Chiropractic Clinic Business Plan

Accurate Chiropractic, LLC will focus on people injured in motor vehicle traffic accidents and work related incidents, as well as those with chronic and acute back and neck pain and their families.   These are groups which respond well to conservative treatment and have often been dismissed by the medical community as malingerers or difficult to treat cases.

Our most important group of potential customers (those injured in accidents) come in all ages. They range in income and social status from the “Actualizers” (the very wealthy who are actually living the American Dream) to “Strugglers” (those that are barely getting by). Whether young or old, these people want to get back to an active lifestyle so they can to return to work, recreation, and family as quickly as possible and they are covered by the health, accident, or workers’ compensation insurance to pay for it or have the legal backing to win it in court.

4.1 Market Segmentation

• Recent Motor Vehicle Accident Victims: our most important segment includes those individuals injured within a 6 month time period of visiting our office.  Insurance claims are easier to handle at this stage making for more lucrative reimbursement rates. In addition, early intervention aids more rapid recovery, which leads to greater word of mouth referral.
• Work Related Injury Victims: this is a yet untapped market in our field.  Recent legislation in the state of Florida (Effective October 1, 2003) makes it possible for Chiropractors to not only treat injured workers but to also function as case managers.  In this capacity we are able to direct the entire care of the injured worker.  With case averages ranging from $6,323-$7,465 this is a very lucrative market. (Case averages referenced from Florida division of Financial services website: www.fldfs.com/WCAPPS/Claims_Research/Stats_Results.asp year 2001 statistics.)
• Victims of Chronic Pain Resultant from Past Motor Vehicle Accident: the segment of the population that has attempted other forms of treatment without the results they were expecting.  They are candidates for not only a natural approach to treatment but also “back end” sales of therapeutic devices such as TENS units, heat and cold packs, and home exercise devices.
• Neck and Back Pain sufferers with onset unrelated to Motor Vehicle Accidents: This accounts for a large percentage of the population, nearly 30% of our population experiences one or the other (we have adjusted our numbers to account for the fact that a large portion of these will have experienced their problem as a result of a motor vehicle accident).
• Other Pain Sufferers: refers to the segment of the market that experiences pain syndromes like Fibromyalgia, Chronic Fatigue Syndrome, Migraine and Tension Headaches, Carpal Tunnel Syndrome, middle back pain, etc. This is a segment of the population we will attract thanks in part to our affiliation with several managed care and major medical programs. These are cases that most M.D.s are not equipped to properly service because their training in musculoskeletal disorders is limited, and the prescription drug route has yet to develop a legitimate answer for these problems.
• Corporate Clients: This segment of the market is primarily overlooked by Doctors of Chiropractic. But, based on the fact that musculoskeletal injuries are a significant contributor to rising workers’ compensation insurance costs, it is an area that is ripe for the Chiropractic Industry. Not only can we provide the care for their workers, but we can also provide the education and follow-up necessary to prevent injuries from occuring in the first place. The rapid development of SouthWest Florida in general, and Fort Myers in particular, has attracted many new businesses. Presently there are over 529 businesses in Lee County with 50 or more employees.¹ By law, these companies are required to have safety programs in place. We can help provide them with the framework for their program to succeed.
• Wellness Patients: Through education and awareness programs,it is our goal to help the community understand the role their nervous and skeletal system plays in their overall well-being. This is the area for the largest growth potential. Whereas the other conditions are tied mainly to population growth, this area is tied to our ability to educate patientswho have healedon theimportance ofcontinuing care on a wellness and preventative basis.

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¹ Lee County Demographic Profile 2003, Lee County Economic Development Office (in conjunction with Horizon Council Team Lee County and The Lee County Industrial Development Authority)

4.2 Service Business Analysis

Chiropractic Medicine in Lee County, Florida consists of several hundred chiropractic offices.  In the city of Fort Myers and neighboring Fort Myers Beach, there are some 73 offices listed.¹

Chiropractic entities range from small operations which do not take or accept insurance plans to multi-discipline offices with medical doctors and physical therapist on staff.  While practicing in New Jersey, I was part of the Provider Panels for several of the largest Health Insurance Providers, including several that are among the most heavily utilized in Florida, including Aetna, United HealthCare, and Blue Cross/Blue Shield.  While I stand a good chance of being accepted into these organizations, due in part to my relationship with a key representative within the Lee County Government Office (letters of recommendation from large employers count a great deal to image conscious insurance companies), this segment only affects a small percentage of my overall plan for success.  Since automobile accident cases do not follow the managed care paradigm, there is easy access to our services without need of referral or membership in a managed care organization.  Within the area of workers’ compensation, although managed care does play a role to a certain extent, our plan to market to “self insured” companies (see Marketing Plan) will give our clinic ample exposure and access to thousands of injured workers without the stipulations of managed care, nor their propensity to slash medical fees. 

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1 Yellow Book 2003-2004, Ft. Myers/Cape Coral Edition, Chiropractic Section, pages 182-185.

4.2.1 Competition and Buying Patterns

The key element in the purchase decisions in the healthcare of accident victims is the patient’s perceptions of the doctor’s competence and empathy with his or her situation. More so than in illness care, there is a certain psychosocial component that goes along with being injured in an accident and the potential of being unable to provide for yourself or for your family for any length of time. The doctor who can demonstrate to the patient that he has a good sense of what the patient is experiencing is more likely to connect with and gain the trust of that patient.  This relationship is fostered by establishing a game plan for that patient’s care and consistently following that game plan so that there are no sudden changes or surprises.

