November 29, 2023

The Riches are in the Niches with Dr Naota Hashimoto DC – Chiro Hustle Podcast 513

Chiropractic found Naota Hashimoto, DC, after a head-on collision and 6-months of physical therapy. A family friend referred him to his first chiropractor when he was still in constant pain despite 6-months of medications and physical therapy.

The chiropractic treatment turned his lights on, and he was excited about the treatments. His chiropractor fixed his debilitating neck and lower back pain and even cured his acne problem that he had struggled with for 5-years that his dermatologist couldn't improve.

He is married to a chiropractor, and they have raised their kids in a vitalistic chiropractic way. They opened up their practice in La Quinta, CA, quickly reaching the million-dollar practice club by their 5th year in practice. He's continually been refining his practice over the years and grown it up to a seven-provider, multi-million dollar practice.

Over the years, he automated many processes in his offices and eventually started sharing his patient-tracking software with colleagues who encouraged him to share it with the profession.

Today their software has been used by over 300+ doctors around the country in 2.5 years on a limited advertising budget. Their focus is on patient tracking, from initial interest to completed treatment plans and long-term patient care.

His goal is to help 1000+ chiropractors add more efficient patient tracking processes so they can help more patients while improving their personal wealth. In addition, he believes that more successful chiropractors worldwide will allow them to donate to chiropractic causes, grow their offices, and inspire more people to become chiropractors.


JAMES CHESTER (HOST):  You've made the Chiro Hustle. Sit back and learn from the greatest influencers in the profession on the world's number one Chiropractic podcast. Before we dive into this powerful episode, please remember to subscribe to our channels and give us a 5-star rating on iTunes and to continue hustling. This episode is sponsored by Transact Card, Align Life, NeuroInfinity, Imaging Services, Chiro Health USA, Chiro Moguls, Pure Chiro Notes, Titronics, Sherman College of Chiropractic, New Patients in a Box, Life Chiropractic College West, Pro Hockey Chiros, Pro Baseball Chiros, and the IFCO. Let's hustle.

LUKE MILLETT (PRODUCER):  Hey guys, welcome to episode 513 of the Chiro Hustle podcast. I'm your producer, Luke Millett, and here's your host, James Chester.

JAMES CHESTER (HOST):  So today we have the opportunity of interviewing Dr. Naota Hashimoto. And if you want to hear the story about how the riches are in the niches, stay tuned. This is another episode of the Chiro Hustle podcast. It's 513 today. I'm really excited for this episode with Dr. Naota Hashimoto. His business is called Track Stat. It's all about following the patient journey. And today we're going to be talking a lot about increasing profits. There's a lot that goes into a chiropractic office. And it's really cool to be working with Dr. Naota on a personal business level and seeing how he's been growing. So I'm really excited to go into his journey a little bit with you today. But before we get into this episode, I want everybody to know the big why. Why do we do it? We do over here at Chiro Hustle. Well, first and foremost, we believe in the First Amendment. That's freedom of speech. A lot of people know that I got my background in journalism. So this show really is near and dear to my heart because it's protecting freedom of speech for something that I really love, which is chiropractic. And then that leads us to talk about two things that really matter. Medical freedom of family health freedom. And chiropractic has been at the forefront of this for a very long time. So if you guys are looking for somebody to help you out with your health, go find a local chiropractor and see if we can get some more people involved with the chiropractor profession. And then philosophically sounding, I was telling everybody that we do support the science philosophy and art of chiropractic. A lot of people don't know that doctor noted that chiropractic is a triune, triune of health. But philosophy is something we don't discuss a whole lot on this show. So I make sure that I give a foundation of that before we actually talk about cool stuff. Maybe philosophy is cool. But it's BJ Palmer's Sacred Trust. Protecting the Sacred Trust is so important when it comes to chiropractic. And if you guys don't know what that means, go your favorite search engine and look for BJ Palmer's last words. You're going to learn a whole lot more about chiropractic than what you previously did. And then we also support civilization based chiropractic. If you don't know what that means, then we need to really educate young chiropractic. And then lastly, we believe in innate intelligence and universal intelligence. When someone gets adjusted, man or woman to physical, when they get adjusted, we believe that it connects man or woman to physical to man or woman to spiritual. Now, with that being said, Dr. Noda, welcome to the show.

