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A
This is Raymond. He owns six chiropractic clinics and he does about $5 million a year and we're going to help him scale, so.
B
Hey, Alex, My name is Raymond Kuner. I own Chiro first of Washington. So we're a chain of chiropractic clinics in the greater Seattle area. So just a little bit about my business. We currently have six brick and mortar locations in the greater Seattle area trailing 12 months. Revenue 5.2 million, EBITDA, around roughly 1.2 million. And our net profit is about 23%.
A
Do you buy those or do you open up organ?
B
So far I've bought all of them.
A
Oh really? Okay.
B
Yeah, But I think moving forward we're going to change our strategy a little bit.
A
Yeah. So who do you help specifically?
B
So our key demographic that we help is 35 to 65 year old men and women that have some kind of condition that we can help with, whether it's pain, discomfort or loss of movement.
A
Is there any kind of like income level or anything like that?
B
Yeah, if they need to be employed, insurance or cash, we're about 75% insurance.
A
Oh, interesting. Okay, got it. So how do you help them?
B
So the way we help them is when someone comes into our office, we'll design a custom treatment plan for them that might be over a period of 60 to 90 days. It might include chiropractic rehab and spinal decompression. So spinal decompression kind of differentiates us from a lot of our competitors because it's a niche service that we offer for people that have disc related injuries.
A
Is that like stretching people out kind of thing?
B
Yeah, okay, exactly. Cool.
A
Well, how do you make money first?
B
So basically on the front end we offer a free consultation. So then when the patient comes in, our packages can range from 2400 to 3600 over a 60 to 90 day period. We're primarily a reoccurring revenue model and roughly one out of every seven of our patients, they come in for a larger case value. So like a car accident or a work injury might be worth up to $10,000.
A
Okay, what's, what's advertising? How do you find them?
B
So for paid advertising, the, the, the two means of advertising are. Number one is Facebook ads. So we spend about a thousand bucks per location on that. The second one is Google Ads. So we're spending roughly 500 to 1,000 per month on, on each location.
A
Okay, so what's sales velocity? How many do you sell per month?
B
On average? We're, we're getting about 35 leads per month. And out of the 35, we have 28 that show.
A
Okay, that's pretty.
B
And so we have a show rate of about 80%.
A
That's great.
B
And our closing rate is about 71%. So total sales probably roughly around 20.
A
Cool, solid numbers. Okay, so what's the goal?
B
My three year goal is to try to get to $5 million EBITDA. I want to try to build a business that can run individually, but then I also want to entertain selling to institutional buyer.
A
Okay, so this is very much up your alley. What we talk about. Okay, so that's the goal. So what's staying in the way? What's the problem?
B
So if I were to prioritize my constraints, what I think they are, number one, I would say is probably lead flow. I think that we could do better in that department. It's not consistent. When I had one location, it was really easy to predict that and to change the outcome pretty quickly. But as we've scaled, I'm having a tougher and tougher time scale. The marketing. Right. So I would say that's like a big one for us. Second one would be like our sales infrastructure because we are 75% insurance based. There's so many different plans out there. Right. So when the patient comes in, we have to determine what kind of insurance they have by verifying it and then make a customized plan based off of that. So if there's a way to, to streamline that into one day, I think it'll be much more effective for us. When I personally practiced, I was able to do it in one day, but I'm having, I'm having a tough time training my doctors to be able to do that. Number three, scaling issues. So decentralizing the marketing has been a challenge for us. Limited employee pool. Right. So right now we're not expanding. But when we do expand, it's harder to find a doctor, obviously, than a regular.
A
You're buying it from another, you know, person who's leaving. Correct.
B
Yeah. And then I got to put one of my guys in there. So the hiring pool is a lot smaller for me than it would be for other people. But that's not an issue right now. I don't think it's a, it's a pressing issue for us until we start expanding.
A
Yeah, got it. Okay. And then people operations.
B
That's people operations. So obviously when I had one location, it was really easy to control the standard. Right. But as we expand, it's harder and harder to have that same standard.
A
So let's See the numbers.
B
So going over the numbers again. So top line revenue, 5.2 million last 12 months. Profit 1.2. Net margin is about 23%. Our CAC is about 700. Our lifetime value is 3400. So that's 4.8 to 1 LTV to CAC ratio. Marketing spend. We're spending about 1500 to 2000 per location right now. The show rate is 80%. Close rate 71%. And our annual ad spend on marketing is about 110,000.
A
Okay. Do you have anything broken out between channels between Facebook and Google?
B
I do.
A
Okay, sweet.
B
So this is our, our Facebook data. I was able to put together like our 12 month numbers for all the clinics for Aspen. Okay. And then for as far as the challenge that we have is because we're insurance based, we don't get paid for like 30, 60, 90 days after. So I had to go back and I picked Q2 for three clinics.
A
Yeah.
B
Okay, so these are the numbers for, for those three clinics in quarter two.
A
Okay. So why is Kit so much better?
B
Yeah, I don't know. That's, that's, that's what I want to replicate. That's where we don't have consistency.
A
Is that your first location?
B
That's our number one. Yeah. It's not our first location, it's our third location, but it's our number. It's probably our number one right now.
A
Is the doc there different than the other docs? Is he good at sales?
B
They're about the. No, he's, he's, he's, he's good, but he's, he's about the same. I, I would say that culture of that team is, is really good. I think that's one thing that stands out.
A
Yeah. Because if you look at. Cause. Cause CAC is, is. I mean, you know, half of Capitol Hill, right?
B
Yeah.
A
But the amount of money that you're making is like you're getting it more. You're getting more LTV and lower CAC at Kent.
B
Right.
A
So are they set? Like, is it that the people that are coming. Because it's insurance. So is it that they're like, like they're billing better? Like what, like how, how could they get LTV to be so much higher?
B
Yeah, great, great question. So Kent would have a higher proportion of those $10,000 cases I was talking about because that's blue collar and then Capitol Hill is white collar. So it's got less of those case averages that are really high. I would say that's one thing.
