EPISODE 369: Ethically Offering Add-On Services to Your Practice with David Rudnick, DC

Hey, chiropractors. We're ready for another Modern Chiropractic Marketing Show with Dr. Kevin Christie, where we discuss the latest in marketing strategies, contact marketing, direct response marketing, and business development with some of the leading experts in the industry.

Dr. Kevin Christie: [00:00:00] All right. Welcome to the show, David. I really appreciate your time today. Excited to dive into a fresh topic. Uh, we are actually pulling up on our seven years of this podcast. Uh, never missed a week in those seven years. And somehow we have glossed over this topic of add on services to a evidence based chiropractic practice.

Uh, before we, we jump into that, tell us a little bit about yourself personally and professionally, and we'll get into it.

Dr. David Rudnick: Right. Thanks for having me on doc. I really appreciate it. And congrats on seven years. Um, my name is dr David Rudnick. I'm a diplomat, American Academy Board of Sports Physicians. I practice in West Boynton Beach.

Um, I've been in practice for about 16 years, uh, owned my own practice for about, uh, 14 and a half 15 years. and I have a fairly exclusive sports medicine, active care, active population based practice. A lot of youth athletes, a lot of active adults, and um, [00:01:00] professional and amateur athletes is what I focus on during the day.

Dr. Kevin Christie: We're not too far away from each other. Uh, I actually grew up in that area. Um,

Dr. David Rudnick: yeah,

Dr. Kevin Christie: I think we're about what, 25, 30 minutes away, uh, which is, which is good and gotten to know you over the last handful of years, and it's been cool to, to see the growth that you've had, uh, which, which, which is awesome. But where did you go to chiropractic school?

I forget.

Dr. David Rudnick: I went to National University of Health Science in Chicago. So this was before they had the Florida location. I went to National, graduated from there in 2007. Uh, opened my practice in 2009. I was an associate for about a year and a half. Um, until I came out to West Boynton.

Dr. Kevin Christie: Perfect. Yeah. Um, and then we were kind of around that same age group.

I graduated no five from, from Logan, but yeah, there was no Florida chiropractic schools back when we were matriculating in. So we kind of had to go somewhere else, right?

Dr. David Rudnick: There was barely a Palmer. Palmer was in its first year when I was about two or three years in. So, [00:02:00] yeah,

Dr. Kevin Christie: I almost got lucky when I was at Florida state university for undergrad.

Um, they were really flirting with that chiropractic school. At Florida state, uh, and it would have actually lined up right when I would have graduated. Uh, but I don't think I would have stayed because I needed to get out of there to focus on studies.

Dr. David Rudnick: I understand.

Dr. Kevin Christie: Yeah. Yeah.

Dr. David Rudnick: I see, uh, Pittsburgh actually created its, uh, first university based chiropractic school.

So that's exciting.

Dr. Kevin Christie: Yes, it is exciting. And it was something that I, I was riffing on something. I forget where I can, I can never remember half the time where I said what, but, um, you know, there's, There's a lot of challenges in chiropractic, right? There, there's just no doubt about that. Um, but there's a lot of chiropractors doing a lot of great things.

And, oh, I know what it was. Someone had posted, Chris Chippendale had posted about, uh, and him and I are going to have a podcast about it, but, uh, optimism versus cynicism. And we're kind of talking about optimism and I use the [00:03:00] University of Pitt as a, as an example of, of some chiropractors being overly optimistic and, and in making something happen, which is pretty cool.

Dr. David Rudnick: No, it's great. I hope it, uh, benefits profession in the long run. So.

Dr. Kevin Christie: Yeah, I think it will. Um, so we're going to dive into add on services, you know, uh, tell, tell us a little bit about what your services are that you add on. And then the listener can really just, uh, they can make, they can connect the dots if they're not offering shockwave, but they're offering something else that's not covered by insurance.

They can, they can obviously take, they can extrapolate out for sure.

Dr. David Rudnick: So let me give you a little evolution of how that was based. I, Open my practice in 2009, like I said, and I was fairly a largely exclusively insurance based practice. I took 4 of the major policies. Um, back then I was, I was participating with Medicare.