DR NAOTA HASHIMOTO DC (GUEST):  Thanks for having me. And I don't think philosophy is like a bad thing. To me, it's just kind of like guardrails. It's your core family. It's what you stand for. And like, there's certain things that our family does in our health, how we run our business, how we do everything. And it just makes it so easy. It's kind of like Southwest. They rocketed up because they had that wheels up philosophy. And when they were trying to make decisions of bringing food on the plane or what kind of routes they picked, if it was part of wheels up, then they would do it. And their thing was, we're going to turn the planes around as fast as possible because we're transporting our customers and making more money. We're going to pick certain airports and certain routes. And like back in the day, they were absolutely killing it when, was it the, what the heck's the old CEO's name, but like Herb Killel or whatever like that. He was just insane, like awesome. But profits can sound like philosophy to some chiropractors as well. Some people think that can be a dirty word. What do you think about that?

JAMES CHESTER (HOST):  Well, you know, I think it's a good opener force because increasing profits is, it's, as they say, the lifeblood of business. Yeah. And it's, it's important. I was talking on my previous interview and I was like, look, when I got my first job, I filled out this thing called a W two. And they told me that I would be paid biweekly. I had no idea what that meant. And that means you get paid every two weeks, which I was like, uh, that doesn't sound fun. Why don't you just make it weekly? That'd be cool to me. And that, and then they're like, by the way, we're going to hold back your first two weeks of your pay to like some, some other like time in your life that you might get this. And I'm like, well, why would you do that? Like now you're not only paying me every other week, but now you're holding back my first two weeks. That doesn't sound like a good deal. Yeah. And I think when it comes to like running a chiropractic office, there's a lot of people that are like, uh, I don't know when I get paid.

DR NAOTA HASHIMOTO DC (GUEST):  Yeah. No, it's, um, but like profits, like, yes, like the goal of a business is to essentially make more money, but it's kind of how you do it. And for us, it's not like profits over people, but we do have to have profits because you have more profit. You could afford to hire that better person that you wanted to add to your team. You could pay your people better. If you want to be a, buy a new piece of equipment, you could buy that piece of equipment. You could pay off your student loan debts and imagine practicing with, you're still going to have stress, but without that stress of making your mortgage, paying your rent, paying off your student loans, it's just going to be so much more fun.

JAMES CHESTER (HOST):  Yeah. I mean, I call it the happily ever after the happily ever after practice. Yeah. And everybody wants that white picket fence, you know, a practice that they have that, you know, they're not thinking about their student loan debts or the overhead on the office or the, the staff and everything, you know, like, I think everybody wants to go towards that direction.

DR NAOTA HASHIMOTO DC (GUEST):  Yeah. And, you know, like I see people, like we have a bunch of clients and people say, it's like they just want more new patients or they want more visits. It's like at the end of the day, you're really after more profits. And, you know, like there's really a few ways to do it. You know, you could increase your fees, you could increase your volume, you could reduce your operating expense and you could collect faster, which is reduce your AR or do like some kind of a prepaid type thing. So like those are kind of like the handful of things. But, you know, like increasing your fees, I think is important. You see a lot of these guys having chiropractic feeds from the 70s and everything else is going up. Netflix is going up. Eggs are going up. Beef is going up. Gas is going up. Taxes are going up. Clothing goes up. Your employees ask for more. Cost of school goes up. Everything keeps going up. And then insurance companies are reimbursing less and doctors are still charging the fees that they charge in the 70s or 80s. And I don't know. Like I don't, I don't get it.

JAMES CHESTER (HOST):  Well, there's a lot of advancements out there. And I think that there's a disconnect between rendered services and price point. And I think that that's been something that's been in the chiropractic profession for a long time. They're like, well, we charge as much to this insurance people will charge as much this insurance people. And over here we're cash. So I think that a lot of times people are like, well, I don't know what's a fair thing to charge for this. And then there's a lot of confusion based on the outcomes.