A
Interesting. Do you have any Other markets that are in that kind of blue collar damage.
B
Everett's right there as well.
A
Well then based on that, would we have more like ROAS? Because the CAC's, you know, close and rose is a quarter, so.
B
Right.
A
Why are the. Why are there so many more cases in Kent than Everett? So high ticket?
B
I would say Everett has more of those 10,000 more cases than Kent does. That makes sense.
A
Interesting.
B
So I didn't calculate that into the Facebook marketing and the Google.
A
Oh, so you didn't include that. Okay, but Everett's a good market.
B
It's a good market for those. But I don't like to be too dependent on one source of patient, if that makes sense. Like I don't want to be too heavy on those auto accident cases in a location.
A
Got it. Okay. Do you have any other data that's. That you've collected together?
B
This is our Google data. Yeah. So these are from Google AdWords.
A
Well, these obviously do significantly better than your Facebook ads.
B
Yeah, for sure.
A
Interesting. All right, are you maxed out on spend here?
B
I don't think I am. I work with a third party company on this and I basically go off their recommendations. I personally would love to spend more obviously on this because the return's so high and these people are in immediate need of help, so they're much easier. Our case acceptance goes up much higher with these patients.
A
High intent. Really good. Well, I mean, shoot, this is the most promising part. Okay. All right, let me think about some other kind of. Walk me through the sales process.
B
The sales process? Yeah. So we have a two day process. Right. So day one patient comes in, we do a consultation, we take X rays.
A
We'Ll do an exam and actually start me from click to close. So the person clicks on is basically the sales process for Google Ads different than the sales process for Meta or how's it flow for you?
B
Yeah. So Google, they will call directly into our. We have a centralized call center. We have.
A
So the call click to call is.
B
The ad click to call or to schedule. On our web. If they go to our.
A
Do you know what the split is? Is a lot of it call or is like. I'm just curious.
B
Yeah, I don't know the answer to that.
A
Okay, no worries.
B
Yeah, that's a good question.
A
Okay, so click to call or they self book. Got it. So then they talk to a rep that's centralized. That rep does some sort of discovery call. Correct. Like triages them and either says. I mean do they. Do they look at their insurance at that point on the Call.
B
They don't. But that's the thing I'm thinking of adding in so we can get on top of that.
A
Keep going through it. So they, so they, they do some sort of discovery. They're currently not doing insurance on the call.
B
Yep.
A
All right, so then they do what?
B
So then they schedule them the, the next available time. We try to get them in the same day or next day right away.
A
What's the show up rate for the, the calls? Because the show up rate that you have here, what you showed me earlier was really good. But that's because they also just got it. They got, they had a conversation prior to doing that too.
B
Right.
A
Okay, so what's the sharp break for that other step?
B
So for the, for the call.
A
Because obviously some is click to call. But the ones that book onto your calendar, you then call them at the designated time.
B
Yeah, no, they just schedule, they can schedule online and then they can make.
A
They can confirm to show up to the facility.
B
Yeah, we just take them.
A
Oh, okay.
B
Yeah, I try to reduce as much friction as possible.
A
No, I dig it. Okay, that makes more sense to me. Okay, got it. So some people call and then they book them and the people who self schedule just book directly. Got it.
B
Exactly. Yeah.
A
And then what's the kind of like reminder sequence there to make sure that. Cause you have really good shop rates.
B
Yeah. So we do three text messages and then we do a phone call. If they don't respond to the text message, we do a phone call the night before to confirm and then we'll do another one like you know, two hours before their appointment.
A
Okay, so three reminders and call if they have not confirmed their appointment and follow up call as well if they didn't pick up the first call or the other ones.
B
Correct.
A
And then if someone doesn't hit any of those five, do you pull them off the calendar?
B
We don't pull them off the calendar, but we, we kind of expect them not to.
A
Just like double book, kind of. Yeah, exactly. Okay. Okay. So then they come in. So they show up to the appointment. Now what?
B
They come in for their appointment. We'll, we'll do a consultation. So we have a patient coordinator that does that, gets the preliminary data.
A
Okay, so it's like an assessment.
B
Yeah.
A
Like movement, like move here, does that hurt? That kind of thing. Like circle where you have pain.
B
Kind of like half your closer framework. Okay, so like, so they'll do the first half of that on there and then, then we'll take X rays, we'll do an exam and then we'll tell the patient that, hey, we need to process these films or these X rays. And then can. We need to get you back in tomorrow so we can go over the results of the X ray.
A
Yeah, and that's really some people.
B
Yeah, that's it.
A
Okay.
B
And then. So then we'll release them for. We'll still do a treatment that day, we'll do a light treatment and then we'll have them come back the next day. And by then? By then we'll have everything verified and then we'll have a customized plan for them. And then we'll present the financial.
A
Yeah, I got some stuff there. Okay, so I'm going to say it back to you.
B
Yep.
A
So disco call that gets them booked. Reminder sequence, three texts, two calls only. If they don't confirm via text, they show assessment, clarify whether they're label them, problem, overview, past experience. Then you take them through some X rays and whatever test that you're going to run. Then you do some light delivery and say, hey, you know, come back tomorrow and then we will sell you the package.
B
Correct.
A
And then. And then, whatever. And the people who you do that service for upfront, do they pay anything like the 10 to 15% that don't actually come to the sales appointment?
B
Yeah. Yeah. So they'll still pay. Like, usually they'll have a copay.
A
Yeah.
B
So that's why we have to verify all that information. Right. So it's kind of. It gets complicated with the insurance. It was just cash. It'd be so easy. But because the insurance is there, we have to verify if they have coverage and then we'll charge them a copay. And it's different for every single person. But our cash fee for that would be like 99 bucks, for example.
A
Okay.
B
Yeah.
A
Okay, got it. What's the. You see, you're running 23% margins. What's the. What are the. What's the best facility run? What's the worst facility run, margins wise?
