of schedule please call the office to let me know ahead of time. I want to make sure you don’t come down here all the way down here to find that we can’t get you in to see the doctor.


CA Retention Manual

ARRIVING PATIENTS Check-In is primarily responsible for ‘checking in’ patients for their appointments, otherwise known as ‘Arriving’ the patient. Each patient is assigned a Chiropractic Care Card at the beginning of their care in our office, and it is the tool that allows a patient to move in and out of the office smoothly.

Arrival Process

There are a few necessary steps to the Arrival process, beginning as soon as the patient walks through the door to the practice:

Greet the patient, especially by first name! Always be aware of the patient’s Appointment Time. Patients need to

be ‘arrived’ in the order of their appointments. Patients who arrive without an appointment need to wait for open

spots in the schedule, if they are available. (See “Early/Late/Off of Schedule” Script). Simply because a patient arrives and wants an adjustment does not necessarily mean the doctor has room for them on their schedule. Offer the nearest available appointment time to the patient, and kindly explain the reason for the wait.


CA Retention Manual

20 MINUTE E-MAILS/PHONE CALLS

We make “20 Minute” e-mails/calls to patients who are more than 20 minutes late for their scheduled adjustment. The primary goal would be to reschedule those missed appointments for the same day, but often another day is necessary for patients.

Platinum Pro Tip: To Send a 20 Minute E-Mail:

Bring up the correct patient file Check that they have an e-mail address in their file Type “L” for List/Report Select “@ e-mail” from bottom of the menu Click Template Select “Missed Appointment” template and click “Open” Click “connect & send” When the e-mail address shows up in the “successfully sent to address”

Box you are done Click Exit Follow steps described in “Cancelling Appointments” to take the person’s

appointment off the schedule book. Stop Manage the patient to reschedule (see “Stop Managers” section)

20 Minute Phone Call:

If the patient who has missed their appointment does not have an e-mail address you must call them.

Here are a few pointers for making those phone calls:

Make sure there are no notes on the patient’s file about not calling.

Call their cell number first if possible, then home, then work

Try not to call anyone before 8 am unless you know they are early workingpeople.

Make sure to follow the steps described in “Cancelling/MovingAppointments” once you have made the call.


CA Retention Manual

20 Minute Call Script:

If you get the patient on the phone:

“Hi PATIENT NAME, this is CA NAME from Franson Family Chiropractic. We missed you this morning for your appointment at TIME , and I was calling to see when the best time would be to schedule a make-up for that appointment.” [then work with them to schedule that make-up]. Okay great then we will see you DAY & TIME. Have a great day.

If you get Voice Mail:

“Hi PATIENT NAME, this is CA NAME from Franson Family Chiropractic. We missed you today for your appointment at TIME, and I was calling to see when the best time would be to schedule a make-up. The doctor’s recommend scheduling make-ups within 24 hours to keep you on your corrective rhythm, so give us a call back here at the office at 978-927-8466 and we’ll get you set up for that make-up as soon as possible.”

Missed Special Appointment Script:

If a patient misses a special appointment (C,N,1,2,4,5) use these scripts:

If you get the patient on the phone:

“Hi PATIENT NAME, this is CA NAME from Franson Family Chiropractic. We missed you today for your Special Appointment at Time, and I was just calling to see when the best time would be to reschedule a make-up for that appointment” [then work with them to reschedule that special appointment].

If you get Voicemail:

“Hi PATIENT NAME, this is CA NAME from Franson Family Chiropractic. We missed you this morning for your APPOINTMENT TYPE at TIME and I was just calling to see when the best time would be to reschedule that appointment. I know the doctor is eager to get that important information to you as soon as possible, so give us a call back here at the office to reschedule. Our number is 978-927-8466. We’ll do our best to get you rescheduled for your APPOINTMENT TYPE as soon as possible.”


CA Retention Manual

3 STRIKE RULE AND MISSED APPOINTMENTS

The 3 Strike Rule is a policy that is explained to new patients at their Break In (Day 3). It states that if a patient misses 3 appointments without making them up their care will be frozen. There are several tools in the office that we use to manage patients who are out of integrity with their schedule and to communicate with the team about patients’ compliance, including PINCs, Stop Managers, phone calls, and e-mails. (For instructions on how to remove appointments from the schedule in Platinum see “Canceling Appointments” page.)

