Dr. Brian Capra: Everyone, welcome to the UAC Best Practices podcast. Dr. Brian Capra here. We hope the goal for today or any of our best practice podcasts is that you learn a little something from one of our UAC members that you can take and apply, whether it be your life or your finances or your practice or whatever it might be, something you can implement to make an immediate impact for you, your life, your patients, experience, whatever it might be. I'm here with my co-host, Dr. Allen Miner, and doc, why don't you take it away, introduce our guest.

Dr. Allen Miner: Thanks, Dr. Brian. Yeah. UAC is obviously comprised of, I think the most unique group in chiropractic. It's not a coaching program. It's a lot of people from a lot of different corners of chiropractic. But what they all have in common is most everybody's built a successful clinic and now people are staying in that, going into other directions beyond that. And so, there's always wisdom and insight and Dr. Nate Deines. Nate, I think you came into UAC two or three years ago. You're up in Sheridan, Wyoming, and it's always been a pleasure hanging out with you. And what's interesting we were talking about before we started recording as a best practice is you kind of run sort of a no schedule model in your clinic, which immediately gets my curiosity and makes my shoulders tense up. Tell me about it. Why do you do it? How's it work? How's it flow? What are the benefits?

Dr. Nate Deines: Okay, well, it's not a 100% no schedule, but we do have schedules. But that's more for just patient reminders, keeping them honest, you know. Yeah, but basically when we walk in in the morning, let's just say we have 50 on the schedule. We'll probably see 100 that day. We have about 50% walk in. And the reason I like that is I don't want to have bars to keep people from coming in. I don't want any obstacles. I want people to come in if they want the care and I want to happily see them right away. So, I have a lot of speed and efficiency to allow that. But I just love walk ins. I love to see people when they want to come in and it really works.

Dr. Allen Miner: How long you been in your community for?

Dr. Nate Deines: 13, 14 years.

Dr. Allen Miner: And when did you start this?

Dr. Brian Capra: That was my question.

Dr. Nate Deines: About 2013.

Dr. Allen Miner: It's been a while. Most of your, the most of your practice. Good part. So how do you... I'll tell you, I actually attempted this once, so I'm curious, your thoughts. For me, it was '08. It was my first clinic. We ran a big subluxation, cash, corrective care kind of CBP model clinic. And '08 hit and I think we went two months without selling a care plan. And I panicked. And I'll give a shout out to this guy in chiropractic, Phil Yamamoto, if you ever come across that name. And back then Phil was teaching. I don't know, it was like it was before the joint existed. It was like 29 or 59 or 79, unlimited care. And you know, pretty quick we figured out state boards don't let you give unlimited care and its insurance. But anyways we hadn't sold anything for two months and we're like, screw it. And we moved the whole clinic to this model. And in the process, I said forget it, let's just open up the schedule. People can come when they want. My challenge is we still were doing corrective programs where we needed to do follow up X-rays and when we, they were at three times a week, we could monitor that.

Dr. Allen Miner: And all of a sudden when we'd recommend three times a week, but they might come once, they might come twice, and we really didn't know who didn't come till the end of the week. We were always kind of backpedaling. And so, I always felt maybe the challenge was doing a corrective model where you know you needed benchmarks. But I'll tell you, Nate, patients loved it. And when we went back to our regular schedule, we never could quite get it under control. And I actually ended up selling that clinic because my other clinics that we start on a schedule were so much easier because once people had a taste of that freedom, they didn't want to stay on a schedule. They wanted to come when they wanted to. So, I don't know, what have you run into around that?

Dr. Nate Deines: I have the same problem that, well one, I don't need them to come on the schedule. But for the first part of that, yeah, we have care plans, and we have decompression and shockwave and all that stuff and new patients’ re-exams, we just squeeze them in. When they show up, we'll do it. Usually, we try to have them on a schedule for that stuff, but if they don't mind waiting a couple minutes, it's not going to take too long. But what I found is when I refer out, especially other friends in UAC that have really strict schedules, my patients don't like them? Because they demand that schedule and I've maybe spoiled my patients, I don't know, I just let them get away with that freedom. But that's the biggest problem I've had is when I'm referring out, I don't know, they just, they don't love it.

Dr. Allen Miner: How do you, here's another question. We inevitably, what would happen to us is we'd be kind of sitting around for an hour or two and then 10 minutes before the shift ended it feel like the whole office decided to show up and we struggled there of like keeping the flow. Do you find doing it this many years that it kind of evens itself out or do you get those bottlenecks at any point?

Dr. Nate Deines: Well, I think in any practice there's peaks and valleys in the time. But what I found is that nobody meets their time anyway for a schedule. Hey, you're scheduled at 10 O'clock. Well, they'll show up at 10:10 or they'll show up at 9:50 or something like that. And so yeah, it actually just evens out throughout the day, and we'll have our peaks and valleys and busyness but overall, it's pretty smooth flow throughout the whole day.

Dr. Brian Capra: So, since you do things that way, one thing a schedule does is when patients don't show up or an appointment at all that day. Right. You know they missed; these days they're getting reminders. Right. In the old days we call them, track them and when there was paper it was even worse. But since there's no appointment, you don't, like Allen said, you don't really know who didn't show up because they're not on a schedule. So, what kind of process have you built around retention? Like what is really retention?