B
Best facility run right now, I would say is Kent out of these ones.
A
Or you have six. Go back one or two. There should be six on there.
B
Yeah.
A
Okay, so we got all of them there.
B
So our two lower, lowest performing are Auburn and Federal Way.
A
All right.
B
Our two top performers right now are Kent and Everett, and in the middle are Capitol Hill and Bellevue.
A
Okay, so what are the margins for the top two? Like net margins for the facility?
B
Net margins for top two are probably over about 40%.
A
Okay, so that's what it should be. Okay, got it. And what's revenue at those two.
B
Those are annual. Yeah, about 1.5 million.
A
1.5 million, got it. That's what you want, right? That's. So those two you're happy with. Because if you're running. So you're running 600k ish in profit on those times two. So one point. Well, that's most your profit.
B
Yeah. Right.
A
And then the other four kind of just like.
B
Yeah. And just a disclaimer like these other like Auburn and Federal, where are like my newer locations. So like the attic. So my is probably even higher than this. But it's just the first six months we had to eat a lot of profit. How old? Auburn is about a year old and Federal way is about 14 months.
A
Okay, can you walk me through the ad funnel with the Facebook ads?
B
So go back one or just.
A
Or do this just right here? Yeah, so just. So just like we walked through the sales process.
B
Yeah.
A
Can you walk me through the funnel from the Facebook ads?
B
Yeah, so like from when they click on an ad. So we have, we have a video ad out there.
A
Do you have ads live right now?
B
Yeah.
A
Can you pull up Facebook ads library? We're going to pull them up and we're going to. We're going to see it. We're going to see. We're going to see for ourselves. All right, so we have different creative. It looks like it's the same copy. All right. So I think there's probably just some work that could just happen on the actual ads themselves. Like, I think you can have a clear call out and the first line, I would probably separate the call outs. So it's like attention ever in surrounding areas. So instead of saying areas, I would go to like residents or something like. Or people basically combine the two. Where it says chronic back pain doesn't have to be a life sentence. Attention Everett surrounding areas. So it'd be like attention Everett like residents with back pain. That combines both lines. Punchier. Put two asterisks on either side. It's like, okay, that's what it is. And you're putting proof first. And I probably wouldn't hear. I'd probably lead with a question which would be like, are you. So either I would lead with a question that'd be some sort of like more specific pain, or I would lead with the offer and then have the proof of why they should believe that I can help them after they've seen the offer. Because, like it took us all the way down to actually see what the offer was. And the headline, avoid surgery, try spinal decompression I would probably just put like the offer there. So it's just like a restatement. Like free spinal treatment decompression. You know, free spinal decompression, boom. $99 value, whatever. Something like, like that's probably what I would. What I would put there. Cause I think it's just like, there's a lot of words and I think you could probably get just like I combined the first, the headline and the next sentence into just like, attention Everett residents with back pain. It's like, boom, we got that. And then it's like, it'd be amazed at how much, like just changing, tweaking the headline, probably compressing the copy into a handful of bullets. It's like, do you struggle with boom, boom, boom, boom? And you've probably tried boom, boom, boom, boom. But there's a better way. This is how we do it. We've helped this many people for limited time, we're doing X, Y and Z. And I think. I think that would probably work. Well, I cannot guarantee availability as we accommodate 10 vouchers of patient schedule. I do like that probably be compressed. We can only see 10 new patients per week.
B
Right.
A
And scheduling availability is first come, first serve for this treatment done.
B
Do you think it's good to go, like, because with Facebook, right. Like, people aren't necessarily going on Facebook and all my backs are. And I got like, you know, Google AdWords. It's like, all my back's fucked up. I need to call somebody, I think.
A
So there's tons of chiropractic advertising. Facebook. Yeah, tons.
B
Yeah.
A
So I don't think you have. I don't think there's any issue with advertising on Facebook.
B
Okay.
A
For sure.
B
Got it.
A
What's the landing page look like?
B
So the landing page. So it's just that instaform that form on Facebook. Right. And that goes to a calendar on GoHighLevel.
A
Okay.
B
Okay. And then they just schedule on, like we have.
A
So there's really not even a landing page. It's just like they're going to lead form straight to basically redirect to scheduler.
B
Scheduler. And then we. We double book for Facebook because the show is lower for Facebook. So so basically we give them like certain times of the day where they can schedule. So they'll schedule their own appointment. And then we put it into our. Then we have to manually put that into our schedule, right?
A
Oh, you manually. You have to like, basically transfer them over into.
B
Into this. Into our ehr. Yeah, yeah, yeah.
A
Okay. Got it.
B
Because. Because it's not connected to our ehr.
A
Okay, understood.
B
So that's for Facebook. Google's, Google's a little different. Google will be kind of like this, like where they can just schedule online.
A
On a page, you mean. But okay, soon it gets 5 million EBITDA. You're doing 1.2. Basically have to get the other four to be profitable. There's a couple of things that I think we can go over in terms of sales process, lead magnets, things like that. The. Honestly, I think a big part of it that's not up here is the ops. Because in this type of business it's so operational heavy in terms of like kind of operational excellence. It's probably because like you absolutely can run a 10 to 1, 15 to 1, you know, ro, well, you're already doing on Google, but you can do that on Facebook as well if the offer is right. And so right now the offer is like there really isn't one. It's just like, try this thing. It doesn't even say free. And so I think, yeah, so let's do that. Why don't you come over here and then we'll, we'll walk through. Game plan. All right, so got a lot of like, there's inconsistent lead flow. There's the sales process that I would look at. I think the discovery process needs something, need a better front end offer, increase ad spend. So those are, those are the really tactical things that I'll walk through. But I still want to talk about ops. So if we have these, these six locations, what would you say? Like, are the team structures the same between all six? Is the business model the same between all six?
B
Yeah, identical.
