Improve chiropractic clinic profitability by increasing PVA
What is PVA and how do you use it? An increasing number of chiropractors have been experiencing anxiety about the future success of their practice. Their concerns span a gamut of issues– from lack of patient feedback about their patient relationships to lack of control of practice management processes to unpredictability of patient flow and cash flow to low profitability. Shrinking practice profitability is a result of five forces that conspire for a “perfect storm:” Rising costs of doing business, from rent to payroll to insurance Shrinking insurance reimbursements Increasingly stringent regulations and growing frequency of audits Delays and underpayments of insurance claims Patient flow fluctuations 3 steps to gain control over your practice’s profitability: Regaining your peace of mind and taking control back into your hands requires a methodical approach consisting of three steps. Measure your case profitability and set a goal for it: Profitability or case profit margin is a ratio of case fees collected minus case costs, divided by case fees collected. Case fees collected is the money spent by the patient in your office over the lifetime of that patient. Measure your patient visit average (PVA): The sad thing about profitability is that there is no way to control it directly. But the good news is that it grows in step with your Patient Visit Average (PVA). In other words, you can control your case profitability indirectly by controlling your PVA. Increase your PVA: Figure out ways to have your patients commit to more than one visit and keep implementing new ideas until your practice’s profitability meets your goals. How to determine case fees collected? The case-fees-collected statistic can be calculated by dividing total collections by the number of cases. This approach has a major shortcoming because it requires the chiropractor to wait until all cases have terminated. For a reliable approximation of the same number without waiting for termination of every patient, follow the two-step approach below: 1. Calculate all collections for a given time period. 2. Divide that figure by the total number of new patients for the same time period. For instance, if Dr. Joe treated 20 new patients last month and collected $10,000, then his case-fees-collected last month were $500. In other words, the average patient last month spent $1,000 before terminating care. How to determine case costs? You can use the same approach to calculate your case costs: 1. Compile total overhead for the same time period used to calculate case fees collected. 2. Divide your total overhead by the total number of new patients for the same time period. For instance, if Dr. Joe treated 20 new patients last month and his total overhead during the same month was $10,000, then his case-costs last month was $500. In other words, the care of average patient last month cost Dr. Joe $500. What does Profitability mean? If your fee to cost ratio is greater than one then you have a profitable practice. Otherwise, you are losing money. Common sense dictates that a profitable practice that takes care of its owner manages a 3:1 ratio of fees to costs, or about 67% profit margin. A common fallacy among many practice owners is the belief that increasing the number of new patients positively impacts profitability. But this may not necessarily be true since increasing the number of patients also increases the overhead, potentially decreasing profitability even further and defeating the purpose of increasing the number of patients. How to compute Patient Visit Average? PVA is a measure of your retention, or your ability to retain patients. In other words, it is a relationship quality indicator. The higher the PVA, the better is your relationship with your patients. As in an earlier calculation, the Patient Visit Average statistic can be calculated by dividing total visits by the number of patients. This approach has the same shortcoming as above because it requires to wait until all patients have terminated. For a reliable approximation of the same number without waiting for termination of every patient,simply divide your total visits for a given time period by the total number of new patients for the same time period. For instance, if Dr. Joe had 300 patient visits last month, including 20 new patients, then his PVA would be 15. In other words, the average new patient returns 15 times to see Dr. Joe. 5 steps for improving your PVA The way to increase PVA is to create a lifetime-maintenance practice. Maintenance patients have a greater understanding and appreciation of what chiropractic has to offer. Create customized treatment plans: Give your patients a customized plan that is tailored to their specific problems at the end of their first session. Block schedule the entire plan in advance: Help your patients understand that you are offering them a complete treatment plan – not a session by session experience. Train your team: Practice “role play,” including specific verbiage and intonation. Without practicing in advance, you leave it to your staff to come up with the right things to say on the spot. Every mistake they make can keep a new patient from coming back and even more importantly – prevent them from benefiting from your treatment plan. Set goals and display results: What you can measure, you can manage and on the same side of the coin what you measure will improve. Go the extra mile: Send thank you letters for referrals. Acknowledge special events like anniversaries, graduations, weddings, or funerals. Thank your patients for being on time, complying with your treatment plan, and meeting payment deadlines.