Contacting Patients about Missed Appointments:

A patient who has missed an appointment needs to be contacted that day. The CA should contact the patient who has missed their appointment in one of two ways.

By Phone:

A patient must be contacted by phone, not e-mail, in the following circumstances (Using the script for “20 Minute Phone Calls”):

They have no e-mail address on file They missed a Special Appointment (N, 1, C, 4, 5 [not R6]) They are in their first 4 months of care and it is the first

time they have missed an appointment They have missed more than 2 or more appointments

consecutively

By E-mail:

All other patients (who have missed a regular adjustment appointment) may be contacted by e-mail if they have not missed their previous appointment. (See instructions for “Sending 20 Minute E-mail” via Platinum)

PINCs:

PINCs stands for Patients In Need of Care. It's one way to keep track of patients who need a little extra help or guidance.

Platinum Pro Tip:There are 3 preprogrammed PINCs in the EHR that can be used to communicate with the DCs about patients missing appointments in their first 4 months of care.


CA Retention Manual

Strike 2 –

The Strike 2 PINC should be used when a patient in their first four months of care has missed two appointments (they don’t have to be consecutive) and have not rescheduled them.

Strike 3 –

The Strike 3 PINC is used when a patient has missed 3 appointments without rescheduling them. If the three appointments are consecutive the patient should be DEMAPPED in addition to being PINC’d and called.

Strike 1 -

This will be the most used of the Strike PINCS. If a patient in their first four months of care misses an appointment the Check In CA should first call the patient to try to reschedule it. If they leave a message or the patient will not reschedule the CA should then PINC the patient as a STRIKE 1 to let the doctor know. The CA should also Stop Manage the patient to discuss rescheduling the next time they are in the office. If the CA gets the patient on the phone and they reschedule the appointment no further action is needed.


CA Retention Manual

THIRD STRIKE DEMAPPING PHONE CALL

Procedure:

When a patient misses three appointments in a row you must call them to inform them that we can no longer hold their appointment time. If you get the patient on the phone help them to reschedule their missed appointments and PINC the patient with “Discuss OSA” so the DC will address the missed appointments the next time they see the patient.

If you get the patient’s voicemail use the following script:

Script:

Hi, NAME. We missed you for you appointment this morning/afternoon. This is the third appointment in a row that you have missed. If we don’t hear back from you we will have to take you off the schedule because we can’t keep holding your appointment time. To get back on schedule or to find a time that will work better for you please call us as soon as possible at 978-927-8466. We hope to hear from you soon.

Procedure:

Then put a note in the file that they missed, and you left a voicemail, take them off the schedule, and put in a PINC. Platinum Pro Tip: RQ, F3 in the appt ledger, and PINC in EHR.


CA Retention Manual

USING THE TELEPHONE

While the Check-Out CA is primarily responsible for handling incoming phone calls, it is important for Check-In to be available to help in this area.

Answering a Phone Call To answer the phone:

• Lift the receiver, or press the receiver button on your headset.• Say, “Thank you for calling PRACTICE NAME HERE. This is name . I can help

you.”

Making a Phone Call To make a phone call:

• Select a line• Dial 1 + area code + phone number.

Do Not Disturb At the end of a shift, either at lunch or closing, the phone ringers are turned off. This function on the phone is called DND [do not disturb]. The DND feature basically turns off the ringer so that from the patient’s perspective their call has gone right to voicemail Turn off the ringers on ALL the phones.


CA Retention Manual

Closing the Shift


CA Retention Manual

CONFIRMATION E-MAILS/ CALLS

Everyday the Check In CA sends out an e-mail to all patients scheduled for an appointment the next business day to remind them of their appointment time.

Sample Reminder Email:

Dear |FIRST_NAME| ,We are emailing you to remind you of your appointment |APPT_DATE| at |APPT_TIME| . We look forward to seeing you then! Have a Healthy, Happy Day!The Franson TeamPlease do not respond to this email. For any scheduling or administrative changes, please call the office at 978.927.8466.