DR NAOTA HASHIMOTO DC (GUEST):  Yeah. And then like, you know, what measures grows. So like one of the things I was recommending people track and we have it in their own purpose is your collection visit average or dollar per visit average. Because if you don't measure it, you have no idea where you're at. And then you could constantly iterate and make changes to do that. Like you could raise your fees. You could look at complimentary services. You could become an expert to that person. Right? Like earlier, we were talking about kind of like doing like weight loss stuff. And you guys were specializing in weight loss services and you became an expert to those people. So if you become kind of like the cardiologist, cardiothoracic surgeon, expert or the pedic surgeon, you can raise your fees. So people will pay not only for what you do, but they'll pay actually a lot more for who you are to them and then you become a celebrity, then you could charge even more.

JAMES CHESTER (HOST):  So let's talk about the volume. Yeah. Can you say price first, not volume? Yeah.

DR NAOTA HASHIMOTO DC (GUEST):  So volume, there's a lot of ways that you do it, but one way is actually getting more new patients. Right? So like, how do you get more new patients? Well, you got to market for them. You're going to become an expert to them. You know, like doing niches, I think are great. Some people don't like doing niches. But even if you're doing a subluxation based chiropractic, you can focus on headaches and migraines. You can focus on sciatica. You can focus on make back pain. You can focus on chiropractic for golfer. So you don't have to abandon your philosophy, but you become an expert in what you do. Because a lot of people think chiropractors just work with low back pain. Like my first experience with chiropractic, I was going to physical therapy for six months after I had on car accident. And I got some improvement, but I wasn't getting better. And it wasn't until they're going to refer me to an orthopedic surgeon when I decided to start investigating things on my own. And when one of my friends dad said, you need to go see my doctor and ask what they did. And he said, it was a chiropractor. He's like, I got headaches. I got neck pain. I also had low back pain and kind of like from a disbode, but it was a lot of upper back and neck stuff. And I didn't put the connection because I just figured they're low back pain doctors.

JAMES CHESTER (HOST):  Yeah. Well, like he said, regardless of the type of model of people practicing, I don't know what I mean. I think that you're right. I've been told this since the early stages of me working in the chiropractic profession is symptom cell. Unfortunately, the people out there looking for chiropractic, they're not educated like a chiropractic mind is like, we're like chiropractors don't take care of that. We don't do headaches and neck pain. We just like adjust the subluxation. The body heals itself. Like that's a chiropractic mindset. But the people looking for chiropractic, they're like, they're like, I have headaches. I heard you can help with this. Can you help me? So if you become that niche practitioner, they always say that the riches are on the niches.

DR NAOTA HASHIMOTO DC (GUEST):  Yeah. And you know, they go through that awareness consideration decision phase. Like the first thing like, you know, it's like people like you got to talk to them where they're at, like in the beginning, they don't even know they're not even looking for chiropractors. In the beginning, all they know is they went golfing and normally their back pain goes away with ibuprofen and Tylenol and some ice in a couple of days. And this time they went golfing and their back's been hurting for three weeks. They've done all the things and they become aware that they have a problem and it's not getting better. And then they're actually trying to find something that's going to work for them. And then they might find that, okay, maybe a chiropractor will work with this. But if you just said back pain for golfers, they're going to start looking for that. Then they go to your website. They're going to look at your reviews. They're going to go to your website. They're going to read about you and you need to make that process really, really easy.

JAMES CHESTER (HOST):  And that's the digital footprint. And I think that if more people have paid attention to like that type of mindset when it comes to building a brand, like digital footprint matters, like your reviews, your reviews correlate with your website, your website correlates with your Facebook page. Your Facebook page correlates with your Yelp. Yeah, it all correlates with each other. It's all digital footprint. Yeah.

