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36 - Opening and Building a Cash Practice with Dr. Carl Baird - Health Fit Biz




On this week’s episode, Anthony and I have our first guest Dr. Carl Baird, owner of Evolve Performance Healthcare out of Portland, OR.

We were in Portland working on a secret awesome project (details coming sometime soon…) and stopped by Dr. Carl’s office to record this week’s episode.

Carl is a rehab-based chiropractor and started Evolve Performance Healthcare as a cash-based clinic from the beginning.

In this episode Carl shares with us the best methods he uses to help patients understand the value they are getting from seeing him out of network, how he gets them to ‘buy in’ to the concept, communication tools he uses, and more.

One of my favorite things about Carl and Evolve is how fun an environment it is. When you walk in, its bright, open, and there is a basketball hoop mounted to a beam. There are surfboards on the wall and the vibe is really positive.

When we talked with Carl about this, he shared an exercise he used to figure out how to truly make the clinic reflect him, his mission, and positivity.

I loved his attitude about making the clinic what he wanted it to be, not what it is ‘supposed to be’.

Who wants to go to some stuffy, depressing clinic? There is no rule that says ‘a clinic must have xyz, be boring, use ugly colors, etc.’.

A clinic can be whatever you want it to be. Your imagination (and some laws) are the only limit.

This Week’s Challenge

Do the exercise we discuss at the end of the podcast.





Ryan: I’m Dr. Ryan Debell. Welcome back once again to the Health Fit Business podcast. This is episode number 36 and Anthony and I recorded this episode actually in Portland, Oregon when we were there recently working on some projects together. And we swung by our friend and colleague, Dr. Carl Baird’s office which is called Evolve Performance Healthcare located in Portland, Oregon. He is a chiropractor, a sports based chiropractor who has a large rehab based clinic in that area. And so we swung by to sit down with Carl, He is our inaugural guest on the Health Fit Business podcast. We talked about what was it like to start a cash based clinic. How does he manage it? What are some good ideas in terms of communication with people to make them value what they’re getting at the clinic like his. So without further a do, let’s tune into episode number 36.

Anthony: Welcome, welcome, welcome to another episode of the Health Fit…

Ryan: Business…

Anthony: podcast!

Ryan: Where are we, Dr. Anthony Gustin?

Anthony: We have a co co-host today. First time we have a guest in the show.

Ryan: Yeah.

Anthony: Please welcome senior Dr. Carl Baird.

Carl: Hey guys.

Ryan: So we’re in Portland and we decided to stop by to see Carl, to see the facility and…

Anthony: Brand new beautiful facility here, Evolve Performance Healthcare.

Carl: Thank you, guys. I appreciate it.

Ryan: You opened three weeks ago, right?

Carl: Three weeks.

Ryan: Three weeks in this new location. You’re cash based?

Carl: Yeah. Cash based clinic.

Anthony: Right. So what are these… Like we typically do is people that are like mining to us, we  go from like crazy tangents about what other people finds strange that we find just very normal and common and what are those things that we talked to with Dr. Carl here is about how he approaches kind of communication with patients, kind of psychology in a way to to not see him like you’re trying to sell stuff all the time. So what’s kind of… What lead on this path originally? Kind of where you picked up these skills?

Carl: Yeah. So right after school I moved to Denver, Colorado and really just kind of lucked into meeting who then became my mentor who was running a cash based clinic. She’s working let’s say three and a half days a week. She’s got a waiting list of people to get in, charges $65 a visit. And one thing I realized, I mean when I came out of school, you know, with a Master’s in Sports Medicine, ART Graston. All these skills and certifications that I thought is gonna be what got people in the door. And when I went to her clinic she didn’t have any of these certifications and she had a line at the door and she was doing a cash based model not relying on insurance or anything like that. So that really stuck out to me. And again, it lucked out that she had a room available and so I decided to open my clinic within her. So I had a separate business within her clinic but again I was there full time and I just kind of sucked up all the information I could from her and I’d say probably the number one lesson that I learned in terms of running a successful clinic and getting patients and keeping patients, wasn’t necessarily the services you provide but how you communicate the services that you actually provide your patients.

Ryan: Yeah. I mean we’re almost like trained to think that you know people are gonna be searching for the person who does this technique, and this technique, and this technique but to the general population like they don’t know…

Carl: Right.

Ryan: They don’t know that what those things are so they are like “Can you help me with my hip pain?”

Carl: Exactly.

Ryan: I don’t really care how you do it like that’s not what brings them in.