Platinum Pro Tip: To Send Reminder E-mail: Type “L” for List/Report Select “@ e-mail” from bottom of the menu Click “From Query”

o Select appropriate Query Click Template Select “Next Day Appointment Reminder” – this will populate the subject

line and body with the appropriate content Click “Connect & Send” – it will take a few minutes to send – do not click

anything until it is done When the e-mail addresses finish listing in the “successfully sent to

address” Box it is done Check the “patients with Invalid E-mail Address” box and write down

any names that show up there. Stop manage these people for a correcte-mail address when you are done (See “Stop Managers”)

Click Exit

Confirming Special Appointments Check In also confirms all special appointments (C,N,1,2,4,5) scheduled for the next business day. If the patient has an e-mail address they will have already received the reminder e-mail that was just sent. New Patients should always receive a confirmation call the business day prior to their appointment but foreveryone else the e-mail is a sufficient reminder.

However, if a patient scheduled for a special appointment does not have an e-mail address they MUST receive a reminder phone call (see all “Confirmation Call” scripts in the scripts section).


CA Retention Manual

ARRIVAL STATS

At the end of every day, once all patients have been cleared from the Z list, the Check In CA must add that day's Arrival numbers & the number of New Patients to the weekly chart. Keep the Weekly Appointment Stats & Monthly Appointment Stats documents on a shared drive accessible by the Check-In station.

Platinum Pro Tip: To get the doctors’ number of scheduled appointments: Shortcut Keys: R > R > Professional (select one doctor) Do this for each doctor and enter the numbers into the correct day/shift

and doctor in the weekly Stats Sheet and Monthly Stats Sheet.

Platinum Pro Tip: To get actual arrival numbers:

‘B’alance ‘P’rofessional (select one DC) Transactions by Service scroll down and press F5 on each ADJ transaction to select it (including OV-

No ADJ) Press F2 to continue Press F6 to print the list. Print one list for each DC (even DCs who didn’t adjust that day*) Once the arrivals have been printed have the doctors look through them

to make sure they are right. Then enter the arrival numbers into the Weekly Appt Stats Per Shift Sheet

and Monthly Stats Sheet**.

* NOTE: Make sure to check the Arrival numbers of ALL doctors…not just the ones who were adjusting that day/shift. Sometimes an adjustment can get attributed to the wrong doctor. If a transaction did go in to a patient’s file attributed to the wrong doctor you must go into the transaction in the patient’s file and change theprovider number. Platinum Pro Tip: Click on the patient’s transaction ledger, highlight today’s ADJ transaction, and then in the details section at the bottom of the screen change the provider # to the correct DC.

**NOTE: At the end of the week, once the day’s numbers are entered, print a copy of the Weekly Appt Stats for whoever keeps track of your Vital Signs. If it is the last week of the month you also need to print the Monthly Stats Sheet.


CA Retention Manual

NP ARRIVALS STATS

In addition to the adjustment Arrival Stats, Check In records the number of New Patients who came in each day on the Weekly Appointment Stats sheet.

Platinum Pro Tip:‘B’alance ‘P’rofessional ‘Escape’ to select all professionals ‘9’ – Transactions by Service Select today’s date Select ‘NP Exam’ – F5 ‘F2’ to get the list The number of people on this list is the number of NPs that day – you’ll know when they came in.

PRINTING DAILY PINCS

Check In prints the PINCs that were entered today at the end of the day for the doctors. Print one copy for each doctor, and highlight any notes that need their immediate attention. Make sure each doctor gets their copy of PINCs before they leave for the day.

Before printing the Daily PINCS, make sure that all of the TICKLES have been entered for all of today’s R1s. (See “Tickles” section of the manual)

Platinum Pro Tip: To print a copy of the PINCs that were entered today: • In any patient file click on “Miscellaneous”• Select “Active Health Messages”• Click the green check mark to accept the date range as “today” to “today”• When list generates, press F6 to print list.• To print a second copy, click on the very top-left box before pressing F6

again• Write the doctor’s names on their individual copies, and highlight any

important notes that need immediate attention.


CA Retention Manual

General CA Responsibilities


CA Retention Manual

MANAGING PATIENT ACCOUNTS

The role of Check Out CA is to keep an over-all eye on the account of each patient. As you help patients schedule appointments and make payments, you should be making sure you are aware of the following things:

Patient Mapping

• Is the patient mapped out for the entire length of their plan?• If they are in their first four months of care they should be mapped out

until their four-month X-ray and stop managed to schedule their R4.