Um, I was just trying to do it all because I came from a practice [00:04:00] that was mostly insurance base. Somewhat cash. And, uh, and some P. I. So that's what I knew. And that's what I felt like I could develop off of. So that was going well. I was obviously growing and ready to expand a little bit, but I felt like as insurances were getting further and further away of benefiting the patient.

I needed to, as my knowledge base, my confidence grew as a, as a patient. Physician, I needed to be able to expand on that and, and help my growth. So, um, and asset to, you know, listening to, um, uh, your podcast and, and, and, uh, forward thinking things and those, those mediums and listening to my colleagues that were doing it and not doing it from a sales point of view, but from a, clinical benefit to the patient point of view, that gave me the confidence to, um, to expand on that and I think do it well.

So when I went and, uh, decided to expand my expertise and, and kind [00:05:00] of owning my craft, and that's what led me into being able to do this more confidently. I went and did my CCSP, my chiropractic sports physician, um, Certification in 2015 2016. Um, then I expanded my office to where I am now. I added about 1000 to 1200 square feet.

Um, I have a gym in here now. I added a couple extra rooms. I added some equipment and then I went on and did my diplomate that I finished in 2018. And now I felt like I could start owning my craft a little bit as a sports chiropractor. And when I walk into a room with a patient. Um, people are generally coming to me because somebody had benefit in, in my office or an orthopedist knows what we do from a clinical care standpoint and a, in a high level care standpoint.

And now I can walk into a room and a patient's not going, I'm just going to hear another sales pitch. They're hearing a very thorough exam. They're, [00:06:00] they're hearing my, uh, assessment from a different angle. And I'm giving them options. I'm telling them that we can. We can jerk around with your knee for another seven, eight, nine, 10 weeks, but you're already frustrated.

You've already come from X, Y, and Z treatments and you've tried muscle stim and you tried some adjusting and you tried, um, general PT before. But what am I able to offer you? That's different because my adjustments, no different than Dr. Smith's adjustment, right? My ultrasound is no different than that.

But what I do know is I have modalities. that can now regenerate tissue, right? And I do that with shockwave. We can stimulate stem cells. We can stimulate growth factors and that inflammation that you're looking for and that you've been searching for reducing. That's not the end all be all. We need to, we can reduce inflammation overnight, but how can we regenerate tissue to allow that arm, that leg, that hip [00:07:00] tolerate load.

So you can go back to playing pickleball, tennis, golf, or you're a college athlete. How can we now make that tissue last longer on a field. So you don't have this recurrency. And here's what I can offer you from that modality. Yes. There's a cost to it. Blue Cross doesn't buy into regenerative medicine and, and, um, and, and curing something, but Unfortunately, the pro athlete gets it, they get it 24 hours a day and we want to treat you the same.

So here's, here's our options. We can still jerk around with the other modalities or here's what we got. How much is it? Oh, it's only 105 a visit. Oh, that's it. That's okay. Let's do that. How many of us do you think I need? Well, if you're not getting benefit by five or six, we're cutting the treatment. We're going to go search for something else.

Oh, okay. Well, that's reasonable. I spoke to them honestly, as a patient and a person. And sometimes they don't even ask me how much it is. They go, that's great. Let's [00:08:00] just do that because they're looking for that treatment. That next phase, that next step.

Dr. Kevin Christie: It makes a lot of sense. And I think some of the hurdles you addressed that a lot of chiropractors are thinking to themselves about this is, um, you know, I don't want to sell.

They're also unfortunate. A lot of people have a little bit of a poverty mindset and they're making, they're putting. Their financial hangups in the way of the buying decision that the other person wants to make. Right. Um, that's, that's problem. We'll tackle that for sure. I want to first kind of go on a little bit of a, uh, soapbox here for, for chiropractors is that.

Um, the more and more I talk to chiropractors, there's a lot of chiropractors that are frustrated with the insurance reimbursement. And I get it. And you and I went through hell with it because we're of that, um, experience level where when we were in network with insurances and no nine and 10 and 11, it was paying fairly.

It was, [00:09:00] it was fair. It wasn't great, but it was fair. And then they, they really put the hammer to us and, you know, some decided to go out and work. Some stayed. It network, but I'm seeing a lot of really good in network practices who are offering other great ancillary services, um, be able to get an office visit average dollar amount.