Anthony: Yeah. And we’re talking about this yesterday when… So I flew in to Portland on Virgin and I was talking to… About this that it’s more of an experience than a flight. And so when you create a clinic experience, you’re gonna have a lot at the door of people wanting to be helped. So obviously, current clinicians will have this understanding but why to new grads or people in school is cash versus insurance or just going completely cash. Something that you frame in your current clinic around?

Carl: Yeah. I mean I guess there’s a couple reasons to that. I mean the first is just the headache that is the insurance world. Not spending 50 minutes with the patients so I could spend 30 minutes filling out paperwork and losing track after 30 days if I have been reimbursed or not. The other thing, then again we talked a little bit about this before, the branding wise, in my opinion if really actually relying on insurance can actually hurt your brand if the only reason that people are coming to see you is because you’re in network. It’s almost like how much do they really valuing the service that you’re actually providing them.

Anthony: Right. Right. So then going back to kind of the top tips you’ve learned from your mentor in about communication. If you are to give kind of several examples of…

Carl: Sure. Yeah. So the very first one obviously the question that you’re gonna get the most especially when people call the clinic on the phone is “Do you accept my insurance?”

Ryan: That’s like the first thing people think to ask, right?

Carl: Right.

Ryan: So how do you… What do you say in response to that?

Carl: Yeah. So that… This is the number one thing that I’ve learned that I’ve practiced over and over and over. Never say no. You never lead off with no. The important thing to understand is that even though I don’t directly bill the insurance company, there are ways that they can get my services covered through their insurance mainly it’s called the Super Bill. That’s a whole other topic we could get into. But in terms of answering the question “Do you accept my insurance?” I always say that I’ve worked with all insurance companies. I’ve been an avid network provider for all insurance companies. If this is something you wanna get reimbursed for I can print you off a Super Bill at the end of the visit. You send it off to the insurance company after 30 days of chiropractic care is covered, they’ll send you a cheque in the mail. And so you end the conversation with “You’re gonna get a cheque in the mail.” And most people are “Wow! Great!”

Ryan: Instead of getting a bill from me in the mail, you’re gonna get a cheque.

Carl: Yeah. Exactly.

Ryan: Because that’s usually what people think, right? Like “Ugh, the last thing somebody want is to get in the mail is a bill from you.”

Carl: Right.

Ryan: Especially if they thought their insurance was gonna cover it. So you can almost like frame it around that, right? Like “We’re gonna send you money.”

Carl: Yeah. And that’s another thing for me that’s really important is the clarity aspect of things so they know what my price is before they, well they ask and I tell them. And that’s the most to let them pay.

Ryan: Transparency.

Carl: Yeah. Exactly. And so this actually happened to my brother. I was talking to my brother the other day and he went to an acupuncturist to… Was in network and said was covered in his insurance so he paid, went in, and got treated. Paid his co-pay which was like 20 bucks. Turns out he wasn’t covered and then he got a bill from that acupuncturist a month later saying “You owe me this much money.” And of course, he’s gonna be pissed off and not go back to that chiropractor. So it stinks to my brother ‘cause he’s gotta pay more and it stinks to the acupuncturist ‘cause she lost a patient.

Anthony: Right. And it’s not like changing the communication hides any facts. You’re stating it in a more clear way. And so we did the similar thing when we I was training my staff for my clinic in San Francisco, somebody calls they say very similar thing “Do you take XY or Z insurance?” The answer is “We have plenty of patients who have the insurance that either have great benefits or have coverage.” You know? And that’s where we go from it. Not like “No.” “Oh okay. Well I’ll just call the next person I found on Yelp or wherever…”

Carl: Yup. That’s right even if they, I realized, even if they stay on the phone they’ve mentally checked out. When they hear the “No” it doesn’t matter what you say afterwards.They’re not interested or gonna keep shopping around.

Ryan: I think another angle you can take to is that you know “Do you take my insurance? Well why don’t you tell me what’s going on?”

Carl: Yeah

Ryan: And then you spend some time and they tell you and you, you know, you kinda get into it a little bit “Well, you know, here are the options so you can think about.” Right? Than just saying no.

Carl: Yeah. And so that’s another way we phrase it. What we do in our clinic and leading it that way

Ryan: Yeah yeah. “Nope. Sorry. Conversation over. Hang up. I don’t understand why I’m not getting new people here.”

Carl: Yeah. Exactly.

Anthony: So, what else Dr. Carl?

