The more I speak to practitioners, the more I’ve come to believe visit/treatment length tends to be a legacy issue. It’s not something we’re giving a lot of conscious thought to. You open your doors and do what you did in school, or copy another practice, and it pretty much stays that way. Most consultative practices have 2-3 different menu options, based on time. And they never change.

My sense is that sometimes those visits are too long – or that a shorter option should be put on the table. Here’s why.

1. Maybe Your Clients Don’t WANT Longer
Many of us are working from a simple premise that more time is better. Says who?

Perhaps it’s true to some extent, but who’s to say a client really wants a two hour initial appointment? Or a 90-minute massage? Either of those is enough to scare me off. Is it possible your clients don’t want what you think they do? Do your clients really need more time, or is it just better time they’re after?

“…for many clients, a 90 minute massage is not as appealing as it once was.”
-Irene Diamond, RT writing at Massage Today

2. Every Client is Different
Just because one talkative client can never get out of your office in under 60 minutes doesn’t mean everyone should have to stay that long. Why treat everyone the same? Are you building your visits around the slowest common denominator?

3. You Can Earn More
When we started offering a 15-minute acute care visit, we didn’t price it at half the price of a 30-minute visit–nor should you. It’s priced about 55-60% of the price of a half hour. That means that an hour made up of four 15-minute visits is worth more than a single hour treatment. Over time, the difference stacks up.

4. You Can Help More
Shorter visits simply mean you can see more clients in the same time period. It’s that simple.

5. More Flexible Scheduling
It can be a challenge to master the tetris-like game of fitting together appointments to make the best use of your time.

There’s nothing more frustrating that a week full of small gaps that add up to a lot of time in total, but that can’t be properly used because individually they aren’t long enough to fit someone into. Shorter visits give you more flexibility for filling those inevitable gaps.

6. You’re Better Than You Were
Let’s face it: when you started practice you were just beginning to master your craft. You simply didn’t have the…well, the practice. It makes sense that for many types of care, you can simply do more in less time once you’ve got some experience under your belt. You teach, explain, diagnose, set up, clean up, treat and process faster than you once could. Why not take advantage of that expertise?

Are your visits too long? Maybe, maybe not. Certainly, more time can be a selling feature, and some modalities simply require some minimum amount of time. But it might be worth asking yourself the following questions:

• Why are my appointments the length they are?
• What would be gained and/or lost if I shortened them?
• What would happen if I added a new, shorter option?

In the end, clients and patients are like Goldilocks. They need a visit length that’s just right. How close are you?

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You’ll find this throughout the CAM/holistic professional community, particularly early in practice: the massage therapist trades a session for an adjustment from the chiropractor. The acupuncturist swaps time with the naturopath, who in turn trades a visit with a web designer. The homeopath exchanges treatments with the landscaping guy who cuts the grass in front of her office.

At first blush there’s nothing inherently wrong with this beyond the obvious tax-dodging implications. And for the practitioners just starting out who are time-rich and cash-poor, it allows them to get their hands on things they need.

The reality is that it’s not as sweet as it looks, particularly if you continue the swapping when your practice reaches a decent size. Let’s take a closer look at some of the drawbacks to exchanging services:

It’s Not Fair
We already have an exchange system in place. It’s called cash. It allows everyone to value their products or services using the same standard. It provides enormous flexibility to describe the value of what you offer down to the cent, with no ceiling. Exchanging services, however, tends to become one-offs: one treatment for one treatment. One haircut for one adjustment. One brochure layout for one massage. As a result, one of services in question is usually being undervalued, and over time, that person gets the short end of the stick. Unless you’re trading an adjustment for an adjustment, someone’s likely getting screwed.

The problem is that you’re a health care professional, and it may just be you getting shorted. You’ve likely got a lot invested in your education and practice, and your time may just be worth more, on average, than many other people. If you’re swapping your health care services for haircuts, you may be selling yourself short. There’s nothing wrong with haircuts, it’s just that you’re trading apples for oranges and it’s hard to strike a balance.

It Makes You “Buy” What You Don’t Need
If you’re starting out and have an abundance of time on your hands, this seems like a great way to get what you need. The truth is, you also ending up buying either a)things you don’t really need; b)more quantity of something than you need; or c)things you need, but from vendors you wouldn’t choose if you were using cash from your pocket.

It Sets a Precedent
It can be difficult to get off the trade train. As you grow, you may find yourself wishing you were billing for that service, and spending the cash on what you need, as opposed to trading.

It Affects Referrals and Outcomes
I can’t back this one up with data – although if anyone can, please let us know – but my suspicion is that the people you exchange with don’t refer as well as people who pay out of pocket. And, as I’ve mentioned before, it’s possible people who don’t pay don’t have the same success from a health perspective.

The bottom line? Trade if you want, trade if you must. But as your practice grows, be conscious of what your time is worth, and whether the trade is a sensible choice.