5 Social Media Tips for Building Stronger Patient Relationships in 2025
Building authentic relationships with your patients on social media is no longer optional—it’s a vital part of running a thriving chiropractic practice. Platforms like Facebook, Instagram, and TikTok aren’t just for brand awareness—they’re how patients decide who to trust with their health. When done right, social media can help you: Retain patients by reinforcing value between visits Gain referrals through shared content and testimonials Build authority in your local community Here are five updated tips for building patient relationships on social media in 2025: 1. Embrace Short-Form Video While images still have their place, short-form videos (Reels, TikTok, YouTube Shorts) dominate in 2025. Patients want quick, useful, and relatable insights: Show a 30-second posture correction tip Share “behind-the-scenes” clips from your clinic Highlight patient success stories (with permission) Pro tip: Add captions—most people watch on mute. 2. Share Bite-Sized, Educational Tips Patients love actionable, easy-to-digest content. Try: “Quick Tip Tuesday” posts with wellness advice Mini checklists for desk workers, athletes, or parents Carousel posts that explain simple stretches or self-care routines This makes your page share-worthy, increasing organic referrals. 3. Guide Engagement With Clear Expectations Don’t just drop a link—tell people what they’ll get. For example: “Here’s a 2-minute video for moms with young kids on preventing back pain.” “Quick blog (3 min read) on how to avoid tech neck.” This sets expectations and respects patients’ time, which increases clicks and engagement. 4. Use Calls to Action That Feel Personal Instead of a generic “Like our page,” use people-first CTAs: “Tag a friend who sits all day and needs this stretch.” “Share this with someone who struggles with low back pain.” “Comment ‘YES’ if you want us to post a video with more tips.” Patients respond when they feel they’re helping others. 5. Spark Interaction With Polls & Simple Questions Engagement fuels reach. In 2025, polls and interactive stickers on Facebook and Instagram outperform text-only posts. Try: Poll: “Do you sit more than 6 hours a day? Yes/No” Quick question: “Describe how you feel after an adjustment in one word.” Emoji response: “Which stretch do you love most? 👍 for neck, ❤️ for back.” Simple, low-barrier interactions keep your posts visible in feeds. The Bottom Line Social media is a patient relationship tool—not just an advertising platform. By providing consistent value, sparking small interactions, and showing up in a human, approachable way, you’ll stay top-of-mind and increase both retention and referrals. 👉 Next Step: Audit your clinic’s social media. Are you giving patients real value, or just promotions? Start applying these 5 tips today to strengthen your community and grow your practice.
From the Wrist Watch, to Siri, to Smart Software
Ask a room full of under 25 year old professionals if they are wearing a wrist watch. If you are over 25 you will be surprised at how few are actually wearing one. Why? The digital world has eliminated the need to look at you wrist to tell the time. The time is everywhere. It is on their phone, on their computer, in their car. For the most part they can find the time at any given time without the major inconvenience of looking at their wrist. In the past a wrist watch was a status symbol. It meant you were able to afford the latest technology. It said, “I am a serious business person”. I heard a quote one time, “I never trust a man who does not wear a watch”, but why? It meant they valued their time and yours. That they lived for more than the present moment and considered the future. Wearing a watch meant you were forward thinking. My how things have changed. So what does this have to do with Siri and chiropractic software? Clearly the new status symbol is the cell phone, or now, “smart phone”. Not only does it say you are cutting edge, but it means you are connected and it even means you are more intelligent Prediction: 30 years from now wrist watches will be for collecting and old people. There is another important distinction sown by the modern smart phone. They are “smart”. Siri has a name. Let me say that again, you can name your phone. Why name it? Because it talks back! You actually have a relationship with your phone! What does the phone tell you? Forget an appointment book. Remember that thing you used to carry around? Gone. Not needed. An analog/paper version. You used to have to memory manage you schedule for the day and tomorrow and next week. Not anymore. Just tell Siri. In the past, busy people, like chiropractors, might have an entire full time or part time employee just to manage their appointments. Not any more. From Siri to Smart Chiropractic Software There was an in between step from the appointment book to Siri (Speech Interpretation and Recognition Interface). That was a digital appointment book. Remember the PDA? Same basic function as the paper appointment book but it saved a lot of space since you could store all of your contacts in it. There were the Palm, BlackBerry and even the original iPhones. Older chiropractic software like Platinum or Chirotouch rely on the wrist watch concept. They are not as bad as paper but they are NO Siri. They are like the Palm or BlackBerry. You can save lot of space, document digitally, and even make your office more efficient. The gaps between these types of systems and a system like Genesis Chiropractic Software are many but in this context, there is one glaring difference. This systems are not going to speak to you. They are not going to tell you how many no shows you have. What’s that? A report? That’s good but there is a big difference between having to look at a report (Appointment Book or PDA) and the report coming to you (Siri Talking to you). Genesis tells you, in the form of tasks, what critical patient relationship risks need to be addressed right now. It identifies the outstanding issues and assigns them to a specific staff member, maybe even you, automatically. There can be many types of tasks. Just to name a few: Missed Appointments Expired Care Plans No Future Appointments Balance Threshold Exceeded Daily SOAP Notes That Are Not Signed Compliance Red Flags Insurance Claims That Need Immediate Attention With software that functions more like Siri and less like a Blackberry, you can begin to gain control over all of the important things that need to happen every day because it is not dependent on you looking anywhere. The information comes to you. It is like not having to look at your watch or look at a blackberry to tell the time or what appointments you have tomorrow. The technology speaks to you in the form of tasks. When all critical tasks are put on one manageable dashboard you can see at a glance you can see who has the most work, what type of problems are happening most, and how much work there is and most importantly, what work did not get finished. Think of the billing software that finds the claims for you rather than digging through aging reports and having no idea if your biller is getting everything finished. Think of a schedule that is telling your team what they must to in order to maximize retention… Imagine a documentation and compliance system telling you when you put yourself at risk of an audit… Imagine a chiropractic software that markets to patients for you based on their specific demographic… Imagine how happy your patients will be when you and your team never miss a step… Your team is more efficient but at the same time more accountable to you. You sleep at night knowing you are safe from a major audit. Less time documenting, more time doing the things you love. Less stress trying to remember everything that needs to be done, more peace of mind. Genesis – The coming into being of something; the origin. This is a whole new world for chiropractic software.