Carl: Yeah. So the other one, and this goes to getting people to sign up for care and be excited about signing up for care. And it goes back to the first exam. And so again the first you looking or going through your exam and this was just another thing I learned from my mentor in Colorado is that people, when people come up with the idea that there’s an issue and needs to be corrected they’re more likely to sign up to care. So, it’s really the difference between me telling somebody that there’s an issue versus coming up with ways to show them there’s an issue. So, that’s what I call it Showing versus Telling, especially in that initial exam. So really during the initial exam, whenever I see, as a provider practitioner, see a positive finding instead of just reiterating that to the patient and stating “Oh look at. You can’t turn your neck to the left.” You ask them. You just ask them if they felt the difference. So if you’re just the example that I use all the time as with neck range of motion if they turn to the left and they had a full range of motion going to the left and then they turn to the right and it’s cut in half, instead of me saying “Oh look at. You can’t turn to the right.” You just ask them “Hey, did you feel the difference with that?” And it’s funny because you get one of two answers. The first answer is gonna be “Oh wow! Yeah. I can’t turn that far.” or I mean this probably happened about 50% of the time as people have no idea that people are pretty numb in terms of how their body moves and what it’s doing and so you know, they’re decreased 45 degrees to the right and they have no idea and so then that’s your opportunity again. It’s a teaching moment where it’ll like “Well, look at this. Turn to the left.” you know, and you show them and you can take a pen from their nose to their shoulder so right above the clavicle and then “Okay, now turn to the right.” You take that same pen put it on the nose it’s like “Oh wow! That’s on your peck. That’s not anywhere close where it was on the left.”

Anthony: Right. So you’re giving the patient a light bulb moment where they responded after figuring out something on their own rather than you telling them what’s wrong with them.

Carl: Exactly. Because you know like patients always have in the back of their minds “Oh of course he’s gonna find something wrong with me because he wants me to come back and schedule another visit and pay him more money.” And so that’s why it’s really important that they’re the ones that coming up with the conclusion that there’s stuff we need to work on.

Anthony: Right. That’s great. So I think the first one, you were moving all negatives and turning it into a positive experience. Here’s how we stream our things. We’re transparent. This example, you know, we’re taking away telling the patient what’s wrong with them and letting them figuring out how you can help them.

Carl: Yup.

Anthony: I feel there’s a common theme here. Taking away negativity. Adding more positivity.

Carl: Yup.

Anthony: Including the patient moreso and their care absolutely than just the authority figure be talking down to them. It makes people feel pretty small and sold to.

Carl: Yeah yeah yeah. Yeah that’s a good word. “Sold to” I think is kind of a good way to put in what you really want to avoid because again as a practitioner you’re trying to help them. I mean that decreased range of motion to the right is gonna be an issue later on down the line if it’s not corrected. And so it’s important that you address it but when you can get them to understand that or identify it and then wanna take action to correct it. It is gonna be more successful and again having them come back for future care regardless of whether they’re in pain.

Anthony: Right. So we have kind of the initial chat, kinda getting into the door showing them that you’re a right spot for them. Give them the initial exam, letting them be aware of their problems. What about kind of let’s say they’re wrapping up or kind of the, in between, another example that you use there.

Carl: Yeah. So that’s again the other problem in this again right when I started out in Denver was one of the biggest problems I had is that you get people better in terms of their pain but I think again as most practitioners you’ll understand that pain necessarily isn’t the issue and that most pains there’s, with whatever their actual cause is, there’s usually an underlying cause. It’s a movement, if it’s relaxation, you know? There’s an underlying cause and if we don’t address it, you know, it be might feel good for a week, they might feel good for a month, they might feel good for a year but that same pain is gonna come back. And the problem is if that pain comes back they’re gonna associate you’re clinic with not getting them better because “Oh this guy just made me feel better for a week and now it came back.” And so, another again communication trick that I was taught to get people to come back after that second or third visit when the pain is gone is to give them a reason to come back. So again, you spend all this time during your exam you find all this positive findings whether it’s cord efficiencies, whether it’s range in motion, whether it’s mobility, those are things to work on and they’re important to work on for longer term results. So giving the patient a reason, so that’s again what I’ve found a lot of new practitioners is articulating that thing those to a patient is often left out. So, what I do at the end of every visit with a patient is I just talk about again what we did that visit and what we’re gonna do moving forward. So at the end of the visit I reiterate, you know, “We did an adjustment. We did some soft tissue work. That’s gonna really help with the healing process and get you out of pain. But listen, like we saw in your squat like you can’t get below ninety and that includes when you’re turning on. So the next visit what we’re gonna do is we’re gonna give you some exercises. They’re gonna hone in on those things to provide longer term results.”

Ryan: You know, I think too like being cash based it gives you the freedom to go there, right? You know what I mean? Because if you’re only insurance based it’s like, well they’re out of pain, insurance companies are gonna be…  

Carl: Right.

