This original article is featured in the April issue of The Chiropractic Assistant Magazine.

The chiropractic report of findings (ROF) starts with the patient’s first visit and depending on the type of practice, the ROF takes place over a series of visits. In my experience of working as a CA with Dr. Miles Bodzin, we did our ROF on the 2nd visit. We successfully enrolled over 97% of patients into care so that is the strategy I will outline in this article.

I want to start by being clear that the doctor and the CA each have their own role in the ROF and work together as a team in order to have a successful outcome. This teamwork also carries over and helps the patient to have a successful outcome as well and turns them into a loyal patient!

The ROF is one of the most important visits your patient will ever have, which is why what happens at your patient’s first few visits is critical. You may also hear these visits referred to as “Day 1 & 2”. In fact, there are entire seminars dedicated to helping DCs master their communication, technique, and skills when it comes to their Day 1 & 2 because of how important the ROF is to a practice’s livelihood.

Now, before we get into what the CA’s role is in the ROF I want to ask you a question. Do you know what happens in the ROF? Meaning, has the doctor taken you through the new patient process? If you do not know what is being done or what is being said at the initial consult, exam, or ROF then I can bet that if your doctor is expecting you to have a part in reviewing the financials with the patient you’re likely not having much success enrolling patients into care. If this is you, take your doctor out for a cup of coffee and have a conversation about this article, and set some goals.

Ok, now let’s roll up our sleeves and dive into the ROF. The goal of the ROF is to get the patient to understand the need for care and once they do, then there is a financial conversation that takes place to enroll them into care. 

We want them to arrive at this appointment thinking to themselves, “I sure hope the doctor finds that they can help me!”. You and the doctor want to create the feeling of hope and trust right from the time they call to schedule their first appointment, and continuously throughout their journey in your office. Not only does this prepare them to have the right mindset to hear the doctor’s findings, but it ensures that they show up for the ROF in the first place! 

There are several other things to make for the perfect ROF, even before the visit has taken place. The treatment plan and financial agreement should be prepared and outlined on a compliant document that is ready to present to the patient before they even arrive. I’ll add here, gone are the days where homemade spreadsheets or fill-in-the-blank plans are compliant or even appropriate. And now that we have the Patient No Surprises Act we should be using helpful tools like the Care Plan Calculator​® to show your Good Faith Estimate.

With all the technology we have today patients love convenience, please tell me that you have text and email reminders for appointments? Your patients need both a text reminder of their appointment time and an email after their new patient appointment thanking them for coming and letting them know what to expect at their next visit. Both the text and email should remind them to bring their spouse or significant other. 

If the parent, spouse, or significant other can’t be there in person for the appointment, the ability to video chat them helps so much! (Be sure to get a HIPAA sign-off from the patient before this video chat begins that includes another party!) This removes excuses like, “I have to go home and talk to my wife,” from the conversation. 

Using technology in this way allows us to easily have frequent contact with our patients and do those little things that help them feel hopeful and confident that they’re in the right place. 

Now before financial conversations occur, it’s imperative that the doctor has done their job with the clinical report of findings by outlining their recommendations for care while getting the patient to agree to the treatment plan.  Failing to do this will make it nearly impossible for you to successfully enroll the patient. We must have patients commit from a timing standpoint, before we ever bring up finances, as time and money are two of the biggest hurdles we face at a Report of Findings. 

Once the patient agrees to the treatment plan, the doctor must get permission from the patient to discuss money to avoid creating the thought of, “Here comes the sales pitch”. This can easily be handled by the doctor by simply asking the patient, “Amber, all we have left to do is to go over the cost of care. We can go over that with you today or on your next visit, which do you prefer?” Most of the time, the patient will say, “Let’s go over it now”. 

Once you have the patient’s permission to talk about money, the doctor should warm up the patient for the financial conversation and make the introduction for the CA coming into the room to review the cost of care. The doctor should say, “Amber, I’m going to have Holly come in and review our program with you.  I want to let you know that you don’t have to do the payment plan that Holly reviews with you as we have other options, but I highly recommend that you do, as it covers everything I recommended and will save you the most money”.

Those two simple steps go miles in helping the patient not feel pressured. This also helps the person going over finances because no one has that used car salesman feeling. No one likes high-pressure sales tactics. 

Now, I know a lot of people think it’s less pressure to have this talk at the front desk. It actually does the opposite. The patient feels rushed to make a decision and a lot of people really appreciate privacy when discussing finances. Reviewing finances should be done in a private room where both parties feel comfortable. 

While in this conversation, we’ve found that keeping it simple is best. Having a professional document that clearly outlines the patient’s responsibility and any discounts applied (compliantly of course) makes things so much easier and more successful. We also want to satisfy the Good Faith Estimate portion of the No Surprises Act with this document. 

Here is an example of how that might sound: “Amber, I’m so glad the doctor found he could help you! Based on the doctor’s recommendations, we’ve outlined the following all-inclusive program of care. If you were to pay per visit, the total cost of care comes to $X.  However, by enrolling into this program, it covers everything and saves you the most money”.  Pause… Let them absorb that information… 

“We can take that total you see here and you have three choices on how to pay. Our first option is with monthly payments.  Our second option, which most of our patients choose, is a larger initial payment followed by smaller monthly payments.  And finally, our third option is to pay in full.  Amber, before I go any further through the plan, which of these options do you feel works best for you?”

This should all be said in a very clear, matter-of-fact tone. We are also assuming that they can afford this. Going into this conversation with a poverty mindset will not get you any enrollments and may actually offend your patient. 

By giving them a choice on what option works best for them, they feel less pressured and you aren’t forcing them to make a purchase decision they wouldn’t normally choose. Better yet, you aren’t making them enroll and get approved for a special line of credit. Convenience is key. When you add additional barriers such as patient financing, it ultimately hinders your patient’s decision, as it’s not the most convenient option. 

Once the patient chooses the option that works best for them, we just need to answer the common questions that come up. Not only are we forecasting the care that they need on the care plan, but we’re also putting them at ease so they know exactly what they’re agreeing to and what to expect in common situations. Our offices love this step because it prevents future misunderstandings when it comes to care and money. 

“Before I review the details of the program, let me answer the two most common questions we get from our patients. The first is, what happens if you go on vacation and miss appointments? Rest assured, you’re not going to lose that time. We’ll extend the program to allow you to make up those missed visits.

The second question is, what if you need to stop the program early? Amber, you can stop the program at any time. You’re not locked into this. Just let us know and we’ll prorate the program for the care you’ve used. If you’ve paid us more than what you’ve used, we’ll happily issue a refund. If you’ve paid less, you would pay the balance of the care you’ve used, not the entire program”. 

After you’ve addressed those two most common concerns, you can move forward by outlining the rest of the plan details. Let the patient know that because they’re choosing a recurring payment option, you require them to leave their billing information on file and their payments will automatically be deducted (be sure that you’re using a PCI DSS compliant program for storing billing information).  Answer any final questions the patient may have, gather their billing details, and enroll them into the program. Keep a signed copy of the financial plan on file and give the patient a copy for their records. 

Now that money is handled, you can go right into scheduling future appointments.  The most exciting part? There’s no need for any new financial conversations until the patient is ready to transition onto wellness!

That’s how we take one of the most nerve-wracking situations and turn it into one of your most successful appointments. This will help you build a high retention practice that is full of loyal patients! 

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