Progress Exams & X-Rays

• Is the patient scheduled for a Progress Exam every 12th visit or 6month scans, as appropriate?

• Is the patient scheduled for their 4 month and/or 12 month x-ray/scan?

Account Balance

• Is the patient on time with their payments?

• Do they have an unexplainable balance?

• Do they have an unexplainable credit?

• Are they stop managed for the correct number of payments?

Workshops

• Has the patient attended their Foundations Workshop?

HMA’s

• Is their HMA plan box set up properly?

• Is their payment schedule set up, or is it clearly indicated that they are on EFT?


CA Retention Manual

PATIENT GIFTING: Overview

Once a week Check-Out is responsible for compiling a list of the PINGs (patients in need of gifting). There are specific gifts given at different times. Each gift is then entered into their electronic file, with the date, and what the gift is for. The list of

times that we gift and what we use as the gifts are as follows:

New Patient Gifting:

New Patient Check Out - Bonfire water bottle

First Progress Exam - $5 Bonfire Bucks

Four Month Review – $10 Bonfire Bucks or Book from Doctor if appropriate

End of Year - Bonfire gift certificate for fish oil or small bottle of fish oil liquid

Referral Gifting:

First Referral - $10 Bonfire Bucks

Second Referral – Fish Oil

Third Referral – Book / TShirt

Fourth Referral - gift certificates/vests/bag/doctor’s discretion

Patient of the Week – see following page for details

Family of the Month – Fruit Basket (Edible Arrangements)

Chiro Kids of the Month – Kids Book or T-shirt

New Moms in the practice – Supplement/magazine subscription/

book…Birthdays - each week, Check-In is responsible for sending out

Birthday Cards to all patients with birthdays the following week. A note is also put in their file, so the doctor will see it during their appointment.


CA Retention Manual

1ST PROGRESS EXAM GIFTING Procedure:

At a newly committed patient’s first progress exam, we gift them for their commitment to their appointment schedule. If the patient has not cancelled or missed any of their first twelve appointments [allow a bit of grace in their judgment] we stop them before they leave and gift them with $5 Bonfire Buck Gift Certificate.

Script:

As you may remember from one of your first appointments, we went over the importance of keeping your regular schedule so that you can keep up your corrective rhythm. This helps the doctors do their best work to help you. We want to give you this Gift Certificate to recognize how well you have done with keeping your appointments in your first few weeks. It is for $5 and you can use it here towards supplements, t-shirts, or anything from the pro-shop. Keep it up!


CA Retention Manual

GIFTING: PATIENTS OF THE WEEK

Check In is responsible for maintaining the list of upcoming Patients of the Week. Always keep an eye open for patients making extraordinary life changes, who have referred new patients or who have shown exemplary dedication to their care.

At team meeting review 3-5 specific noteworthy attributes about your chosen patient for the week.

What specific ways have they demonstrated a commitment to theirChiropractic care (referrals, lifestyle changes, great with schedule…)?

Have they made it priority to get their family checked?

What unique feature of their character can you edify?

Before the patient arrives for their appointment that week, draw up a paragraph appreciating the specific attributes you’ve reviewed. Conclude the paragraph with something to the effect of:

THIS week, we are recognizing ___name as Franson Family Chiropractic’s Patient of the Week for his/her consistent commitment to the spirit of Chiropractic and hi/hers dedication to a lifestyle of wellness.

Additionally, jot them a personal note of appreciation which includes these qualities, but it should be written directly to them as opposed to being written about them.

When the patient arrives for their appointment, have one of the doctors bring that patient to the front of the practice and read the paragraph aloud to them and those present in the office, following with a round of applause. As they leave, pass them the personal note you’ve written for them.


CA Retention Manual

LETTERS Once a week Check-In is responsible for compiling the Welcome, DNC, Ref to DC, DNC, Referral, Testimonial, and Inactive letters as determined in the PINC’s meeting. These letters need to be signed by the doctor and mailed to the patients along with any necessary superbills or statement accounts as soon as possible.

Welcome, DNC, Ref to DC, and No Show letters are discussed in the CA Conversion Manual.

Referral LettersThank you letters should be sent out to anyone who referred a new patient into the office the previous week. (See example letters at end of manual)

Testimonial LettersThank you letters should be sent out to anyone who wrote a patient testimonial for the office, as well as a thank you letter to the person who referred that patient into the office along with a copy of the testimonial. (see “Letters” section)

Inactive/Come Back LettersThese letters should be sent out during the week after the PINC’s meeting when the doctors decide which letter a patient needs to receive. These letters require a doctor signature.