DR NAOTA HASHIMOTO DC (GUEST):  And some people hate on Yelp, but like depending on where you are in the country, Yelp matters. Like I'm in California, Yelp matters. I hate Yelp. But it's just like, I remember years ago, like in our complex, we had a one star review from someone. There's like a primary physician like right next to us and they had a bad experience there and their labs didn't get covered. And then they went and gave us a negative review. It's like, they meant to do it for a primary care clinic. This is a chiropractic practice. Nowhere it doesn't say that. They say it's against our policies. It's like, they wouldn't even remove a review for the wrong business.

JAMES CHESTER (HOST):  Yeah. And see that's the thing too, with congruency and the business models for people is, you know, that's why I think a lot of times in tech, we develop new things because things get stagnant and they don't work anymore and we have to innovate. And I think that that's what we've done really is on the digital model, people are innovating left and right. No one owns a space anymore.

DR NAOTA HASHIMOTO DC (GUEST):  Yeah. And then like with a footprint, like most of the stuff starts on mobile, like for one of the things I recommend people do is, yeah, either go to Google developer mode where you could like just kind of right click and go into the inspect and do that, or you could just go on your phone and you can look for like best chiropractor near me or best whatever. See what pops up. Are you in that three pack? Kind of like Google will show kind of like the top three plus like the ads up there. Are you in that? And if you're not there, you're SOL and you need to get in. And then once you go there, you're going to look at the reviews and then they're going to go to your site. If your site loads too slow, it sucks. And then you need to open it up on mobile and you need to have like some kind of an offer. It doesn't have to be something free. It doesn't have to be a discount, but it has to be like a call to action and just make it easy for them. And I see people, they have these sites and they're all janky and stuff like that. And there's no reason for me to book there. And like you're not going to get new patients. So like that would be like a new patient thing. And then like they have the new patient experiences off, right? Like someone opts in and requests information. They don't call them back. Someone calls, that's how they answer the phone. And then when they finally come in, they'll have them fill out like an hour of paperwork. And I'll see some people where like they'll have the patients arrive like 45 minutes to an hour early, then they'll spend an hour and a half with the patient. Then the next visit, they're asking them to come in three times a week for eight weeks. And they're thinking that I was in there for two and a half hours. The patient starts counting the time from when they walked in the door. Now when their appointments started, when they walked in the door. So I was there for two and a half hours plus drive time. So now that's three and a half hours. I don't have three and a half times three times a week for the next two months. And it's just it's killing people. Like that's that's a conversion problem. So I always try to like in our office from when you walk in the door, you're getting greeted, offered a beverage. They've already watched a video tour of office before they arrive. They know what to expect and they're getting brought down, vitals brought into a room with their beverage of choice. They watch a four minute video of what to expect. And all of that happens there. That's happening within five minutes of their appointment. Yeah. Yeah.

JAMES CHESTER (HOST):  Sit back and learn from the greatest influencers in the profession on the world's number one Chiropractic podcast. Before we dive into this powerful episode, please remember to subscribe to our channels and give us a 5-star rating on iTunes and to continue hustling. This episode is sponsored by Transact Card, Align Life, NeuroInfinity, Imaging Services, Chiro Health USA, Chiro Moguls, Pure Chiro Notes, Titronics, Sherman College of Chiropractic, New Patients in a Box, Life Chiropractic College West, Pro Hockey Chiros, Pro Baseball Chiros, and the IFCO. Let's hustle.

I think what we have a different consumer today. Yeah. And I think that we also have to deliver to that consumer the way that they have created in their mind how it should be received to them. So I think you're doing something really well. I think talking chiropractic business is what people need.

DR NAOTA HASHIMOTO DC (GUEST):  You know, it's we're in the Amazon generation, right? Like people just like, they don't want to do three. It's 72 hours. And they just like, pain now, like they want to just do like one, two clicks and then boom, it's at their house and one to two days. It's crazy. Like, I don't know how old you are, but like I was around like pre Google, right? Oh, yeah. Like I remember going to the library and looking and shit up.

JAMES CHESTER (HOST):  Yeah. Yeah. Now everybody leans on Google like it's their brain.