Dr. Nate Deines: Great question and I haven't mastered that yet. Yes, there's always the people that you forget about in your week-to-week thing. We use track stat to help track our patients and their payments and all that stuff. That is the hardest part. But what we usually have is the people that are the walk ins or the wellness patients anyway they just like to come in randomly. The care plans do pretty good job of scheduling and if they don't we have systems and notebooks that they write all the people down and give them a call. Just like the old days, I guess. But it isn't fail-safe, that's for sure.

Dr. Allen Miner: How do you charge? Does somebody on wellness pay when they come in do you bill them each month, so they know they've got a visit for that month or how do you structure that?

Dr. Nate Deines: So, they're basically punch cards, monthly autopay and then they're... There are years to, you know when they want to use them. If they want to use them all in a month, they can. If they want to spread it out over two years, I don't care for their visits, but we usually try to structure it into the weekly or bi-weekly.

Dr. Allen Miner: Yeah, that's great. How about the decompression and shockwave where it takes some time, and a device is taken up. Do they just people just wait in line, or do you schedule those services a little more? How do you handle that?

Dr. Nate Deines: Yeah, the decompression is a little bit more scheduled. Not strict by any means. And we're not a capacity there either. I have four tables so there's a lot of leeway. You know one table is usually opening up at all times.

Dr. Allen Miner: How do you. Which... DRX, which traction machine do you use?

Dr. Nate Deines: Yeah, Chattanooga.

Dr. Allen Miner: Chattanooga. And can you talk just briefly about. This is an obvious trend. It's interesting to see in UAC we see it all. Functional clinics, integrated clinics, pediatric clinics, subluxation correction clinics. But I will say on over at Chiral Matchmakers there's a growing number of docs that come to us that hire associates I talk with that have brought in Shockwave or one of those stemwave who are doing decompression. How have you evolved your clinic in adding those services? And can you speak a little bit? Have they helped with your margins? Have they helped get people better faster? Was there any hiccups in doing that? I mean what are your thoughts on that ancillary non adjustment services you brought in?

Dr. Nate Deines: Great question. I don't love the shockwave. I love what it can do. I haven't really implemented it full bore into my practice. People love it. And I, maybe I don't have the right systems or marketing around it, but it just never took off. Decompression I do love just because of what it does for disks and stuff. And I found people get better faster with the decompression tables and as far as margins, that's a hard one for me too because I don't understand exactly my collections per visit. Something's been going on and you know my story, Allen. My last year is just crazy. Just leave and you know they had babies and married and disappeared and so the whole System just kind of broke down and fell apart. And I'm rebuilding that. And so that's one of the things I've been looking at a lot as far as the margins of each decompression table itself, and I don't have that either 100% down.

Dr. Allen Miner: Do you guys combine plans or people that have chiro and decompression and shockwave, or do they all stay in their own separate categories with patients?

Dr. Nate Deines: Yeah, we have three. So, one just adjustment, one just decompression, and then we do combine the decompression and adjustment, the shockwave. We don't, we have blocks of visits for those, but they're not included with any of the other plans. They're just separate.

Dr. Allen Miner: It's a separate thing. Yeah, that's great. Love it. Well, that's a great curveball. Dr. Nate, the open, you'll get that one very often. Yeah, I love hearing it. And that's the point of this podcast, to get people's brains going about. Because I think what you're working against is chiropractors love to control. It's always we track our missed appointment rates. But there's another side to that coin of what do patients want. And I was really aware when I did that, they loved the open schedule. It was really hard operating the clinic, which is why I struggled with it. But if your goal is to really maximize patient satisfaction, lower barriers to entry like you said, and make it easy for people to use your clinic as part of their lifestyle, there's a lot to that. I mean, let's look at the joint. I don't think they work off schedules. I think people come into that model and they've got them all over the country. So, I think it's fascinating you're diving into that, and I appreciate you sharing that. I think that's going to get some synapses firing for people.

Dr. Nate Deines: Yeah, I hope so. It's fun. It makes the click more fun and it's always surprising how many you get to see in a day. And...

Dr. Allen Miner: Yeah, last question. We always wrap with. UAC. What's been the benefit to you? What have you taken from it? Why are you a member of UAC?

Dr. Nate Deines: UAC is a blast. Just high-level conversations, fun times, great places that we go to. It's always bougie, which I like. But yeah, I got UAC thanks to the Smiths in Cheyenne. And I just loved everybody when I met everyone and I mean, because it's fun, it's an experience and it's mind expanding every time.

Dr. Allen Miner: Well, we love you being a part of. It's always fun to get get time with you, Dr. Nate. And thanks for sharing some wisdom in that nugget. That's awesome.

Dr. Nate Deines: Yeah, it's great talking with you guys.

Dr. Brian Capra: Thanks, doc.

Dr. Allen Miner: You too, man. Appreciate the time. Thank you, guys. Have a good one. We'll see you. Everyone, welcome into the UAC best podcast episode. This episode we're interviewing Dr. Nate Deines. He's out of Wyoming and has a really unique take on a really successful practice with no schedule, an open model. So, we talk about the pros, the cons, how it works, the benefits to patients and lowering the barrier of resistance to people coming in and getting care on a regular basis. This is a great one. You're going to enjoy it.