A
Okay, Identical model. Got it. So the people coming in are different. That's part of why the LTV is different. And so in terms of the individual location operators, if you had to power rank them like one to six, who's the best loc? Is, is the, is the doc kind of like the manager of the location? Is that kind of how it works?
B
That's kind of, that's what we're relying on right now.
A
Okay, why don't you just show me, why don't you walk me through with the actual like what the model looks like and we'll do the boxes and they'll talk about the acquisition stuff.
B
Like the org chart. Yeah, yeah. So the docker should be the SO docs here.
A
Okay, got it.
B
And then underneath them is like, like a team lead.
A
Okay. Like an office manager kind of thing.
B
Yep. Yeah, I guess you can call it. We don't call them that, but yeah, sure. Yep. And then there's just usually a scheduler and a rehab tech. That's it. So I'm trying to, I try to keep it to four employees per location. I like that.
A
So you've got a schedule. So basically we lead, nurture. Are they remote? Are they in person?
B
So this is a scheduler for when they come into the office. But I also have a remote team that does all the inbound calls.
A
And it's centrally.
B
Yeah, central.
A
Okay.
B
Y.
A
Got it. So that's it. Like that's the, that's the model. All right. I mean, shoot. Really? What do you have to pay the docs?
B
They, they make between base of 80,000 a year, but they probably like our top ones making like over 150.
A
Okay. And do they get some sort of like profit share or something like that?
B
Yeah, I offer. They range between 10 and 20 net profit. That's good.
A
That's. I mean that's usually what I, what I like to have, especially for like a high skill thing, profit. That makes sense.
B
Question on that though. You recommend getting like I try to get them equity, so. Because I want them to be come along for the ride. Or does that. Cause I mean that would increase our EBITDA, obviously, because it wouldn't be payroll, that 20% will go under. It would improve our EBITDA, but then it also gives them ownership. Or would you not recommend doing that?
A
Well, if you think about equity, right, you've got, you've got cash flow. So like distributions, you've got sale. Like if you sell it, there's value from that, there's risk and then there's control. So like that's what equity gets you. Right now they're not going to get control because you're the one who owns it. You're going to be making decisions. Doesn't really matter.
B
Right.
A
They probably don't want the risk.
B
No.
A
Okay. So then it just comes down to them getting paid on a sale and them getting distributions in the meantime. You already have this one. If you want, you can include something called a profits interest because you probably have LLC for each of them.
B
Yep.
A
Yeah. And so this would be something that basically functions equity, like so that if they sold they would get whatever percentage of the profits interest. So it'd be like, okay, we're going to say that the business today is worth 500k and you're going to get, you know, call it 15% above that goes to you.
B
Okay.
A
And then it's also key for them too. Because you're like, hey, for us to get above a $500,000 EV for this thing, then we need to have profit for the location at 200 or whatever.
B
Right.
A
And it's like, hey, but if you get profit per year to 500k then we're probably looking at something like 4 million. So you're going to get 15% of 4 million. So you have another 600k check on the day of exit that way.
B
Got it.
A
And I would just draw the same quadrant which is like there's four elements and so I want to make you an owner and this is how we're going to do it.
B
Got it.
A
The benefit to them is that when you do this there's no tax implication.
B
Got it.
A
So they, because it's like if you were to issue them shares. Yeah. They got to pay taxes on. The other benefit is. And this is just being real is that let's say in five years you don't want to sell, you change your mind or they decide they want to move with their family. Your equity doesn't walk with them, it comes back to the pool and you can give it to the next person.
B
Got it.
A
So it's basically this is fundamentally like phantom equity. And I think that's totally fine if you want to do that. The question is whether or not that actually changes their behavior.
B
Yeah, yeah, that's.
A
And so that's kind of like it doesn't really. I tend to agree.
B
Yeah.
A
For this particular role. But I do think the profit share is a much faster feedback loop and that. And I think that works because there's.
B
Months where they hit like the 20. If they're 20% and they, they could be taking on like 12, 15,000.
A
They see it profit in the next.
B
Month, but then that kills our EBITDA for the next month if that makes sense. Because it's come out of the payroll versus distribution. Yeah, I don't know if that makes sense.
A
No, I understand. It's basically.
B
Maybe it's too small thinking.
A
No, it's. I mean there's. The thing is, is that when you sell there's add backs.
B
Right. Okay.
A
And so like the person who's buying it is going to do their own math on what they think.
B
Got it.
A
The actual. So like you're even. They're going to, they're literally going to throw out your financials. They're going to do their own financials and then decide that makes sense. Then that means that the other four locations probably are really low revenue.
B
So Auburn and federally for sure.
A
Okay, what's the revenue of those two?
B
Revenue is roughly 40,000amonth.
A
Okay, so like 500K. Ish.
B
Yeah, 500K. Okay.
A
That's the issue.
B
Yeah. Which is like our breaking number. Right. Then Capitol Hill and Bellevue are higher than that. So they're middle.
A
Are they. How, how geographically concentrated are these?
B
They are all within 30 miles.
A
Oh, so all of them are in one city.
B
Yeah, so, well, interesting. In the same area. But Auburn Federal Way and Kent are awesome because they're like within five miles and it's so easy to rotate staff, etc.
A
So do you say Kent Federal and what's the other one?
B
Auburn or like 5, 10 miles auburn.
A
Interesting.
B
Yeah, but those are two new ones. Right. So like Auburn and federally, kind of hard to judge. And if you looked at our, our EBITDA now, like if you did six months trailing versus 12, it probably higher ratio than that because. Because they were kind of eating themselves in the beginning when I first opened.
A
You to put some cash into it.
B
Yeah, exactly.