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Reader E. writes:

“I was wondering how you handle when people start to ask for free advice. I am starting out my practice and want to come out of the gates honoring my abilities and not giving things away for free. I don’t mind a general question here and there, but when someone keeps asking very detailed, specific questions where my education and experience really comes into play – I want to set that boundary.”

This is a common practice challenge, particularly for startups. Early in your practice, you may not yet have the confidence, experience and poise to deal with the patients who constantly ask for free advice. I’ve written before on pro-bono work, but this is a bit different. How do you deal with those clients who seem to have a knack for getting you to cough up free advice?

First, Change Your Mindset
What’s really at the root of giving out too much free advice? Often it’s a failure to truly value the service you’re providing. This leads to a subconscious reluctance to bill for your time.

Sometimes you need to remind yourself that you’re really worth it. Try adding up how much you’ve spent on education and starting your practice. Then look at how much it costs per month to operate. It’s likely no small number. Your expertise is worth money, period. You need to “own your fees” – be comfortable with your rates, and feel no reluctance in billing for any amount of time. That’s not to say you shouldn’t ever do anything for free, just that you should feel comfortable billing when it’s appropriate.

Know What Free Advice Isn’t
Not every question that arrives without a check attached constitutes free advice. A patient calling for clarification is not asking for free advice – they’re trying to correctly follow the advice you’ve already given. An inquiry as to whether you can help someone with a specific condition isn’t free advice, it’s simply a sensible inquiry into how you can help. You may even want to dole out “freebies” to good patients – the kind who come often, pay promptly, and refer frequently.a

The easiest way to tell if you should be billing is this: if you feel like someone is taking advantage of your time, then they likely are. They may not be doing it on purpose, but nonetheless, it’s time to start handing over the invoice.

Adjust Your Paperwork
It’s important to let patients know the deal. State outright on your intake and consent forms that you bill for phone and email consultations. Decide your rate, and clearly state it. This will brush off a few advice-seekers, and give you (and your staff) a clear process for billing the rest.

Use Your Staff to Turn Advice-Seekers Into Bookings
It’s easy to bill people when they’re in your office. The office is where money changes hands – patients expect to spend money in your place of business. Try to respond to requests for free advice by getting people in for official visits.

Use your staff to help with this. Have them screen your calls, and book appointments instead of transferring advice-seeking calls through to you. If someone emails you asking for advice, simply reply with something simple and pleasant – “It sounds like we should get you in next week for an appointment. I’ll have Susan call you.” Just CC your receptionist, and he/she can call the patient and book the appointment.

If you don’t have staff, use the same line. “It sounds like we should see you in person.” Be diligent in this.

Explain Why
It’s potentially unsafe, unethical, ineffective and dumb to diagnose remotely – by phone or email, for example. One of the strengths of most CAM modalities is the ability to see a broader picture of an individual’s health, and you can use this as a tool to deal with free advice-seekers. Simply tell them that you need to see them in the office to get more details.

Be persistent. When a patient asks, “Can you just tell me if such-and-such herb will help my diabetes?” tell them no. Every patient is unique, and you need to see them in the office. In the end, they’ll get better treatment, love your service, and refer more patients to you instead of getting advice based on poor information, then complaining that your services are lousy.

Bill Them
If you absolutely can’t dodge someone (on the phone is typically the toughest to deal with), just bill them. Period. Once you’ve decided your phone consultation rate, just send a bill. Don’t be afraid – you’re a professional and your expertise is worth money. It’s critically important that you learn to respect your time. Until you respect it, other people won’t.

The truth is, if you have patients who are trying to get free advice from you on a regular basis, they’re really not the patients you want. If they corner you on the phone, just bill them. You’ll either convert them to solid, paying patients, or you’ll lose them. Either way, you’ll be further ahead.

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The Integrator Blog has an update on the Working Class Acupuncture story, including several interviews and comments. Worth a look – there’s a larger picture here that goes beyond acupuncture.

Link

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John Weeks’ The Integrator Blog featured an interesting article on Working Class Acupuncture, a Portland, Oregon clinic built on the concept of making acupuncture more affordable.

As Lisa Rohleder, LAc, began trying to make sense of the business of professional acupuncture, she witnessed two distinct phenomena. First, she observed that a huge percentage of the working poor and even the middle class of people in the United States cannot afford to pay for acupuncture treatment when individual appointments cost $65-$200. Second, Rohleder observed that over 50% of graduates of acupuncture schools abandon practice without ever figuring out how to make a living at it.

What’s wrong with these pictures? The price-point for an acupuncture treatment seemed to her to be related to both problems.

I highly recommend you read John’s piece regardless of your modality. His interview with Lisa Rohleder is quite interesting, and also contains the basic financials for the business model she’s using and actively promoting. The fact that it makes a great service more affordable and can help practitioners earn more at the same time makes it doubly compelling.

