Discharging to Maintenance or Wellness: What’s Next?

“Begin With the End in Mind” – Stephen Covey

Stephen Covey, the author of The 7 Habits of Highly Effective People, says, “Begin With the End in Mind.”  He says it means to begin each day, task, or project with a clear vision of your desired direction and destination and then continue by flexing your proactive muscles to make things happen.

Let that sink in for a moment as I dive into beginning with the end in mind and how it affects patient enrollment and retention.

When the patient stays the course of care outlined by the doctor’s treatment plan, they get better clinical results and will be ready to transition to the next phase.  Whether the next phase is maintenance or wellness – you’ll need to know what’s next and how it’s communicated to the patient.

Before we go on, I have a question for you.  Do you know what the goal of care is that the doctor provides to the patients?  For example, in the practice I worked in, the main goal of care was restoring the patient’s cervical curve.  No matter what the patient’s complaints or symptoms were, based upon the patient’s clinical diagnosis and that they were a candidate for care, the goal for our patients was always the same….restoring the cervical curve as it would provide optimal health and wellness.

Once our patients reached the goal of care, they would maintain the results by transitioning or being discharged onto the next phase, which we refer to as maintenance or wellness care. 

Now your doctor’s goals for patient care may differ vastly from ours; however, I ask if you know what the goal of care is that your doctor provides because if you don’t know, then likely the patient doesn’t know.  

And if the patient doesn’t know, then the chances of them dropping out of care are very high.  If they don’t see the goal of care, they will assume it’s pain relief since you’re treating their symptoms.  Once the symptoms are gone – so are they.

It’s critical for the patient to achieve results or expected progress outlined by the doctor in the report of findings, so they know when to expect that it’s time to transition to maintenance and wellness.  

For example, if we don’t start with the end in mind, the doctor may say to the patient, “To achieve results, I’ll need to see you 3x a week for four weeks, then 2x a week for eight weeks…….”.  A lot of patients freak out hearing that type of schedule and may start to think they can’t afford it or don’t have the time to commit to it. 

In our practice, Dr. Bodzin always communicates with the patient what the goal of care is by starting with the end in mind, which results in higher patient enrollment and retention.  

In the report of findings, instead of going over the treatment plan from the beginning, he starts with the end and works backward.  He lets the patient know how infrequent he will need to see them when they reach the maintenance or wellness phase of care. 

By doing this, the patient is reassured and less afraid about what it takes to reach that point.  We have found that the best way to get them to listen to the whole recommendation is to start with the end of the treatment plan and work backward. 

For example, the doctor tells the patient, “When we reach the goal of care, I will only need to see you once per week, and it could be as little as once per month.  So I won’t need to see you very often but to get you well we will need to see you twice per week.  And during this time, I will be re-examining you every month.  Jayden, I’ve been doing this for many years and have cared for thousands of patients like you.  I know exactly how well you should be doing at each progress exam.  And as long as you’re reaching the goals that I anticipate, we will stick to this exact treatment plan.  However, if you’re not making the progress I anticipate, we’ll figure out why and make appropriate changes at that time.  I understand you’re in pain and want to feel better as fast as possible.  I need to let you know that to get the results I showed you; I don’t need to see you any more than twice per week.  However, if you want to feel better faster, I recommend you come in 3x per week these first few weeks to feel better faster.“

In this conversation, we’ve entirely neutralized the patient thinking the goal of care is pain relief – they are clear on the care goal and are more accepting of the treatment schedule.

I’m opening the article with this because everyone involved needs clarity when discharging the patient to maintenance or wellness.  

One of the first things that need to happen is the DC and CA need to be on the same page.  This means that the CA needs to know from the doctor the treatment plan and goal of care.

When consulting with CAs, this is a big hurdle in the office, so if you can relate, please sit down with your doctor and respectfully discuss this topic.  When there is a clear understanding of this, you can better assist the patient in staying the course of care and reduce patient dropout.

The next thing you need clarity on is what happens when the patient reaches the goal of care.  How is it communicated to the patient?  What do financials look like at that point when they’re transitioning to the next phase of care? 

A couple of things can get in the way of patients agreeing to the next phase of care, such as the way it’s presented and how financials are handled. 

When consulting with practices about their treatment plans, I hear a variety of common protocols when talking about care, and one of them is that the doctor will tell the patient, “Let’s get you started and see how you do until we get you to your next exam.” 

This method will kill your retention because the patient never knows when they’ve reached the goal, as the doctor recommends more care repeatedly.  This is the same as no treatment plan or patient care consisting of a visit-to-visit program.  

If you have a lot of patients dropping out of care, it may be because the patient didn’t have clarity that there is a game plan and a goal for care. 

When collecting for services, patients who pay per visit or purchase blocks of care have lower patient retention, which translates to fewer patients going to the next phase of care.  Furthermore, patients dropping out of care means they are not experiencing the true benefits of chiropractic.

What about asking patients to prepay for care?  Prepaid care plans sound like an excellent option because when patients choose them, they’re more committed and compliant.  But it’s not always a natural financial choice that most patients would make.  

When asked to pay for care in a way they don’t usually pay for things (monthly payments), it leads to a feeling of being sold and usually requires high-pressure sales tactics.  No one likes that.  

Moreover, once the corrective phase of care is over and it’s time to transition to wellness, the patient has a big new financial decision to make.  For example, “Jayden, you’ve reached the goal of care and are ready for wellness.  Your initial corrective care program was $5,000, and the wellness plan is $2,500.“

If they were on a monthly payment from the start of care, they would already have established chiropractic into their monthly household budget, making it easy for them to transition onto the next phase of care. 

For patients who have been on a monthly payment from the beginning and are now ready for the next phase of care, it’s always best to couple the good clinical news with good financial news.  For example, “Jayden, you’ve reached the goal of care; congratulations!  As you recall in your report of findings, once you’ve reached the goal of care, we only need to see you 1x per week, and because of that, your new monthly payment is going down.”

Forecasting care in this manner helps the patient understand what to expect, which leads to better follow-through and successful outcomes.  And when we do this with many patients, we’ll have a high retention practice.  

We have more joy in our jobs, and patients are getting better clinical outcomes and experiencing the true benefits of chiropractic!  I challenge you to use this article at your next team meeting and get clarity on the goal of care and when the patient will be discharged to maintenance or wellness.