Thought I would post a great article here that Dr. Bodzin wrote!
CareCredit® Says “No More Prepays”. I Say, “So What!”
Did you get the letter? CareCredit®, a finance company that many chiropractors have used for years to provide financing to their patients, sent out a letter in October 2009 stating that it will no longer allow doctors to do prepays.
They go on to say in the letter, “In an effort to improve patient satisfaction, we will be …”. It appears there have been too many situations where a patient has stopped care and stopped making payments to them.
When a patient stops care early, the patient must be refunded the money for the unused services. Not doing so is a big no-no. Apparently there have been “dissatisfied patients”. One can only assume the patients are complaining to CareCredit because the doctor is not making the appropriate refunds, thus leaving CareCredit holding the bag; hence the reason for the letter. CareCredit stated in their letter that they will only allow services to be paid for on a per-visit basis.
So what are your alternatives to using CareCredit? Well, before I address that questions, I’d like to discuss whether prepays are even a good idea at all. Let’s start with the end in mind. What is the outcome we are looking for when we use prepays as a method of payment? What are we trying to accomplish?
In interviewing doctors who do prepays, the goal is quite clear – get the patient to commit to care and pay for it upfront so they are “committed to care”. The idea being, if they just pay for it all upfront, they won’t quit care. OK, I get that. There is some truth to that. People who do prepay tend to stay longer. But what about after the initial care plan is up? What about wellness care?
When I then ask these same docs how many of your prepay patients renew for wellness care plans, they admit it’s not so great. Let me go back to the question, “what are we trying to accomplish?” Let me answer this one for you. “We are trying to accomplish the goal of creating life-time wellness patients.” Am I wrong in saying that when it comes to caring for our patients, the mission of chiropractic is to get them well, and then help maintain that wellness with ongoing chiropractic care for life?
In fact, when I press these docs, we find that even though they tend to see higher volume and their PVA is higher than average due to patients staying longer, they still need just as many new patients each and every month as they did years ago to keep their revenue up. My point is if their patients were staying for life-time wellness care, eventually you should get to the point where you were full; where you wouldn’t need as many new ones to keep your revenue up. But they do – and here is why. The vast majority of patients who prepay for care do not continue beyond the initial program of care. The patient simply “decides” not to renew.
I emphasized the word “decide”, because that is the key to understanding why prepays are sabotaging the health of your practice. I have discovered something very interesting. Although prepays commit someone to their initial care plan, they also create a situation where a patient will “have to decide” on going on to the next program of care when the prepay lapses. Its the “decision” they have to make that gets in the way of them continuing.
Prepays create an obstacle to the mission of chiropractic. They are a subluxation to the health of your practice; the side effect being difficulty in transition patients to wellness care. Imagine you’re the patient who just finished a program a care – for example you just finished 12-months of care you paid $3,600 for last year. And your chiropractor is now telling you, “John, good news you’re ready for wellness care. The new program is $1,800.” The fact is, your last payment made was a year ago and you now have a decision to make. Do I continue or not? Do I want to buy again or not? I’m no longer in pain (yes, they still think about pain) – do I value wellness enough to commit again?
Some (not many) will renew. But this is where most prepay patients drop out. The fact that they are being asked to make a decision, is the issue. Couple that decision with the fact that it involves money and you will soon see why most patients drop out at this time. And beside the point, if chiropractic is about life-time wellness, when did anyone every pay for anything life-time all up front.
Here’s the bottom line. The more situations you have where a patient has to “decide” on whether they continue with care or not, the more often patients leave you. I’ve identified several common areas this takes place in a practice. The most common among them all is in the area of money. I discovered that “the more often a patient has to think about money, the more often they drop out”. Let me clarify – it’s not the money that’s at issue. It’s the “thinking” about the money that’s the issue.
The more often a patient has to think about money, the more often they will be making a decision about buying your care. This is why practices that have patients pay-per-visit have the lowest patient retention and practically zero percent on wellness care. Are there exceptions? Of course. But we’re not talking exceptions to the rule. It’s not smart to build you business model on exceptions.
Then there’s the office that has patients pay for block of care – 12 visits at a time. Although these offices have better retention than a pay-per-visit model, they too have nearly zero percent on wellness. The doctor doing there often says they feel like they are always reselling the need for care. Well, that’s because they are.
Then there’s the prepay for a period of time (like a 12 month prepay). Again, these offices have an even better retention and even have some people on wellness care. But as I’ve already stated, we see the vast majority of patients drop out of care at the end of the prepay. It’s not that they don’t get chiropractic. Many of them do. Have you ever had a patient who got the big idea – and still dropped out? It’s not how educated they are. It’s that, as a consumer, they just don’t want to buy again. They’d rather spend the money on a new flat screen TV.
So what’s the answer? What if I said there was a financial model that was congruent with the mission of chiropractic stated earlier. A business model that allowed a patient to easily signup for a program of care, removed the “thinking” about money and allowed the patient to transition to life-time wellness care without a big financial decision to make – a business model that completely removed the subluxation getting in the way of patients electing to continue beyond the initial care plan and onto wellness care.
Without a doubt, we have seen the following model accomplish the goal. The doctors doing what I am about to share with you have extraordinarily high patient retention. The vast majority of their patients go on to life-wellness care. They’re income rises dramatically and becomes consistent month after month – no longer going up and down due fluctuating numbers of new patients each month. And their staff are happier.
So what’s the model? Similar to a prepay plan, we offer our patients a program of care over a period of time. But instead of having the patient prepay for the plan of care, we have them leave a bank account or credit care on file (there is a legal way to do this) and we auto-debit them once per month. Simple! The plan we offer actually lets the patient choose either monthly payments, make a larger down payment followed by smaller monthly payments or they can choose to prepay.
So let’s revisit the scenario above where you were the patient ready for wellness care. “John, good news you’re ready for wellness care; and your $300 monthly payment is going down to only $150 per month. By the way, the wellness program is month-to-month. Just let us know if you ever want it to change.” I think you will agree that seem a whole lot easier to swallow (as a patient) than having to decide to buy again.
Here is what we accomplish with this business model. (1) The patient can decide which payment option works best for them. This removes any “pressure” allowing them to feel in control. (2) Automating the payments removes the repetitive “thinking” about the money. (3) The monthly payment allows you to present good news of the payment going down when the transition to wellness occurs. This is huge. (4) When they go onto wellness care, you never have to ask them about money again. (5) Your revenue becomes consistent month after month. (6) Your staff spends much less time collecting money.
So I say, “Who cares if CareCredit no longer allows prepays”. Get on board with a business model that is congruent with the chiropractic model. Ongoing wellness care with ongoing monthly auto-debit payments. Check out this previous blog entry for more information: The Benefits of Having a Cash Based Practice or How to Keep Patient’s From Dropping Out of Care When the Insurance Stops
Miles Bodzin, DC
Founder & CEO Cash Practice Inc.
http://www.CashPractice.com
877-FIFTY-50
drbodzin@cashpractice.com