Ryan: Kind of like, well…

Carl: Yeah.

Ryan: So there’s like another layer of consideration. That’s almost the selling point to you that you could use like “Look, we’re gonna get you out of pain but then we’re gonna take you and make you better than you were.” And by not having to go through insurance that way like we have the freedom to do that. One common complaint, and I’m sure you’ve ran in this too, people are like, you know, they have multiple things going on but the insurance, let’s say they’re going to PT and they have to go get a referral. “Well, they only refer to my shoulder but my hip also bothers me.” So, you can help them with more than just that one particular area. What really struck me when I walked in here first is how fun the environment is.

Carl: Yeah.

Ryan: Like you have a basketball hoop right there. I’m curious if you could just like briefly just talk about, you know, what environment you’re trying to create here? Because it is very, it is quite unique in that sense of it’s light, it’s bright, it’s fun, it’s enjoyable just being here.

Carl: Yeah. So that’s actually really a question. This was from a book, it’s called Built To Last by Michael Porter which is again highly recommend for people business and a clinic. But he had an activity, they recommend that everybody does again ‘cause you want your clinic to feel authentic so you want it to feel like you, you know? And so that activity they had people do was, you know, get your ten closest family and friends and send them an email and ask them like “Hey, there’s five words to describe, you know, what you think of me and like maybe to put in a special memory that you have of me or whatever.” And so, I did that with all my friends and family and the number one thing that came back with some version of fun or funny. And what I realized in Colorado in my clinic there is I become so serious about trying to build a business and trying to be a professional and trying to you know stand out and be the super serious guy and you know that wasn’t who I was. And so when you put that, you trying to put that message out there but it’s not authentic with who you are as a person. I mean patients it’s a subconscious thing probably but they picked up on it. So I did that exercise. I mean with the fun and fun so I need a new clinic that I built at it had to have some aspect of fun involved in it and again I played basketball growing up so…

Anthony: Fun fact, Carl here is a basketball star. He actually dunked. So we walked in the clinic here and within three seconds he like “Yeah. I’m hanging this up by twelve feet so I’m the only person who can dunk in here!” and just crashes it immediately.

Carl: We’ll go with that.

Anthony: I mean that’s exactly how we approached this podcast to this.

Ryan: We talked about this last night actually. )

Anthony: You want a mic?

Ryan: No. We talked about it, a similar idea, that you touch on it, it’s like you know there’s this expectation of you know “I am a healthcare provider. It has to be the serious thing like no one’s allowed to smile.” And we’re talking about that this morning when we’re talking about these things that we’re going to do.

Anthony: Right. And just that fact that… I mean we’re supposed to be in this professional environment getting, talking about business stuff like you said like a clinic environment which is pretty serious.

Carl: Right.

Anthony: I mean, we do a bunch of random show at a time, it doesn’t make any sense and like probably people we will lose lot of listeners on so we go from like 34 to 32 some weeks but it’s worth it for us just be us like you said be more authentic.

Ryan: I think that more people need to be, start… Why can’t I say these words? Too much caffeine? I think more people need to be okay expressing themselves through their business and not think they have to fit within this box that society predetermine is the right thing.

Carl: Absolutely. That is again, I mean you can go on my webpage and I have like it’s called their ethos and it describes what it is, what it feels like to work here when you come in as a patient. And then two or five words, two of them is one is fun and then the other is unconventional. Because again there’s a major problem with the way at least, again this is my opinion. This is a major problem with the current approach to medicine in general and if you’re just trying to fit in the box and do it the way that it’s always been done you’re not gonna really make the changes that you wanna make. And so you kind of have to be a little bit out of the box or unconventional to get results that are gonna be long lasting.

Anthony: Right. Another thing that I’ve noticed about putting out what we’re about and just be authentic is you get that in return so you put on the fun environment- an athletic environment you’re gonna get fun young athletic people who are trying to improve themselves. If you have a stuffy clinic you’re gonna get a bunch of stuffy people in there.

Carl: Yup.

Anthony: And so that’s what you’re gonna attract.

Carl: Yeah. That goes back to again I really highly recommend this Build To Last book by Michael Port but another exercise that he does, he talks about is think about five patients that you love to treat, and think about five patients that you really don’t like to treat, the ones who drains on you and you know you leave the clinic and you’re feeling beat down because you know. And think about their personality traits and what it is about the five people that you love to work with. You know, try to think of their personality traits and why you love to work with them and then think for the people, you know, kinda drain you. What is it about them that’s very draining and really hammering that out so that you can attract the people that you love to work with. And you can’t be everything to everybody so it’s not like the people that are draining are bad people it’s just not a good fit for your clinic and then having somewhere you could you know “You might be a fit over here at this clinic.”