A
Yeah, got it, got it, got it. Okay, so starting with the lead magnet, I think that offering $1929 somewhere in there, first consult or free X ray or something to that extent would probably go way better. And I do like, especially for your type of business, to do a low ticket and say it's something like this. So It'd be like $29x Ray, you know, plus, you know, assessments, blah, blah, blah. And the reason I like this is because you get the credit card on the phone and even though it's an insurance thing, it's like, yeah, no worries. We just put a card down just for. For shop rate. Obviously we have a doctor who's going to be there. We just need to make sure that you're going to shop. Right. And the thing is that if we build them the 29, then the likelihood they shop is super high. And this is literally just to take shop rates to like, basically 100%. Hey, guys, real quick. This podcast only grows from word of mouth, quite literally. There's no other way to grow a podcast in word of mouth. If there's some element of this that you think somebody else should hear or would be relevant to them, it would mean the world to me if you shared this via text, via Instagram, via dm, via whatever way you like to share stuff with people you love. Thank you. So then. And this is over the phone. So we do this now when they walk in the door.
B
Okay.
A
So this is going to be a little bit of a departure.
B
Okay, yeah.
A
So they Walk in the door. And when you. And I think the reason that you probably sold better, obviously you're better at sales than probably your. Your docs are, right? But if you think about how sales works, so sales, you want to sell at the point of greatest pain, not the point of greatest satisfaction. And so the easiest analogy I have is like, okay, someone's starving, they come to my restaurant, I give them a steak, and they're like, oh my God, that steak was amazing. And I'm like, hey, do you want another steak? And they're like, no, no, I'm good. But that steak was amazing though. I'm like, yeah, but do you want another steak? And they're like, no. And so it's kind of the same thing here where people are literally coming in pain. And ideally, what I would want to do is we take the assessment instead of doing the treatment, then I want to sell the package.
B
Got it.
A
Then if you want, if they have time, they can do it or they can come back tomorrow, get their first treatment.
B
Got it.
A
So it's the same time scale. We just move the order. Oh, yeah, that makes sense because, like, I mean, I've been this patient. So, like I go to the chiropractor, they do something, I'm in pain, they adjust my back, and then they're like, hey, come back for this. And I was like, oh, no, I'm good. Like, you fixed it. I'm great.
B
Yeah, totally, right?
A
And then they're like, but it's not a long term solution. And I'm like, good enough for me, you know, like, and I'm out for sure. And so that might be an immediate, like 15, you know, 10 to 15% boost in sales. So, like, that's number one. But the thing is, is that I think that your close rates are going to go up. So one is like, you're losing some.
B
On the drop off, right?
A
But I think close rates are go up. And like when you're in pain, your desire for a more per. Like all the desire is there in that moment and we're missing it. Right. And so I always had this rule at least, like with fitness, it's like when someone walks in the door, first thing I want them to do is expand the gap of where they are, where they want to be. So I have everybody hop on the scale. And the amount of people, I don't want to hop on this. Like, I know, I'm like, get on the scale. We got to know it's just a number.
B
We got to know where we're at that makes sense.
A
And so it's the same idea with this. Got it. Lead magnet. In terms of offer, I do think this would be good. This will increase show up rates overall. Getting somebody to get a $29 credit card purchase over the phone is like not hard. Right. They do that, that secures their spot. Then when they come in, we do same day sale. What has been the issue with the docs making this sale? Like you said, they struggled with it. So there's two elements. You said there's insurance, like some insurance stuff there. So what's the issue here?
B
Yeah, so the issue is patient comes in and then we have to verify the benefits. So there's like 20 different insurances and every patient has a different coverage or whatever, right?
A
Yeah.
B
So then we got to, we have to, we have to make our treatment plan, then take out whatever the insurance covers and then they pay their co payer contracts. So just doing that process. Yeah, I think when they're on the floor seeing patients and then having to switch gears and do the math of like what this, you know, here's my recommendations, here's, you know, all that. I think that part kind of stresses them out.
A
How much of it is templated?
B
Most of it's like as far as the. So we have a.
A
We know that someone has blue cross for shield. So whatever.
B
Yeah, yeah. It's all Excel spreadsheet. We can punch in numbers. We have financial calculator for that.
A
So question. So someone calls. So basically there's two spots that we can put this, this process. So either we can do it on the phone.
B
Right.
A
With the disco.
B
Yeah.
A
Or we can do it the moment they walk in the door. So it would work like this. So someone walks in and say, hey, do you have your ID on you? I just want to confirm your appointment. Yes. I'm Sarah. Cool, great. Do you have your insurance card on you?
B
Yeah.
A
And so you ask that. That way we can get the templates already like ready to go.
B
Right.
A
So that then the dot goes.
B
Yeah.
A
And then he leaves them in there and he says, cool, let me get the X rays. And then he comes in with the X rays and with the template for their specific insurance.
B
Totally. Yeah.
A
And then you can just match them and just do the sale.
B
Yeah. So the issue is like some of those, some of those. So I centralize where they verify those benefits. Right. Some of them could take like 30 minutes to an hour.
A
Okay.
B
So if that's, that's the.
A
Okay, so then we have to do. On the phone.
B
Yeah, I Agree.
A
Okay.
B
Yeah.
A
So. So if the $29 thing gets in the way.
B
Yeah.
A
Then we can still just do the. Just like you could either do a free offer, like free X ray, free assessment, whatever. Just if that's an issue, I mean, personal preference. Get the credit card and the insurance card. Yeah. Over the phone. If it seems like a training issue, then I would prioritize the insurance card.
B
Yep.
A
But then that way it's like you already have everything. They're preloaded, and so then they come out after the X rays, get it printed out from the scheduler at the front desk.
B
Right.
A
And I mean, shoot, the morning of, I probably just add the sop. Print all the. Print all the packets out for everyone, and then the doc gets them in the clipboard when they walk in the door.
B
Perfect. Yeah.
A
I mean, do you think that would work?
B
I. I think so.
A
Okay.
B
And then if they ask like, hey, why do you need my insurance? I thought it was 29 bucks. Then we'll say like, hey, just in case the doctor thinks he can help. You just want to know all your insurance.
A
Yeah.
B
Et cetera.
A
I'll give you a different one. This is just how we always do it.
B
Okay.