DR NAOTA HASHIMOTO DC (GUEST):  Yeah. So it's, and that is just like part of the new patient equation. And then so many people are focused on new patients. And then one of the things that tell people do is like how many people you get to finish their treatment plan. They finished their treatment plan. They're going to get the outcome that you told them that they're probably going to get. You're more likely to get a referral. You're going to get more visits. You're going to get more revenue and you're going to get a better outcome. There's a lot of offices where the patients will just self discharge versus a doctor saying, Hey, you got to a certain point. We're going to discharge you or we're going to put you into the next phase of care or we're going to refer you out. But it should be a decision between you and the patient, not the patient on their own.

JAMES CHESTER (HOST):  I call it the chiropractic breakup. Yeah. Like chiropractors get broke up with more than anybody I've ever met just because people start and then they discontinue and then you're like, Oh, where, where did James go? He was just here last week. And now we go on reaction. We go on reactive modeling and we were like, call, call, call, call, call. Where's James? Well, James is thinking he's better. So James is gone. He doesn't want to finish this pre plan. Actually, he wants refunded.

DR NAOTA HASHIMOTO DC (GUEST):  Yeah. And then, you know, what PVA is, right? Patient visit average. Like people have talked about that. And like, and I know a lot of consultants teach this and they like PVA and I think PVA is popular because it's easy to measure. But I don't think it's going to show you where the problem is. Like PVA was just going to show you, you know, you're going to have your total visits divided by new patients. And you know, I think that there is some value to that, but you have an influx of new patients that number goes down versus like, if you look at like patient drop off analysis, patient drop off analysis is going to show you like what specific visit number people were dropping off of that. So I was like patient drop off analysis, which is another thing that we do in ours because drop off analysis is going to show you specifically what visit you need to fix and which provider is having the problem, right? Yeah. I think the also the temptation that a lot of our clients have is they want to focus on the provider that's doing the porous. And a lot of times they'll take like, I'm not going to call them the weakest link, but the lowest performer and try to focus on training and getting them up. But let's say you have one provider where your average patient drops off at visit six. You have another provider where their average patient drops off at visit 24. That's a big jump. So I say is like, I'm not saying to give up on the new grad or the new person, but like figure out how you could take stuff off the plate off the workhorse. So if they're doing their soap nuts, get them a scribe and figure out all the little mundane things that they're doing and figure out how to get that off of their plate. So you could take that workhorse and get them working harder and then work on your lower performer too at the same time.

JAMES CHESTER (HOST):  Well, I think there's a lot of headspace issues when it comes to growing something in a business and some people will see like one part of what we think they should be doing is not their responsibility. And then they've made that in Toronto decision without having a conversation about it. And you can see the performance challenge at a certain juncture and that that patient's experience. So when somebody says, that's not my job, we can see that now through the numbers.

DR NAOTA HASHIMOTO DC (GUEST):  Yeah, and it's everyone's job and kind of depending on the school you went to, like I went to LACC Southern California University of Health Sciences. It's a mouthful, but like we call it more of an evidence based school. And it's like a lot of these docs say, it's like, oh, I don't want to see people like X amount of times. It's like, well, even if you look at the Mercy Guidelines, that was like three times a week for a month and one to three times a week for four to eight weeks. And like last year, I took a look at patient drop off analysis. We did like an analysis. I think it was like 800 chiropractors that we looked at. It was like pitiful. Like most of the people are dropping off between visits like four and six. And you're not like if you're trying to build up muscle tone, it's going to take 12 weeks to build up muscle tone. You're not kind of like increasing flexibility of tendons, ligaments. You're not doing any kind of subluxation correction. Like you're not doing any of that in like four to six visits. You're working on symptomatic stuff at best. And I think some people are so worried about being a high volume doctor for the evidence based people. And it's like, you know, like you go to, you go to a restaurant and you see a bunch of reviews and you go and you see a lineup out the door. You want to go there versus like if you're a low volume practice, I'm not saying that there's anything wrong with low volume practices, but there's not a ton of energy in there. And people go to where people are. And it's even if you're a high touch office, like I remember when I was getting going on my own, we was just like me, my wife was doing her thing. I was doing my thing. You know, like I cluster book people in the morning. I see two people at a time and I had one person start on the therapy, adjust other person and switch them around. And then I cluster booked at the end of the day and I worked on my practice in the middle of the day. And versus like just spacing them out sequentially, it just, I don't know, like it's hard to build up that high energy. And you know, like it makes a difference. I just remember I had four patients in practice, my first four patients and like I remember what I would say is like, oh, gosh, it's so busy. I just cluster booked them five and five fifteen. And I just, um, at the very end of the day, it was like, I just chuckled that. It was just like, Oh, doc man, you're so busy. I was like, Oh yeah, super busy. That's like, you didn't know that I only had four patients and I was seeing all four of them three times a week.