That is fair. So, yeah, maybe the, there's the 1 blue cross patient comes in and you get 45 dollars for it, but then the other blue cross patient comes in. And you get the 45 plus they buy a shock waiver, a dry needling or a laser package. And now that visit actually was a fair visit for everybody involved.

My visit average

Dr. David Rudnick: went up 300%. That's the point.

Dr. Kevin Christie: And I was, I was going to ask you, so I'm glad you mentioned it. Um, it can be done. You don't, you, you, if you do it right. And then obviously if you are in a state like Florida and there's a lot of other ones where if you can get a handful of personal injury, it pays really well.

Do you get a little bit of personal injury here [00:10:00] and there?

Dr. David Rudnick: No, I, I've chosen to only take personal injury patients that are current patients of mine. Um, it allows me to sleep better at night. I know that I'm, some of our colleagues will probably drive me into the ground for saying that. Um, but it, it's just less stressful.

My staff is less stressful on me. It's not the population I want to focus on. Um, I know I can fix a cuff in four to six weeks and it doesn't take three years. So that's just, That's just my niche and what I've tried to stay away from. If I know the person and they're a good patient of mine, I'll take a case if they're involved in it.

Dr. Kevin Christie: Yeah, no, I totally, totally get that. Um, I do know some chiropractors in Florida that, um, you know, great practices that are in network with insurances, but they end up getting. You know, four or five autos a month, and they're doing it the right way. It's still hard. It is hard on your staff, as you mentioned.

Uh, but that alone has kind of improved their office visit average. So, um, the, the moral of this little kind of story part is that you're providing [00:11:00] great care to the patient. You're able to provide them an option in your office. In network, and you are getting compensated well, and the profit margin is there.

Uh, so I want people to start looking at that angle, uh, when they're doing it now, let's tackle the sales component because you mentioned it doesn't have to come across as a sales job, which is great. Um, What, what do you think helped you get to the confidence level of just telling the patient what they need and letting them make the choice?

Where, what was the kind of process? And that's

Dr. David Rudnick: exactly it. It's, it's letting the person make the choice. It's not telling the person, this is what you have to do. And if you don't leave my office with a 4, 000 traction package, we're not going to treat you. And that's not the type of office I have. Um, I have a very big toolbox.

Sometimes it's difficult to choose what, but let me give you an example of a gentleman Who actually came in today [00:12:00] and I had done his ACL rehab for him last fall. Um, Surgeon sent them to us for rehab because he knows that we work with that active population. He wanted good rehab. He didn't want them stuck in a Medicare PT center.

Um, you know, doing bands for the rest of his life. He wanted to get back to playing baseball and, um, wouldn't bat league stuff. And. Uh, so he sent over here. Anyway, he had a great experience with us. And we, we never did shockwave on him. It wasn't something that he was interested in back then, but he's had an ACL reconstruction back when he was in college.

So we're talking 20 years ago. Okay. And now his right knee is starting to bother him because the graph starting to loosen up. And he's got a little away in there, but he doesn't want surgery and it's not really a surgical knee. So he came into me literally today and he goes, my left knee is great. My right knee is starting to give me problems.

I know we talked about this a few months ago. Um, and what, what can we do? And I said, I remember us talking briefly [00:13:00] about shockwave. And peptides. So we have a nurse, an RN, and a medical director, um, as part of our office who offer that next bridge of regenerative medicine care of peptides, PRP, stem cells, um, and IV therapy.

So I implanted the seed in his head and I said, look, we're not going to heal all your things. Not a surgical patient. So this is the next level of thing. We left it. He calls me. He goes, let's talk about my knee. He goes, what can we do? I go, look, we're going to first get an MRI on your knee. We're going to define what's going on.

But he goes, I remember you talked to me about that shockwave and the PRP and he goes, I've done some, some research on it. So already he's already sold himself, right? So what do I do? I talked about literature. What is it going to do? It's going to reduce inflammation. It's going to, it's going to modulate inflammation.

It's going to help. Repair some of the tissue in there, the part of the tissue that I can repair. And that's ultimately your goal range of motion and repair. And obviously the exercises have been doing at home [00:14:00] and the other things he's gone through, he's gotten a cortisone in there and it just, and some, some hyaluronic acid.