A
It works only every time. It's just like, oh, this is how we compute our patient profiles.
B
Okay, perfect.
A
Like, it's better to appeal to policy.
B
Totally.
A
So they'll get this. If this, for whatever reason is you'll prioritize the insurance, they'll come in, they're going to have the printed out stack of all the insurance. The doc gets this on a clipboard.
B
Yep.
A
Right. In order of the patients that he sees that day.
B
Perfect.
A
He's like, okay, Mrs. Johnson, I've got your X rays here. I've got your insurance here. Okay. This is what we're going to do for you.
B
And then this prescriptive close makes sense.
A
Okay, so right now, are there some locations that are having, like, way higher close rates than others or like, what's.
B
The highest close rate? Probably, I would say Capitol Hill. And what's the difference, though? The doctor has a lot of certainty.
A
No, no. No percentage difference.
B
Oh. So let's say Auburn is. Let's say they're averaging about 55, 60%.
A
Okay.
B
And then Capitol Hill might be at like 80%.
A
Okay. Not. I mean, they're both okay.
B
You're terrible. Yeah, they're not terrible. But if you look at. Because. Because a lot of these people have insurance, so their entry level, like, financial is not like super high on some. So the ones that are those $10,000. They have zero out of pocket. So I mean, you got. You're going to have 100%, so kind of. Yeah.
A
So this is how I would. So I would imagine that the packages themselves are going to be similar. It's just how much is being covered is going to be the difference.
B
Yeah.
A
Is that about right?
B
Yeah. And then also the fact that I think if a clinics use a lot of those 100% coverage ones, then they kind of skip, then they start. They don't work on your sales skills. For the ones that are right. It's like, oh, these are crappy leads or shitty leads or whatever.
A
Yeah.
B
But you just. Because you have to work a little bit for them. Right. So I think just creating that training that's. That's on me to train them and role play more.
A
I'll give you something that will help you a lot with brick and mortar. So I've done a lot of brick and mortar sales processes in my life and as much as possible, I like them to be like clicks and checkboxes. So it's like, like when we sell supplements, for example, it's like you literally just turn a laptop around and then you just like punch through it and you literally just say the words. And then at the point that you ask for the thing, you ask for the. Like, you really can machine it that way. And that will eliminate so much of the variability between people. And so I would look at what the top 80% guy is doing, consistently. Break that into the. Basically the deck.
B
Okay.
A
So that they have a visual aid to go through it. And then she feels like, oh, this is, this is the next step. I do this. This is what you need. This is what we cover. He circles the thing on their. On their thing, turns it to them, and then they, they rock and roll. And then they just book out their next appointments, I'm assuming.
B
So they're kind of looking at a teleprompter, almost like, okay, got it.
A
But they can show it to them.
B
Okay.
A
So there's two ways to do it.
B
Yeah.
A
One is you have the laptop and you turn it towards the customer and then you basically read the words on the slides. That is like the perfect sales pitch but with visual aids and whatnot.
B
Got it.
A
The second way of doing it is you have that clipboard, but they don't know what's on the clipboard. And so the clipboard just has the script.
B
Got it.
A
And so it's like, cool. I'm just gonna ask you a couple questions. And so you basically go through the sales process. And you just look like you're checking off the boxes as you're going through a script. But then they always say the script. And then the doc can visually show this, which they then staple to the patient contract. That way, you know, they followed the process and then it just keeps it consistent every time. So either of those work. I've done them both.
B
Okay.
A
Okay. So from. So that was so number one, we had.
B
Would you have the doctor do the sales process or do you think. Do you think it's okay to train them how to be good at sales? Do you think of having like a patient coordinator do the sales. You know what I mean? Because, like. Yeah, because they always have some, you know, reservations. Yeah. You know how doctors are compared to like a regular.
A
I do know how doctors are. Okay, so you're saying this person or this person.
B
This. This person.
A
Oh, this person doing it.
B
Like, if you have a doc that doesn't have a lot of confront or conviction, a lot of times the manager will. So I don't know if it's better or.
A
Honestly, I mean, I like it better here.
B
Okay.
A
For some of the reasons that you already outlined.
B
Right.
A
Because you already have this person. And if the thing is, is this will. You'll start hiring differently if that's their role. Because they're really just become salesman.
B
Exactly. Yeah.
A
Which I'm not against, to be fair. It may impact the compensation of the docs, though.
B
Yeah.
A
Because like, this guy. This guy or gal probably needs to make somewhere in the neighborhood of like, they should be able, if they're doing a good job, to 800 grand a.
B
Year if you want, like, you know. Yeah, yeah, for sure.
A
Like, if they're. If they're hitting, you know, if they're getting out of the park, they're doing 600,000 profit for the location. They can make an extra 50 grand or 40 grand with commissions.
B
Yeah, that would be the most important position in the office at that point.
A
Yeah, 100%. Because I mean, which I kind of like. Because then you could swap docks out if you need to.
B
Totally.
A
For being weird or whatever it is. Right. Okay. So I do like this. So I would probably not roll that out immediately to all of them. I would just like go to Auburn and be like, okay, this is the person that I will try it out. And if the close rate's higher. And then also you can get your efficiency up. Because totally. Yeah. The doc only does half work. The other person does the other half.
B
Right.
A
Okay, so the next one is, I think ad spend Needs to go up. So what? Because you're not spending very much.
B
Yeah, I know. You know, it wasn't until I had to do this process, I was like, we can. I mean, because the return is so high on some of those things. And if, I mean, I would spend like a million dollars a month on Google AdWords if I could.
A
Yeah.
B
So how do we look? I guess that would be one thing to increase.
A
Well, the first thing I would just, just literally tell them, like, I need you to double the ad spend and I need you to find more keywords.
B
Okay.
A
So just find more for me.
B
Got it.
A
The other thing that might be worth looking into would be local SEO.
B
Okay.
A
Because SEOs especially for intent based. So it's like, obviously there's search, but it's not hard to win at SEO locally.