Always be sure to edit the content so that the exact wording is appropriate to the patient's situation. Make a note in the patient's file of the date the letter was sent, and which letter it was.

NOTE: Some letters may involve a balance or credit, and should not be mailed until either the statement has been printed, or a check has been printed. See the Office Manager before proceeding.


CA Retention Manual

Referral Letter: Sample

Thank you [First_Name]!

The greatest compliment of all is the referral of a family member, friend, or loved one. We truly appreciate your trust and confidence in us, and will do our utmost in providing the same level of care that prompted your referral.

Our practice operates under the premise that if we continue to satisfy and delight our patients, they will achieve greater health faster and will be more likely to tell others about chiropractic.

We look forward to serving you and your family in the future on your journey toward greater health through chiropractic.

Very truly yours,

The YOUR OFFICE NAME Team


CA Retention Manual

Testimonial Letter: Sample

Dear [First_Name],

We just wanted to thank you for writing your chiropractic testimonial. We are so glad that someone cared enough to share chiropractic with you, and that we have been able to help!

Our purpose is to educate and adjust as many families as possible toward optimal health through natural chiropractic care. It is really encouraging for the whole team to hear how you have been helped in your journey toward wellness by what we do here in our office.

We are looking forward to continuing to work with you in the future.

Thanks again,

The YOUR OFFICE NAME Team


CA Retention Manual

Inactive Letter: Sample

Dear [First_Name],

It's been a pleasure to serve you during the course of your care in our office. I hope that we've demonstrated our real concern for you and your health.

We've noticed you've missed a number of appointments recently. We interpret this to mean that you've received as much benefit from chiropractic care as you want at this time. Since you've opted not to follow our recommendations, we'll assign an inactive status to your case file. (Please resolve your outstanding account balance of $[amount due].)

We hope that we clearly communicated that it is vital to correct and maintain a healthy spine and nervous system throughout your life in order to experience true health and wellness. Your records will always be here, along with our genuine concern for you and your health. Please call if I can answer any questions or be of help to you, your friends or your family.

The staff and I have the unique opportunity to help patients with a variety of health goals. It's always exciting to see patients get the results they want. Please accept our warmest thanks and gratitude for allowing us to participate with you in your health journey.

From within,

Dr. NAME


CA Retention Manual

Checklists


CA Retention Manual

DAILY OPENING CHECKLIST: Check In (Example)Turn on Front Desk computers Start Electronic Health System (EHR)Print Exam list Check Huddle Sheet against EHRCollect PINCs/TICKLES from previous day from the Drs. Make sure letters are in order (if you use a Letter System)Make sure Success Story Screen is turned on Check for first progress exams – set aside correct PEQ Turn on TV and Workshop Turn on Phone Turn on Music

DURING SHIFT CHECKLIST: Check In (Example)20 minute calls/e-mails Manage New Patient process - Make folder & Input patient info into EHR Call Doctors before report time Manage Report Time Prepare tomorrow’s Huddle Sheet Make reminder calls/e-mails for special appointments/ NP confirmation call E-mails/ Phone calls for missed appointmentsCall Doctors to inform them of last patient of shift

DAILY CLOSING CHECK LIST: Check In (Example)Give Doctors/Staff Pink Phone Messages Print/Text PINCs/ TICKLES for Drs. Arrival Stats Lock Front doors and turn off lights Finalize and Print Huddle Sheet – 6 copies Phones on DND Collect Letters Turn off TV/Workshop/Music Close Arrivals Program Make any last missed appointment calls/e-mails Send tomorrow’s appointment reminder e-mail Make sure Heat/AC is set to 66


CA Retention Manual

WEEKLY TO-DO LIST: Check In (Example)

Monday D-Tech Slides – update and make sure slide show is running - CD/Doc

Prep PINCs/MIAs for Meeting

Print R4/5/6 Gifting List

Tuesday AM Manage Foundations Workshop

Prepare Stats and Time Performance Graphics for Team Meeting

Wednesday PM Record Voicemail with new workshop

Manage Foundations Workshop

Thursday PM (See Thursday To Do List in Team Docs>Check In) Birthday Cards & PINCs Welcome Letters Huddle Sheet Arrival Stats Shut off monitors in changing rooms PINCs calls Special Appointment reminder calls REMINDER CALLS/E-mails for Monday Update Slides