Auto accident patients frequently are referred by personal injury attorneys and medical doctors; therefore, it is essential to build relationships with attorneys in the area that specialize in personal injury litigation as well as medical physicians. Maintaining these relationships requires prompt reporting, open lines of communication, and the utilization of a team of specialists in other fields of diagnostic imaging and medicine.

Patients rarely compare providers.  Typically if they are referred by an outside source such as an attorney, physician, or other patient they follow the word of mouth referral.  It is rare for someone to go price shopping from one chiropractor to the next, although some will “shop” for a second opinion. 

The most important element by far is what it takes to keep a patient and have that patient refer their friends and family.  It is well worth the effort to go the extra mile and return the patient’s (or attorney’s, or doctor’s) phone call personally or provide a free cervical pillow to the accident victim, especially in light of the potential revenue each of these cases brings.

In the area of workers’ compensation, the principles of patient’s perception are similar, with the added element that the patient’s employer also needs to feel confident in the type of care provided.  It is essential to understand the investment each company has in their employees, beyond just their ability to perform a specific job.  A clear focus on constant communication with the company’s safety manager and an emphasis on rehabilitation to return the injured worker back to the job as quickly as possible are essential components.

In this area, ancillary services such as follow-up education for injury prevention, post-job-offer screenings, and updating the employer groups in changes to workers compensation law are ideally part of the package companies are looking for when considering a doctor to oversee the care and rehabilitation of their injured labor force. 

4.3 Target Market Segment Strategy

We have chosen this target market because it represents a portion of the population whose needs match our offerings.  Although for years many have viewed Chiropractors as “bone doctors,” we are actually specialist in helping correct problems related to the muscles, tendons, ligaments, and nerves, who use bones as mechanical levers to assist the body’s natural healing properties.  Most injuries due to vehicular and work related accidents involve the soft tissues of the body, namely the muscles, ligaments, and nerves.  In addition to the facts mentioned above, it makes complete economical sense to target this market, because it is still the most financially rewarding, with case average amounts being 30-50% higher than cases covered by traditional insurance plans. Perhaps most importantly, this area needs this type of service. As of the 2000 Census this section of Lee County (a 7 mile ring around our projected office location), one of the fastest growing counties in the country, had over 75,000 people in the 15-54 years of age category, a segment of the population that is projected to grow 6% by the year 2005.  Accident rates for this segment of the population are close to 30% higher than the general population.

According to a compilation of data obtained from NHTSA (The National Highway Traffic Safety Authority), The Crashworthiness Data System, The Fatal Accident Sampling System, as well as the General Estimates System, the national average with regard to incidence (that is the number of a given event occuring within a population in a given time period) is 770 out of 100,000. That is, 770 out of every 100,000 people will be involved in an accident each year.  In a growing area with as many young drivers as in Fort Myers, Fl., that number is much higher. In fact, according to data for the year 2001 obtained from the Florida Department of Highway Safety and Motor Vehicles, the incidence for motor vehicle crashes across all age groups (age 15-85+) in the state of Florida is closer to 2,270 out of 100,000.¹  This is nearly 3 times the national average. Based on information provided by Scan/US Inc. That translates into over 3,500 motor vehicle accidents for the residents living within a 7 mile ring around our office location.²

Another key factor in analyzing our market is calculating injury prevalence.  Prevalence is the number of people who suffer with a given problem at one time.  Assuming a 25% chronicity  for a period of 25 years at the national average rate of incidence (770/100,000), 6.7% of the population would be affected. Assuming a 50% chronicity, 9.6% of the population would be affected.³  That translates into 10,803-15,479 people within a 7 mile radius of our office suffering from chronic neck, back, and other pain syndromes resultant from motor vehicle accidents alone. Keeping in mind that the incidence rate in Florida is 3 times the national average this is a very conservative estimation.

Much like the victims of motor vehicle accidents, a large percentage of those injured at work experience problems with the soft tissues in and around the spine.  According to data provided by the U.S. Department of Labor, as of the year 2001, 20% of all work related injuries in the U.S. affect the soft tissues of the neck, back, and extremities.⁵  In Lee County alone there were 20,603 reported cases of neck, back, trunk, and extremity injuries that required medical attention.⁶  These are people who would benefit from Chiropractic care and up to now have not had the opportunity to receive it on a broad scale. As previously stated, recent legislative changes make that possible.⁷

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¹ 2001 Florida Traffic Crash Facts www.hsmv.state.fl.us

² 2000/2005 Scan/US Estimates for Site located at 26.5214, 81.8977 www.scanus.com

³ Foreman SM, Croft A.C.: Whiplash Injuries The Cervical Acceleration/Deceleration Syndrome (3rd Edition). Baltimore, Lippincott Williams Wilkins Co., 2001

⁴ U.S. Census Bureau Statistics for 2000 Census with Population Reported by Age and Sex.

⁵ U.S. Department of Labor, Bureau of Labor Statistics Injuries, Illnesses, and Fatalities www.bls.gov/iif/home.htm

⁶ Florida Division of Financial Services workers’ compensation Claims Statistical Query (made 10/1/2003) www.fldfs.com/WCAPPS/Claims_Research/Stats_Results.asp

⁷ 2003 Florida workers’ compensation Reform