JAMES CHESTER (HOST):  And that's just it too. It's like we can create our own realities. Yeah. And I think that's a great thing about what you do to help people with your, your tracks, that system is it helps people create a better reality for the model of practice they want to run. And it gives people a chance to like you can see the drop off of a care plan, or you can see where, you know, one practitioner performs really well and does well up to a certain spot. And you are right. The chiropractor has been beating their chest for years about PVA and you're probably spot on. It's so easy to say. Yeah, that matters. Well, it's easy to track. But like you also said, it doesn't take into account PVA's suffer when you see a lot of new patients. So if you're seeing a bunch of new people coming in, your PVA is not going to be high. But that means that you're experiencing a different growth pattern.

DR NAOTA HASHIMOTO DC (GUEST):  And some people calculate it based on new patient conversions. So it just depends on like where you got taught. But yeah, it's, I think it's a overall symptom. It's kind of like a patient walking into your office and saying, I don't feel good. Where does it not feel good? And I know some of the people on here are more civilization based, but like that's why people are coming in.

JAMES CHESTER (HOST):  Well, here's the, here's the thing too is we were always trained like about visit seven to do like a reeval on our patients. I worked in a clinic for six years and I had to do the reeval. So I'd always ask people, Hey, do you remember what the original thing you came in here for? So many times people forgot why they originally came into the, our office because they got better. And that's why people break up with their chiropractor because after seventh visit, you don't re enforce why they're still there for the next like three times a week for the next two and a half months.

DR NAOTA HASHIMOTO DC (GUEST):  And doing an early reeval like that is smart because a lot of people will do it at like say 12 visits, but a lot of people are dropping off by 12 visits.

JAMES CHESTER (HOST):  So that's where we saw our performance drop. We saw it happen about the seventh visit. And then we shot to the line and we shot ahead of like the fall off and we started having these like little interventions with people.


JAMES CHESTER (HOST):  And how long do we take? We reengage them.

DR NAOTA HASHIMOTO DC (GUEST):  Like how long did it take? Did it take a long time? Five minutes. That's it. Just a more unique seventh visit. Yeah. That's all they have to do. And sometimes it's like having a more impactful third visit and maybe it's seventh visit. It doesn't have to be a 30 minute thing on the books.

JAMES CHESTER (HOST):  Well, then we saw Dr. Norel, then we saw people staying longer and those people became our champion practice members. They started referring more people in. Yeah. It was pretty cool.

DR NAOTA HASHIMOTO DC (GUEST):  Yeah. So it's like those things kind of like matter and other things that we track are like leading indicators because like we'll track like just looking at the average of the last two weeks to front desk rescheduling rate of canceled and missed appointments. And then we automatically track kind of like their percentage of people leaving with a future appointment. Right. And those things are going to change before visits change and visits are going to change before revenue changes versus a lot of people they get to the end of the month and they say, what the heck? WTF? Where's all the money?

JAMES CHESTER (HOST):  So let me ask you this. This isn't like any scripted thing, but I'm really curious. As you've seen the development of technology and chiropractic offices, do you feel that because of technology with two way texting and messaging systems that it's helped improve the position of like a front desk person? So they're not always on the phone rescheduling things and calling people.