Is Your Chiropractic Software A Piece of Junk?
The word “Guarantee” is good, but No Regret is what you really want. I bought an iPad about three months ago and it is obsolete today. Sound familiar? Imagine if it cost $15,000? What if your software is obsolete in 3 years? Don’t believe that can happen? Things are changing faster than you think. I’ll come back to this. I am about to show you the how “owning” chiropractic software is not only a misnomer (Sales ploy used to make you “feel” good about spending your hard earned money) but one of the riskiest investments you can make in your practice. While companies promise you it protects you, it actually leaves you and your practice vulnerable. I will debunk the big fat myth that it costs your less money to “own” a chiropractic software, (which you actually never do), and show you how you can guarantee that you will not regret your software decision. We will discuss the REAL cost of the two main types of systems and pricing models. Web bases systems vs. Client Server (The one they say you “own”) Data Protection – The biggest lie told today is that somehow your data is safer in your office. It is it better to backup your data offsite regardless. It is useless without the software anyway. Just ask doctors who were in the path of Hurricane Sandy which is better. In the end I will show you how web based systems like, Genesis Chiropractic Software and Billing, pay for themselves and possibly even put some money back in your pocket. Price Comparison SaaS (Software as a Service) – Is a pricing model. Today it is usually reserved for software that is web based. In the past other chiropractic software used this model and charged upwards of $700 per month. They got away with it for years and eventually switched to the “purchase” model. SaaS charges a smaller monthly fee with little to no upfront fees. Let’s do the simple math Some systems on the market are as cheap as $12,000. Compare that to the cost of a SaaS product at $250 per month. $12,000/$250 = 48 month. In other words, at $250/month it will take 4 years before you pay the same amount! Read on and you will see how you can go from 48 months to 60, 100 or unlimited months. Meaning it will never cost you more than $12,000 to use a system like Genesis. But then I own it after 4 years! Really? Do you own the code? Can you tell the company what to build next? What if they go out of business two years later? More importantly REMEMBER the iPad… When you “purchase” you are not buying software, you are buying a license to use the chiropractic software. The company that supports that chiropractic software could be gone tomorrow. Big Difference. If that happens your license is useless. Unless you want to buy the code. I promise you, it isn’t cheap. When you “purchase” you still need to pay for upgrades. $50 per month. Subtract $50 from the $250 that SaaS offers since upgrades are included in the SaaS model (that’s the service part of Saas). With that factored in 4 years becomes 5 Years Remember the iPad. I know what you are thinking, I get upgrades. True you get upgrades. You can buy new computers and they will send you the upgrades so what’s the big deal. Here it is. There are actually 3 things you need to be concerned about. The hardware – That is the actual computer. Those will need to be replaced on an ongoing basis regardless of what type of system you buy. The software code – This is what words are in the code, if you will. In other words you can add new paragraphs to a document in the English language. With software more words equals updates. The system adds function, features etc. That is great. The language – The breath of options is limited to the language the software is built in. When you buy a software you buy it knowing full well that the language your system will be written in 5 years from now has NO Chance of being upgraded. The language is the language. The reason Google is so successful is due, in part, to the fact they are constantly evolving the language they use. It’s not just the words. The capabilities are increasing because the language is changing. Since they are also web based they can upgrade their systems and you don’t see they difference. Just amazing new function. This is the same with your practice software. Software you buy will be limited in just a few years as web based systems language AND code rapidly change. Not so with client server systems. So you are paying a fixed fee because the functionality is fixed in time with today’s language. Clearing House Fees -Included with Genesis billing – $50/month with other systems – Now it takes 6 years to pay the equivalent of other systems. Network Maintenance – With web based systems, computers do not need to be networked together. Only connected to the web. Other systems require a server and network which will cost $1,000-$2,000 to set up. ….. Figure another $50 per month for upgrades to hardware, maintenance for the computer guy to fix things when they break down, and down time….. 8 years easy. Are you betting static software language is going to be as cutting edge in 8 years? Data Backup Service – $25/month 8.5 years (included with web based systems like Genesis.) Peace of mind – Infinite peace of mind. Genesis data center was in the path of hurricane Sandy and experience zero down time. Some clients who lost their office where able to be back up and running instantly with a wireless laptop or iPad. The didn’t lose any data. Others weren’t so lucky. Now what if they paid you? Why not? SaaS systems have it built into their price to have a referral fee. We pay