Anthony: Right. And so I think when we all getting in school or getting out of school we have this notion that we have the skills, we should help anybody that comes along.

Carl: Right. That’s a big mistake.

Anthony: And thing is, Carl you’re great provider but I don’t think you’re the only chiro in Portland.

Carl: Yes!

Anthony: There’s plenty of people and so like you said the people that energize you, you’re gonna give better care if you’re treating those people than if you’re treating the people that drain you. That’s gonna be different for everyone.

Carl: Right. I mean it goes back to I mean getting the right type of clients but also to just your personal life. I mean you go home and you’re happy and you’re in a good mood versus being like “Ah gosh! I really fudge that one today” or like “Gosh! That person was a real downer.” You know? And then it just carries over at your actual life.

Anthony: Carl you can say whatever words you want. Ryan puts the explicit tags on our podcast just in case. So don’t worry. It’s R-rated podcast.

Ryan: X-rated! You know, you make such a great point though like you’re not gonna be everything to everybody. For example, let’s say Dr. Anthony Gustin… Let’s say both of you guys like vanilla ice cream and I like chocolate ice cream.

Anthony: You’ve given this one before.

Ryan: Okay! I guess I’m consistent. I’m not gonna say it again. Take this. You know we should do? You know we should do? You know we should do is, we should give away a copy of this book.

Anthony: Built To Last?

Ryan: Yeah. How are we gonna decide who to give a copy of this book away to?

Anthony: A draw…

Ryan: Okay. How are people gonna submit this?

Ryan: Yeah! We I probably should have thought about it by this time! Okay. Here’s the deal, if you’re listening to this and you send us a message on Instagram and say “I listened to that episode.” We’re gonna pick from that list of people someone to mail the book to. Yeah? Does that work? Am I allowed to do this, Anthony?

Anthony: Sounds great.

Carl: Make sure you get them the workbook. So it has not just like the traditional book but then it has the workbook that’s like the shorter version of book with…

Anthony: Yeah! We’re all about taking action so that’s great.  Yeah! Before we get to the Challenge of the Week, Carl, Dr. Carl, tell people where they can find you. Any other interesting tidbits you want them to know?

Carl: Yeah. So we’re in Portland, Oregon on the corner of Northeast 7th and Hancock. Stop by. We got the music playing, we got some La Croix in the fridge.

Anthony: La Croix.

Carl: That Bill has been guzzling.

Ryan: Oh my gosh! If it wasn’t for La Croix I would be a pile of dust. Because it the only, keeps me hydrated and it also green so I had to drink it. What about online? Where can people find your clinic and follow your stuff?

Carl: Yeah. So it’s performancehealthcarepdx.com. So we do have a blog post that we try to keep weekly and again kind of combining the functional fitness with rehabilitation so using functional fitness equipment to rehab certain areas. We try to stay pretty active on that. And then Instagram as well, performancehealthcarepdx.

Ryan: Boom! Alright.

Anthony: Alright. So I think we have a couple COWs this week. One we just revisit to Carl’s points about communication. I would say the main theme there was to take a negative and turn to a positive. So think about one way you could do that either if you’re in school, communicating to someone else or if you have a clinic or a gym or anything like this. And then the second, do you think, can you explain the one of those exercises about in Built To Last? Maybe somebody can do those at home.

Carl: Yeah. So I mean I think the first part to start… So building a business is a very introspective endeavor and so doing the one I talked about earlier where you pick out five to ten friends, send them an email and be like “Hey, if you could describe me in word like can you give me three to five words that you would associate with me and then provide one memory that you have that really sticks out to you.” And it’s really a great experience ‘cause it’s really positive and honestly when I sent the emails out I did feel a little bit uncomfortable ‘cause I’m not necessarily touchy feely type of guy but like it’s really amazing what people send back to you and it’s like “Wow! I had no idea and like you remember this story from high school. I completely forgot about that.” You know what I mean? And that was a great memory that we had together and I just completely forgot about it and it’s something to him that really stuck out. So that’s really fun exercise and recommend everybody try it out.

Anthony: There you go. Do the exercise, send us a message on Instagram, get a free book and…

Ryan: Get

Anthony: After it.

Ryan: Thank you guys for tuning in to this episode of the Health Fit Business podcast. If you found it helpful, please share with someone that you think it would also help and leave us a five-star rating on iTunes. Make sure also to go to healthfit.biz and sign up for the email notifications to which you can find right on the homepage so that you get all the updated podcasts and blog posts sent directly to you. Until then, we will see you next time.