DR NAOTA HASHIMOTO DC (GUEST):  It does. One of the things I have found and you probably found this even with your marketing clients, it's just like your top people, your top people. Like our top 20% or winners and they just win. Like I could take some of our top clients and parachute them into a random town, give myself a piece of paper and a pen, come back in a year and they got like a rock solid practice. Like winners win. So one of the things that this does help is it takes the people that are just below that and making it easier for it to succeed, but like it's not a guarantee of success. So which is why I would say on average, not always, our current and former coaching clients. No, we don't do any coaching, but clients that came from like some kind of business coaching, they do well because we're taking stuff that they were doing manually and then just automating it. And it's our goal for software. We're not there yet is I want to make it where a 20 year old that doesn't know anything about anything to log into our software because we're already doing some AI stuff and algorithms in just telling them what to do. Like we have a recall AI where we take a look at like patient value, do they have money on account, likelihood of them scheduling, how many visits they had and based on that we score it and we put them in order. So the person doesn't even have to know who the patients are. They go top to bottom and we put the top 20% that are more likely to schedule more valuable at the top. We're doing that with some of our things. And our goal is to eventually do that with everything. And my hope is at that point is we could take someone that has no coaching experience and to run their practice like they had a ton of coaching.

JAMES CHESTER (HOST):  That's so cool because I think a lot of times the reason things have like a fail rate is because of the human element. People either lose interest in it or they just don't know how to do it. And I think that if you help people with their fail rate, which that's an encouraging thing to say, look, if you do it this way, we can take your old model and we can save you from those issues. Yeah.

DR NAOTA HASHIMOTO DC (GUEST):  So it's unfortunately not everyone in chiropractic is great at business. Not every dentist is great at business, not every mechanic is good at business. And sometimes some of the people that are best at business aren't the best clinicians. Like, you know, it's like I have some like friends that I know from school and other things and phenomenal clinicians, phenomenal, horrible business people. So like, it's just so like, I just, my goal is I think that if we get more chiropractors becoming successful, they could afford to pay their people better. If you could increase the average salary of the chiropractors, you're going to increase the amount of people going to chiropractic school and you're going to get more people under chiropractic care. Like, I think there's what 66 to 70,000 chiropractors out there, physical therapy, I think there's like 240, 250,000. I know some people will turn feather me, but like the outsider looking in, we are more similar than different, right? They're saying that they're taking care of say neck and back pain without drug surgery or shots. And you know, like as physical therapists are starting to manipulate and pop bones and chiropractors are starting to do rehab. So like, I know in some conferences, some people will turn feather me, but like if you're Joe Blow that doesn't know anything about anything, they just see, okay, they work on back pain for golfers without doing surgery, without medications, without surgery. So like the line is getting more and more blurred and they have three to four times as much of us. And the reason is that their average salary is just the hair higher in some states.

JAMES CHESTER (HOST):  Mm hmm. Yeah. And I think when we talk about the chiropractic profession getting stronger, I hear a lot of times it's harder to get out of a chiropractic office and transition out of it because it's personality driven. And I think that if more people looked at it to become a numbers driven practice, then it would be easier for them when they're ready for their swan song. They could sell it for more and they could transition out of it easier if they focused more on the numbers and automated systems because that's attractive to the future practitioner. The future practitioner doesn't want a bunch of old x-ray files. They don't want a bunch of dead files. They want numbers that they can follow that are sellable, unusable and recoverable. And they don't want to come into a sick practice. They want to come into a practice that doesn't have to be, you know, hinged on someone's personality or someone's ego. They want to come into something that's better system managed.