So he's done X, Y, and Z. So now it drove him to asking about something else. He goes, it doesn't matter what it costs. So he's already sold himself on it. He's going to do BPC injections. He's going to do shockwave and he's going to do rehab. So I talked to him as a clinician. This is how it can benefit your thing.

Not It's going to take you 15 visits. And if you do this, and if you do that, what is it going to do from a literature standpoint? There's 9, 000 studies on shockwave. And I said, I talk about shockwave. It can apply to laser. It can apply to dry needling. You have to know the research and I don't talk to him from a money standpoint.

How is it going to benefit that patient? And the next one's going to come in. It's going to benefit them differently. So how am I going to relate to that person? This guy plays baseball. Right. How, how can he play with his kids play ball? How can he stay in the wooden bat league? How is it going to relate to them from a goal standpoint?[00:15:00]

Right now we're talking about clinical goals are very important to us. We never talk about money. My job is not money. I'm a clinician. How is it going to benefit them? How is it going to provide them relief? Or, or not and how is it not going to be applicable to them and create that humanistic side that emotional side to their issue.

Um, and, and that's how I present it. I'm, I don't do sales and if they go, you know what, I'm not really interested. Great. Let's stay with the other things that are in network. And you're going to get the person that's a 5 copay with Blue Cross, who's not active, who doesn't want to do this stuff. And I'm never going to mention it to him.

Never. There's literature in the waiting room. There's signs out there that say the cost of things. So they see it. And if they want to inquire about it, they do the sales for me, right? I'm not a salesman. I'm a clinician first. So I hope that answers the question.

Dr. Kevin Christie: No, it does. And that's why I had you on for this topic was because I could have brought someone on that's just a, you know, a born salesman and, and can sell beach at [00:16:00] the sand.

But I wanted to bring someone on that was a clinician that's doing a really effective job of Add on services in their practice without being so salesy. Now, if a person's listening to him, they happen to be really good at sales naturally, then even, you know, you'll, you'll do fine much

Dr. David Rudnick: easier.

Dr. Kevin Christie: It

Dr. David Rudnick: does.

Most of my patients get turned off from that, right? Maybe they're already come from that. They're, they're smarter. My, my, most of our area is upper middle class. Right. I mean, the average home price in my area is 850, 000. Most people are making 150, 000 to 200, 000 a year. They're not stupid, right? They're, they're not being sold.

They don't need to be sold. They're intelligent people. And if I talk to them at an intelligent level, they're going to respond to that. Some people go, they don't want to hear about stem cell stuff. And you're right. If I see the eye roll of I'm losing them, I don't need to talk about research, right? I'll back it down.

But, but I, you need to know your population. first, right? And if you know your population, then you can [00:17:00] speak to them at whatever level of clinical expertise you feel comfortable doing. But I know my patients are smart and I'm not here to talk to them dumb. Right. I don't need to show them an X ray and draw lines.

And I'm not that type of doc. Um, I'm here to tell them what they either haven't heard or elaborate on what they have heard from their orthopedists or their other sports docs or their PTs. And provide them something that they've missed out on. That's all.

Dr. Kevin Christie: This is great. You know, and I just think it, it's, um, it's important to realize too, that you're offering a lot of good things for, uh, for, for the patient.

And it's, uh, you got options and they can make decisions. It's about educating and you can build a really nice practice around it, even though, cause I just hear a lot of chiropractors. Complain too much about the situation with insurance. And I get that cost of living is expensive. All the things are hard, but you can do this in a way where you are providing great [00:18:00] care and you're able to build a cool practice.

Like you have to do it and then be able to offer more things, right. As, as you go along and it's, that's good to see. And it does take profit margin to do that. That doesn't need to be your sole purpose in life, but it is nice to have some meat on the bone to grow a great practice and build a great team.

Thank you. And I'm sure by increasing your office visit, visit average by 300%. It's helped to do that.

Dr. David Rudnick: Yeah. And the outcomes are there. The outcomes are right behind it. Somebody's walking out and going, Oh my God, that made my shoulder feel better. Do you think this can work on my husband's Achilles? He's got a really chronic.