B
Okay.
A
Like nationally you want to win back pain and good luck. But like, yeah, you want to win Everett, you know, chiropractor, Everett spine, Everett pelvic health, Everett low back, Everett lumbar, Everett, like, you mean, there's so many sciatica, like all those. I think you could probably win on long tail keywords.
B
And then one thing that helps us on that I think is we're pretty good about getting reviews. We have more reviews than everybody in our cities.
A
Oh, it's great.
B
And then I think that helps with the local SEO. But yeah, and I guess the big question is like with ad spend, a lot of these. So the agencies that we hire, like they work with many chiropractors. Right. So those most chiropractors don't do what we do, which is sell packages of 2400. They do visit to visit, which is a nightmare. Yeah. So I think that they base our ad spend, the recommending our ad spend based on that. But my return on it is so much higher than the average guy. Oh yeah. So then I'll spend everybody. Yeah, totally.
A
So if you want to have to talk in. In marketer speak for them.
B
Okay.
A
And just give them our target cpa like cost to acquire or cpl and just say like, listen, I can, I can pay up to.
B
Got it.
A
This. So like make it rain, dude. If. As long as it's under this, I'm good.
B
Okay. And would you. When would you consider bringing that all in house? Because I kind of. I hate dealing with these.
A
No, I get it, I get it. It probably wouldn't be my priority right now.
B
Okay.
A
Because like, if I look at this, I'm like, okay, we got 12 to 124 to 191 so I'm like, we're doing pretty well on this.
B
Right.
A
And do you not have. Do you have Google on the other three as well?
B
Yeah.
A
Okay. It's just not there.
B
I picked a one like a high, middle, low.
A
Oh, so that's low. Nine to one is a low one.
B
Yeah, for sure.
A
Oh, that's great.
B
Geez.
A
Okay, cool. So I would say basically I'd stop it at five to one.
B
Okay.
A
And say like so basically double or triple whatever the CPA there currently is.
B
Right.
A
Sometimes what you'll find though is that if you can double or even triple how much you can spend to get a customer, you might be able to like 10x lead flow. I seriously, it's not like, it's not, it's not, it's not proportional.
B
Right.
A
Because you just all of a sudden you spend this many more people.
B
Yeah.
A
Okay, so this is specific to Facebook.
B
Okay.
A
Which I think could be the, like, honestly this could be the differentiating factor in terms of how much like this could be something that just like in terms of leverage.
B
Yeah.
A
Could be a double or triple on your Facebook, which then would get you closer to that 9 to 1 or 10 to 1, which I think it should be.
B
Right.
A
The ad copy thing we already talked about discovery process is this new guy where we're going to get insurance and the card on the phone, then they're going to print it out the next morning or whatever. Print same day stack. The doc is going to just do the X ray and the assessment and then he gives the handoff with the clipboard that has for the patient sales manager, then does the sale right then. And I think that we just book the treatment that next day.
B
Okay.
A
Just book them the next day.
B
Okay.
A
So I think if we do these things and that's probably about six months of work.
B
Yeah, yeah. And would you recommend doing this like, should I do it in this order for locations also? Should I start with one or like. Because like would you do Google Ad spend and the Facebook at the same time?
A
So I would do these one at a time. So Google Ads, when you probably increase across all of them because you're already.
B
Yeah, yeah. Because when I had one location, I mean we did none of this stuff. I mean all I did was gorilla marketing.
A
Yeah.
B
And, and then. But you can't scale that. It's so hard to scale that. So you can.
A
It's just tougher. It's just basically it becomes more operational. So like if you look at, you look at some of the like the big like gym chains and whatnot. Like, they run their trainers the same way. They go. They do lead boxes, they go to Whole Foods, they stand outside, they get names. Like, they just. That's just the culture. And in a different way, the cool thing about the gorilla marketing is that it always works.
B
Yeah, Right.
A
It's just it. It always works no matter how technology changes, no matter where. And I think that's why those guys do that. I remember you still. I used to laugh at them because I, like, could run Facebook ads. And I was like, man, these guys are idiots. And then I realized that they had a $2 billion company. And I was like, yeah, maybe. Maybe I'm the idiot.
B
But it also helps with communication, sales, because, I mean, I read all my sales skills through that because I got shut down so many. Got kicked in the nuts so many times that you guys have to keep getting back up and doing it over again. Right.
A
So, no, this is great.
B
Awesome.
A
So you have six. You start. What did you do before this?
B
Before the clinics? So I opened my first one in 2007.
A
So you're a Cairo.
B
Yeah. So I practiced till 2012. One clinic.
A
Yeah.
B
And then what'd you do in that clinic?
A
Top line, bottom line?
B
3 million. And top line and bottom line is probably about 1.7.
A
Yeah. Yeah.
B
So. But yeah. So then it was burning me out, though. I was exactly like, I'm going to.
A
Burn other people out.
B
Yeah. So then I started building housing. So then I started building houses, and I was making good money off that for, like eight years, like, luxury homes. But I still own my main clinic and had associate in there. It was. It was doing okay. And then 2021, I thought that where 2020, I thought the market was going to tank.
A
Sure.
B
So then I thought, hey, what can I do with my clinic? There must be something I can do bigger than just one clinic. Right. And then started talking to some of my friends that were.
A
Learned about M and A. And.
B
Yeah, like, one of my really good friends founded Valley Village. Another one, his dad found Cinnamon. So then I started thinking, like, a.
A
Little different in locations, in terms of rolling things.
B
Yeah, they started. They started those. They're the original founders of those companies.
A
Super cool.
B
And then. So it's giving their perspective on things and what I should do to grow. And they told me, hey, you should open up. If you can replicate it. Open up multiple practices and sell to private equity.
A
I like the lean. I like the lean model.
B
Yeah.
A
Okay.
B
For sure.
A
Well, dude, awesome.
B
Thank you so much. Appreciate that. That's awesome.
