In this special three-part series of "Outside the Box," we'll be uncovering the challenges, the solutions and the results of our study of successful and unsuccessful practices of chiropractic. -- WCA Executive Director Jeff Smith, and Chief Executive Officer Tony Palermo, D.C.

You're a gifted and passionate chiropractor. You ooze enthusiasm and love to share the chiropractic story with everyone you know. You will do whatever it takes to eliminate the scourge of subluxation. You'll serve your people regardless of their condition or their ability to pay you. You are serving a great and high volume of people but you struggle to make ends meet.

Why?

You have neglected one of the most fundamental facts of chiropractic, one so simple it's rarely discussed. Your practice is a business. And business is a game of math. If you don't know your numbers, you are in trouble. It's difficult to offer your service when you're out of business. Unfortunately, an alarming number of doctors are far closer to being out of business than they ever imagined.

For years, Dr. Palermo has taught chiropractors the significance of keeping accurate track of their "Critical Indicators of Success." Without them, a D.C. may be on the verge of failure, even though his or her waiting room is packed.

One of those Indicators that we implore the members of our 2X+1 Chiropractic Mastermind to track monthly is their Cost Per Visit (CPV). Recently, one of our clients did this exercise and, in Dr. Palermo's words, "his head darn near exploded!" Like most D.C.s, he operated his practice under the false assumption that it cost him "nothing but a few minutes of my time" to deliver an adjustment.

He -- and they -- are absolutely, 100% WRONG.

Knowing the accurate and specific cost in real dollars for the delivery of one adjustment in your office is one of the fundamental principles of business.

@Column Head:Knowing CPV a must

Here are the TOP FIVE reasons why you MUST know your CPV (starting today):

Many doctors charge a fee that is reasonable and customary for their community based upon insurance payment. Others charge a fee commensurate with practitioners in their community. Both of these reasons are poor justifications and irrational conclusions for establishing a fee for service in YOUR office.

You can't ask for the best fee for YOUR office from "Outside-In." The financial profile of an individual practice is as unique as the fingerprints of the practice's owner. A doctor with a practice on 57th Street in Manhattan and 12 staff members has an entirely different CPV than a D.C. running a solo practice in Iowa. Therefore, the "best" fee (and fee structure) for each of them will be entirely different.

In order to determine the fee that's right for you, you must know the real dollar cost necessary to deliver an adjustment in your facility. To that you add your profit. Don't ask what your profit should be. One of the key principles of success is that you are FREE to consciously create any life you want. You are also free to consciously create any profit YOU desire. The key is to choose YOUR ideal, not someone else's.

How do you choose this? As we teach, simply determine what it costs to live your ideal lifestyle. Once you know the cost of that, you can work backward from there to determine what kind of profit serves you best.

When you perform this exercise many of you will find that the thought/notion of reducing your fee for kids, grandmas, homeless, jobless, CAIs ("can'taffordits"), etc. is ludicrous!

For example, an Oklahoma chiropractor followed our coaching advice and recently performed this exercise. To his dismay he discovered that he had dozens upon dozens of practice members for whom he made a deal. When he did his CPV analysis he stared at his numbers and felt a rush of nausea!

He realized that his cost per adjustment was MORE than what he was charging, so he was giving $5-15 to those practice members per visit. Some of these people were coming into his office two-three times per week!

Remember this key principle of success: You simply cannot lose money per visit and make it up in volume.

When pressed to find out why so many doctors have turned a deaf ear to the numbers in their practice, we have identified four myths they are falsely laboring under:

Reality: So is unemployment! Think of it this way: can you imagine playing a sport without keeping score? Then, why are you trying to play the sport of chiropractic practice without keeping score?

Reality: You've made a grave mistake. We find that doctors who use this excuse are actually just saying, "I am not willing to take responsibility for my own practice. If I let someone else do my stats and totally ignore them myself, it's a nice, convenient way for me to have someone to blame when my practice doesn't work the way I'd like it to."

Reality: Either your ego is out of control and it's hiding behind the mask of service, or you're scared to admit you have no clue about how to run a business.

Reality: You've been sold the wrong plan. Chiropractic care is a privilege, not a right.

Unless and until you know the cost to deliver an adjustment in your office, you're spinning your wheels. You can search for the next marketing trick, the next referral script, the next "big thing" and you can be sure it won't fill the void that uncertainty created in your mind.

If you're the last on line to receive a paycheck in your office (behind the landlord, mortgage company, staff members, vendors, utility companies, etc.) it's a sure sign you haven't no idea about the costs involved in operating your clinic. You have undoubtedly hired everyone else except yourself.

The doctors who have followed our advice and performed the CPV Exercise have eliminated fear, established fees that serve them and their families and present their fees with authority and confidence. They no longer have to worry about the bills getting paid. No more are they hooked on the "Serve Myself Broke" drug and are serving at their most profound and profitable levels.

These doctors are free to be 100% present every time they are face to face or hands-on with a practice member. Therefore, the quality of their care and of their adjustments skyrockets.

So, the reality is:

*** When you run your practice like a business, you ARE serving on the highest possible level.

*** You can't run your practice like a business until you understand the Critical Indicators of Success for your practice.

For all of you who are curious about your cost per adjustment or who immediately grasped the importance of this critical number, here's your chance to calculate it for yourself:

-- Step One: Calculate all expenses for the month. That's every check that you write out of your practice for rent, mortgage, staff salaries, heat, light, utilities, supplies etc.

-- Step Two: Be sure to add in your base salary (income necessary for the basics of your survival including rent/mortgage, food, utilities, etc. for your home.)

-- Step Three: Divide that total of expenses by the number of visits that you served in the course of that same month.

Suppose that your expenses totaled $5,000 in a given month and that you served 500 visits in that same month. Your actual NET COST per visit (meaning the precise number that it costs you to deliver an adjustment in your office) is $5,000 divided by 500 visits and your cost per visit therefore is $10 per visit.

We invite you to calculate your cost per visit. Share your insights with us via e-mail. Be sure to include the positive benefit(s) that this exercise provided for you. E-mail them to: Dr. Tony Palermo -- Drtonyp@aol.com; Mr. Jeff Smith -- Stressfree@lvcm.com.

In part two of our series, we will share specific strategies and solutions to the challenges we've posed this month. In part three, we'll share YOUR specific insights and results of the WCA Community, along with those from our 2X+1 Chiropractic Mastermind Community. "Outside the box" ideas? Certainly. Effective? Profoundly. Until next time, consciously create life in YOUR own ideal.