MONTHLY TASKS: Check In

Birthday Celebrations

o Get card – for everyone to sign

o Have balloons at their seat at team meeting


CA Retention Manual

DAILY OPENING CHECKLIST: Check Out (Example)Check Voice mail – write messages on back of Huddle Sheet Make all call backs – (after 8 AM if AM shift) Take any cancelled appointments off of the schedule Write any messages for team members on Pink notes Print Outstanding List – make note of anyone scheduled that day who has

outstanding financial plan Count Cash Drawer – make note of starting amount Take phones off forward Check for first progress exams – set aside gift Make sure Slide Show is running in changing rooms

DURING SHIFT CHECKLIST: Check Out (Example)Input any NPs from screenings and make any follow up calls Check Out Reports – NP, 1, 2, 4, 5, C Answer incoming phone calls Address all Stop Managers and check off list as you go Manage Green Box List Make call backs Check balance periodically Make Lunch Time Bank Deposit

DAILY CLOSING CHECK LIST: Check Out (Example)Review Huddle sheet to make sure all necessary transactions have been entered Balance financials Count Cash Drawer – make sure we are not over or under starting amount Prepare Financial Packet Make Deposit – at end of every shift Put phones on forward Lock Filing cabinets Check Heat – set for 66 Turn off EHR – make sure it is off on ALL computersLock Office Doors


CA Retention Manual

WEEKLY TO-DO LIST: Check Out (Example)

Monday: AM Update DTECH Slides

Print Workshop check listGifting: POWs, FOMs, KOMs. R4s, Progress Exam

Order Gifts

Make sure we have ideas for next mont’s POM, KOM, FOM

Lunch Bring Down Deposit (daily) Prep Stats for Tuesday Meeting: NET-MO – Write NPs conversion names FSV – Review R2/R3 and R5 Conversions Collections – Look at in light of month and quarter Inactives

Look at Reports schedule for the week Take notes for POM Note(Last Monday of the Monthy)

PM Look over huddle sheet – confirm all transactions (daily) LOCK Filing Cabinets! (daily) Check heat – set to 68 (daily)

Tuesday: AM Write POW Note

Prep weekly stats for Team Meeting

Wednesday: PM Letters to referrals (Testimonial Thank Yous)

Thursday: AM Print Updated Green Box List

Bring down deposit at lunch Update New Patient Schedule for next 2 weeks

PM Lock Filing Cabinets Feed Fish – Weekend Feeder (if Nina is not going to be in on Friday) Codes! (NP, R1,R2-3, R4, R5)

*Check all transactions*Confirm all providers are correct

Continued on next page…


CA Retention Manual

Go over all huddle sheets – Front and Back * Confirm all call-backs have been made

Update Voicemail ( workshop/closure dates) Update New Patient Schedule PINCs Calls Go over Green Box list Count Drawer – Get Change Go through PIP Patients (using Pincs) to verify EXAMS! Balance for the week Shred Bin Review all huddle sheets from week – confirm all messages left were returned Review Outstanding Transaction list from week – confirm all transactions entered

MONTHLY TASKS: Check Out

Print Monthly R4/5 lists for Drs (for gifting) Clean out Green Bin


CA Retention Manual

MARKETING CA/DC CHECKLIST (Example)

Write Blog Posts Load Blog Posts Email Blog post Post Blog on FB, Twitter Analytics for Social media

Google Analytics Facebook Twitter

Facebook Post Events Post Promo results Video/Articles of Interest

Keep Promo Calendar Up To Date Create Bi-Monthly Calendar

Post to Website

Update Website with Current Calendar

Constant Contact

Update patient emails into constant contact

Promotional Event and Advanced Workshop Prep

o See Workshop Master Checklist Guide on Basecamp


CA Retention Manual

TRP CA Competency Checklist[NAME:]

[DATE:]

Skills Module DeliveryPatient Take

Away Signature DateScreenings

NP Call In

Scheduling NP Appointments

NP Confirmation Call

Expectation Video #1


Away Signature DateNP Check In

*Intake Form, Consult Notes, Coupon - on Clipboard

*Notify DC

*Creat Physical Patient File

*Add patient info to Platinum

*Set up Consult/Exam Rooms (Where Applicable)