Related Links:

Integrator Blog Article
Working Class Acupuncture site

PS – You might also want to check out Rohleder’s book The Remedy: Integrating Acupuncture into American Health Care, as well as her free ebook love your microbusiness: marketing for a community-based acupuncture practice a short, but very sweet manifesto on practice growth.

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If the post on why you should raise your CAM practice rates has convinced you that the time is right, here are a few tips on how to make it painless for you and your patients.

Plan It
So here’s the dilemma: Inflation’s always there, and as a result of it (and other good reasons) you want to be raising rates. But you don’t want to do it too frequently. Plan at least two rate hikes in advance – the current one, and the next one. That’ll help you plan the amount of the rate hike, and also help with some of the next steps below.

I’d recommend a couple of things for price changes in your alternative medical practice: First, do it once a year at the most. Second, shake it up a bit if you can. Raising your fees every New Years Day gets predictable, and after a while your long-standing patients may come to see it as unrelated to anything tangible, and simply an annual cash grab. I prefer a larger increase every couple of years, but that’s up to you.

Give Notice
Give your patients plenty of advance notice. Don’t treat this as a change that you’ll just “sneak by them”. You want to increase your rates, yes, but you also want to ensure that your patients continue to return. Remember that most holistic and CAM medicine practices are working in a free market – your clients may have other options to choose from.

If you have a regulatory body, you may want to check with them, as well – boards may dictate how much notice you have to provide, and in what format (posted in writing, etc.).

Own It
The easiest way to make your rate change painless for you, and readily accepted by your patient base is to “own it” – make sure you’re comfortable with it. Do you feel like you and your services are worth the cash? Do your best on this one and the rest will be easier.

You may have to defend your practice pricing with your patients, but the more comfortable you are, the less this tends to happen.

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Few business decisions is more feared, ignored and avoided than raising prices. But while we’ve all hoped the issue would go away, it hasn’t. So, on the count of three, we’ll all (including me) pull our heads out of the sand, and face the day.

Here are a few reasons you should be raising your prices:

Inflation
Prices rise over time – or, conversely, your dollars buy less over time. Just ask your parents what they got paid in their first job, and you’ll hear (for the zillionth time) how little per hour they made, and how a movie cost a nickel, and kids these days don’t appreciate….blah, blah. The point is, the world gets more expensive as time goes by, and most practitioners don’t address it. All the costs in your business are increasing, on average, by 3% per year. If you go for five years without raising your rates, you’re taking home less money. Imagine if you were running that movie theatre today, and still charging a nickel admission and 3 cents for popcorn…

You’re Better Than You Were Last Year
It’s true. You now have more experience, and your skills have improved. (If you’ve gotten worse since last year, you have bigger problems than inflation.) You are gradually becoming an expert in your choosing field of alternative medicine, and your patients are reaping the benefits. Over time, that expertise is worth more in the marketplace. Why should a shiny new TCM practitioner make the same as you, the 15 year veteran?

More Profit
I’m not suggesting you be greedy, but remember that when you raise your rates by 5%, you’ve pretty much added that extra cash to your pre-tax income – there are no extra expenses associated with the rate increase. It is, essentially, extra money.

“What if I lose patients?” you might ask. It can happen, but you may find that a price hike lets you keep your best customers, and in fact make more profit on fewer total clients. That, in turn, translates into better life balance.

Define Your Niche
The business world is full of stories of products that sell because they’re priced higher than others. This is part of the larger picture of your pricing strategy of your holistic practice, but for now remember that your price says something about the value of your offering. Are you trying to be the cheapest, or are you offering a premium service? If you’re in the latter category, you’ll want to be sure your rates consistently reflect your position.

Convinced? We’ll discuss how to do it in with minimal pain in a future post…

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The Mackinac Centre for Public Policy has an interesting piece on the “myth” that free public health care empowers the poor. I’m not here to debate the public versus private issue (not today, at least) but it does raise some interesting questions.

They claim that paying for health care is more empowering, since it forces the system in question to treat you as a customer to be satisfied, and therefore leads to a higher level of service.

Interestingly, many alternative health practitioners have argued for years that patients who pay for their own care actually get better faster than those who don’t. They claim it forces an investment in the outcome for both doctor and patient, and therefore increases compliance to treatment protocols.

This has applications at a more subtle level in your practice. Many CAM docs, when starting out, or out of the goodness of their hearts, may be inclined to discount their services for those in need, to offer free care as a public service, or to offer “bargains” to get new patients in the door.

The problem with this is that it erodes the investment that the patient makes in their care, and if the anecdotal evidence I hear has any credence, it hampers their healing.

Am I saying you shouldn’t “give back”? Nope, but if you want to help the less fortunate, or give to your community, try doing it in a way that doesn’t involve cutting your fees or doing pro bono clinic work. Volunteer at a blood donor clinic. Talk to students about nutrition. There are endless ways to give that don’t involve lowering your prices.

Patients who are successful using your treatment plans are the best referral source out there. If paying full price helps get them healthy faster, why argue?

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