DR NAOTA HASHIMOTO DC (GUEST):  Yep. And then raise your face. Like a lot of people, there's chiro's I remember I was, um, fitting at a conference and like, you know, fab, famine scene was that they're talking. And like, you know, he was talking to the guy sitting the fees for like, I think Medicaid or something like that, or Medicare. And he was complaining to him, was like, why are you paying? If you value chiropractic so much, why are you paying? It's like, we don't set your rates. You guys say your rates. You have actuaries that go out and they kind of look at the lowest average rate. And that's how the fees are getting set. And chiropractors are shooting themselves in the foot. If you look at ASH IT or what is it? ASH. Sorry. But like you look at all these things, they're just, it just, you know, like, I remember they'll pay you a higher rate if you are in the better tier and the better tier is less visits and everyone's like just racing to the bottom. Um, you know, like you'll see this in medical groups like all the time. Like I remember, and I think it was in Colorado, there was a group of cardiologists they banded together and then they, they refused to see patients from a certain pair, a camera, like Blue Cross and then they raised their rates because they held the line. They held the line and it's like, we're not going to see them versus a lot of chiropractors. It's like, what the heck? I'm going to go in there and see all these people and I'm going to be the only guy that sees this ASH or Blue Cross. So like we need to, I think we need to increase our business acumen. We need to increase our profitability. We need to increase our dollar per V visit. Like we need to do all those things. And I think we're going to be stronger. So like those are important and, you know, like just, you got to collect on the services that you render. Like a lot of people, the right and all of their accounts receivable and, you know, like that was one of the things I was going to talk about. Like one of the little things that we did is we looked at who was coming in the next day. We had someone like just kind of go through and like roughly price out. We had fee schedules for what each person should pay and we did pre-pays, but we did a fairly quick once over and we collected for the services before they were rendered. Even if it was an approximate when we're doing insurance and, you know, like all of us have been to Adentis and what happens before you go out? They do not let you out until you schedule and pay. Right? That's it. So it's like you got to schedule and you pay and you can't get out of there without paying versus chiropractors. It's like, hey, see you later.

JAMES CHESTER (HOST):  And schedule on you're ready.

DR NAOTA HASHIMOTO DC (GUEST):  Yep. No payment. And it's like that's a big thing. And you know, like the last thing I was going to probably focus on is just reducing your operating costs like and leveraging software and automation. Like that's one of the things we do. People say it's like, well, we have a process for that. It's like, well, how many hours is it taking you to do that process? And is that process accurate? And is it consistent? And they'll say it's like, well, we're paying our people's salary. But if you're freeing your people up from finding information, finding out what to do, they can actually reach out to patients. So you could have a patient's mom that is recovering from hip surgery and you sent the patient's mom a get well card or you sent someone else's get well card or a happy birthday or little things like that. That's where you should be spending your time. Like, you know, one of the things they used to do is I call people after their first adjustment. And that made an impact. And now with technology, like there's a software called Loom, you could shoot quick, quick one minute video and it automatically uploads it and you could just text that link out and you could just watch that little video. And you know, a lot of people want to automate that process and you can automate that process. But I think that's worth not automating. So if you could put in a couple of specific things about them and about their goal, how they want to go on that trip to Italy or play with their grandkids or play with their dog, like that stuff matters. And I think it's a human to human relationship and automate as much as you can, but like some things that don't think are worth automating.

JAMES CHESTER (HOST):  So tracks that helping improve the patient experience and helping increase profits. And just if you guys want to learn more about the tracks that system, go to Chiro They're one of our sponsors. So we thank them so much for believing in what we believe in and supporting this beautiful profession of chiropractic. Dr. Nota, is there anything I didn't cover that you wanted to discuss before we call it a day?

DR NAOTA HASHIMOTO DC (GUEST):  No, that's pretty much anything. And then when people visit our site, all they have to do, they'll go there, they could watch a demo and then they could schedule a call right there. It seems like it's right for them. We do a free trial. So if it doesn't do what I say it's going to do, then they don't have to sign up.

JAMES CHESTER (HOST):  Cool. Well, thanks for being our guest today. Your episode 513 of the Chiro Hustle podcast. And I look forward to seeing you soon. Thanks for having me. All right, I'll just tell everybody like I always do closing out. You're just one story away. Keep hustling. I'll see you guys on the next episode. Thanks Doc.

All right. Bye for now. Thanks for listening to Chiro Hustle. Don't forget to subscribe and check back next week to continue hustling.


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