Office Tour

5 Traumas

OPQRST

Biostructural Exam

Thermal Scan

Drop off at Check Out

NP Check Out

*Schedule Report

*Copy Insurance Card

*Sign HIPPA

*Sign Terms of Acceptance

*Accept Payment

*Gift Patient (ex. Waterbottle)

*Enter Patient Information Into System

* Assign Primary DC

* Expectation Video

Report Confirmation Call

Gown in changing rooms (if female report/where applicable)

Icing Instructions

Individual Breakout


R1 Check Out

*Schedule and Code next appointment

*Accept payment

*If Yes - setup care plan box

*If "Out" - Stop Manage for HMA next visit

Click Colored boxes (workshop/payment)

TICKLE PINC

Send Expectation Video #2


Away Signature DateCheck In

*Explain check in - Red box

*Notify DC of patient arrival

Break In/Office Flow

Check Out

*Take payment - if still "Outstanding"

*MAP with exams

*Schedule Workshop

*Schedule family members

*Stop Manage R4

*Stop Manage PEQ gifting

*Confirm Primary DC in Platinum

*Sign Acknowledgment Form


Away Signature DateProgress Exam Check In (PEQs)

Progress Exams

R4 Check In

R4 Check Out

R5/6 Check In

R5/6 Check Out

Skills Modules DeliveryPatient Take

Away Signature DateScheduling Patients

Managing the Flow

Running Payments / EFTs

Entering Transactions

Manging Patient Accounts

*Financials

*End Dates

*Examinations

*Patient Record Requests

PINCs (Patients in Need of Care)

PINGs (Patients in Need of Gifting)

Advanced Workshops

Objection Management Training


Away Signature Date

Report New Patient Numbers

Report New Patients in Process

Report Collections

Report Compliance

POW- Patient of the Week

FOM - Family of the Month

KOM - Chiro Kid of the Month

Discuss Inside Promotional Events

*TRAIN ON PRIOR TO ARRIVAL

Team Meeting / Training

Day 4+

CA Skills

Day 0: NP Attraction

Day 1: New Patient

Day 3: First Regularly Scheduled Adjustment


CA Retention Manual


[DATE:]



NP Call In







*Notify DC




Office Tour

5 Traumas

OPQRST

Biostructural Exam

Thermal Scan


NP Check Out

*Schedule Report


Away Signature DateR1 Check In

*Set up Chiropractic Swipe Card

*Notify DC

Group Intro/Video


Icing Instructions

Individual Breakout


R1 Check Out


*Accept payment




TICKLE PINC







Check Out


*MAP with exams

*Schedule Workshop


*Stop Manage R4

*Stop Manage PEQ gifting

*Confirm Primary DC in Platinum

*Sign Acknowledgment Form

R5/6 Check Out



Managing the Flow




*Financials

*End Dates

*Examinations




Advanced Workshops



Away Signature Date



Report Collections

Report Compliance







CA Skills


Day 1: New Patient

Day 2: New Patient Reports



CA Retention Manual


[DATE:]



NP Call In







*Notify DC




Office Tour

5 Traumas

OPQRST

Biostructural Exam

Thermal Scan


NP Check Out

*Schedule Report

*Copy Insurance Card

*Sign HIPPA

*Sign Terms of Acceptance

*Accept Payment

*Gift Patient (ex. Waterbottle)

*Enter Patient Information Into System

* Assign Primary DC

* Expectation Video

Report Confirmation Call


Away Signature DateR1 Check In

*Set up Chiropractic Swipe Card

*Notify DC

Group Intro/Video


Icing Instructions

Individual Breakout


R1 Check Out


*Accept payment




TICKLE PINC







Check Out


*MAP with exams

*Schedule Workshop



Away Signature DateProgress Exam Check In (PEQs)

Progress Exams

R4 Check In

R4 Check Out

R5/6 Check In

R5/6 Check Out



Managing the Flow




*Financials

*End Dates

*Examinations




Advanced Workshops



Away Signature Date



Report Collections

Report Compliance







Day 4+

CA Skills


Day 1: New Patient

Day 2: New Patient Reports



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