A
You're going to crush it real quick. Guys, I have a special, special gift for you for being loyal listeners of the podcast. Layla and I spent probably an entire quarter putting together our scaling Roadmap. It's breaking scaling into 10 stages and across all eight functions of the business. So you've got marketing, you've got sales, you've got product, you got customer success, you've got it, you've got recruiting, hr, you've got finance. And we show the problems that emerge at every level of scale and how to graduate to the next level. It's all free and you can get it personalized to you. So it's about 30ish pages for each of the stages. Once you enter the questions, it will tell you exactly where you're at and what you need to do to grow. It's about 14 hours of stuff, but it's narrowed down so that you only have to watch the part that's relevant to you, which will probably be about 90 minutes. And so if that's at all interesting, you can go to acquisition.com roadmap R O A D map roadmap.
Summary of "Helping A Chiro Scale Past 6 Locations | Ep 837" on The Game with Alex Hormozi
In Episode 837 of "The Game with Alex Hormozi," host Alex Hormozi sits down with Raymond Kuner, the owner of Chiro First of Washington—a thriving chain of six chiropractic clinics in the greater Seattle area. The episode delves deep into Raymond's journey from running a single clinic to scaling a multi-location enterprise, highlighting the challenges and strategies employed to achieve significant growth.
[00:01 - 00:48]
Raymond Kuner introduces his business, Chiro First of Washington, outlining its current status:
Raymond:
"We currently have six brick and mortar locations in the greater Seattle area trailing 12 months. Revenue 5.2 million, EBITDA around roughly 1.2 million. And our net profit is about 23%."
[00:08]
[00:29 - 00:36]
Raymond shares his approach to expanding the clinic chain:
Alex:
"Do you buy those or do you open up organ?"
[00:29]
Raymond:
"So far I've bought all of them. But I think moving forward we're going to change our strategy a little bit."
[00:32]
[00:36 - 01:25]
Raymond:
"Our key demographic that we help is 35 to 65 year old men and women that have some kind of condition that we can help with, whether it's pain, discomfort or loss of movement."
[00:39]
Raymond:
"Spinal decompression kind of differentiates us from a lot of our competitors because it's a niche service that we offer for people that have disc related injuries."
[01:00]
[01:25 - 02:24]
Raymond elaborates on how Chiro First generates revenue:
Raymond:
"We're primarily a recurring revenue model and roughly one out of every seven of our patients, they come in for a larger case value. So like a car accident or a work injury might be worth up to $10,000."
[01:25]
[02:24 - 07:00]
Raymond discusses the marketing channels employed:
Raymond:
"So for paid advertising, the two means of advertising are Facebook ads and Google Ads. We're spending about a thousand bucks per location on Facebook and roughly 500 to 1,000 per month on Google for each location."
[01:53]
Raymond:
"Our closing rate is about 71%, so total sales probably roughly around 20."
[02:19]
[07:00 - 03:48]
Raymond identifies key obstacles hindering further growth:
Raymond:
"Number one, I would say is probably lead flow. I think that we could do better in that department. It's not consistent."
[02:44]
Raymond:
"Second one would be like our sales infrastructure because we are 75% insurance based. There's so many different plans out there."
[03:00]
[07:00 - 12:25]
Raymond provides a breakdown of the performance across his clinics:
Raymond:
"Our two top performers right now are Kent and Everett, and in the middle are Capitol Hill and Bellevue."
[12:06]
Raymond:
"Our two lower, lowest performing are Auburn and Federal Way."
[12:06]
[07:48 - 19:15]
Raymond outlines the comprehensive sales process employed in his clinics:
Initial Contact:
Appointment Scheduling:
Patient Show-Up:
Consultation and Treatment:
Financial Transactions:
Raymond:
"So we have a two day process. Right. So day one patient comes in, we do a consultation, we take X rays."
[07:48]
Raymond:
"We do three text messages and then we do a phone call the night before to confirm and then we'll do another one like two hours before their appointment."
[09:35]
[18:02 - 20:37]
Raymond explains the organizational structure across all clinics:
Raymond:
"And then there's just usually a scheduler and a rehab tech. That's it. So I'm trying to, I try to keep it to four employees per location. I like that."
[18:12]
Raymond:
"They can make an extra 50 grand or 40 grand with commissions."
[32:29]
[19:15 - 35:54]
Alex Hormozi provides actionable insights and strategies to overcome Raymond's scaling challenges:
Enhancing Lead Flow:
Streamlining Sales Process:
Operational Improvements:
Boosting Efficiency:
Alex:
"I think a big part of it that's not up here is the ops. Because in this type of business it's so operational heavy in terms of operational excellence."
[35:02]
Alex:
"I would recommend improving the sales process by using visual aids and structured scripts to ensure consistency and increase closure rates."
[31:00]
[36:22 - 35:54]
Alex wraps up the discussion with strategic steps for Raymond to implement over the next six months:
Alex:
"So I would do these one at a time. So Google Ads, when you probably increase across all of them because you're already doing pretty well on this."
[36:41]
Alex:
"If you want to have to talk in marketer speak for them and just give them our target CPA and say like, listen, I can pay up to this, as long as it's under this, I'm good."
[34:38]
Notable Quotes:
Raymond on Marketing Challenges:
"When we had one location, it was really easy to predict that and to change the outcome pretty quickly. But as we've scaled, I'm having a tougher and tougher time scale."
[02:44]
Alex on Sales Strategy:
"I always had this rule at least, like with fitness, it's like when someone walks in the door, first thing I want them to do is expand the gap of where they are, where they want to be."
[24:39]
Raymond on Team Efficiency:
"I try to keep it to four employees per location. I like that."
[18:12]
This episode offers valuable insights into the complexities of scaling a service-based business, emphasizing the importance of consistent marketing, streamlined sales processes, and operational standardization. Raymond's candid discussion with Alex provides actionable strategies for entrepreneurs aiming to replicate his success in the chiropractic industry.