And so you talk about, here's a sales thing. They've walked out. They've already scheduled a spouse, a kid, a neighbor. And I didn't even talk to them about their neighbor's issue. Does this also work on, they did it for me. And then I just talked clinically. Yes. It helps Achilles because of X, Y, and Z. Done,

Dr. Kevin Christie: right?

And that's the big difference between historically a lot of [00:19:00] chiropractors over the years have done too much of a burn and churn model where if you're trying to do a really hard sales job on say a massive Package of, you know, a 4, 000 package and you have to do a really hard sales job on that. Um, it can get tricky because you might convince someone instead of compel, you might convince them to make that purchase, but they kind of leave a little bit like, you know, and they're not going out telling their wife or husband and they're not really You know, telling all their friends, you got to go say they kind of like, uh, it's just like, let's give it a try.

But you know, they're not leaving like that. They're actually leaving compelled. And then they're excited about what they're getting themselves, um, you know, as far as a treatment. And then obviously they want to tell other people.

Dr. David Rudnick: Yeah. And you understand from the sports world, they're not here. Yeah. To jerk around for weeks or months on end, they need recovery quickly because something else [00:20:00] is coming up.

So if you can provide them that quick recovery, the marketing is easy because I don't have a marketing budget. My marketing budget is getting people better and they do the marketing for me. So people go, how much do you apply to marketing? I go, I don't, I spend time. That's it. Yeah. Time and good standard of care.

Dr. Kevin Christie: Yeah, let's, uh, let's get, get a little bit into the system or whatever. You know, the patient comes in, uh, you've, you've done your exam and all that type of stuff, and you sit down to go over things with them. What does it look like, uh, from when you recommend an add on service to when they go from your room to the front desk?

Are they presented, uh, with something like, what does that whole little system look like for you?

Dr. David Rudnick: Yeah. Um, my, my front, my office staff is not. They're not clinicians, right? I have my associates. I have my massage therapists. I have my, my nurse. We're the clinicians. So the front desk is there to receive phone calls, send out notes, write back emails, [00:21:00] right?

Send out records, um, check out the patient, right? But they're not there to sell anybody on anything. So, um, I already have a good idea of what that person's coming in for before so that the front desk does that. They do a really good job triaging. That person, if it's they vet them, if it's not something that they feel like we can help them with, they won't schedule them, which automatically increases our efficacy and our outcomes, because that person's coming in and probably going to get helped.

So, um, let's give an example. Um, you know what? I had a really competitive. Elite level of pickleballer that was in, um, a few weeks ago and she, uh, had already been to ortho. She has a grade 2 tear of her, um, extensive corporeal radialis brevis. She already came in with her imaging. She's had a cortisone injection, actually, maybe even two, which, you know, that's a whole other story, but, um, she, she failed some home PT.[00:22:00]

Surgeons recommending surgery, doesn't want surgery. What else is there? Okay, so great. So the person that's come in trying X, Y, and Z, and I offer A, B, and C along with X, Y, and Z, so that makes for a little easier conversation. So let's use that as an example. They sit down on the table. We already have our diagnosis.

You've tried A, B, and C. My A, B, and C is no different. I have X, Y, and Z. My X, Y, and Z offer is consists of extracorporeal shockwave. We have two different types. We have dry needling techniques and we have extensive rehab. Okay. We also have, um, a little bridge that we can, uh, get it outside the box with peptides and, uh, or PRP.

The people are very astute. They're familiar with these terms now, which is also very helpful. Some people are not, but you talk peptides, you talk regenerative medicine, and [00:23:00] I think it's been around for just long enough that now you're speaking something that people are a little bit aware of. So how can those help you?

Okay, look, you have a tear. Advil is not going to help your tear, right? Exercises you've been doing, but we need to regenerate that tissue a little bit more than a wrist extension exercise and a shoulder exercise. How can we do that? Shockwave does this. It regenerates tissue by, by promoting stem cells, by promoting growth factors.

And we can take these fibers. and that are separated and start to bring them back together. Does that happen overnight? No, but pain modulation does. You can now grip a coffee cup fairly quickly with that. So now you can work on your strength exercises are going to be a little bit more effective to you.

We're going to stay away from cortisone because that's just going to break tissue down, right? You don't have an inflammatory problem. You have a discrepancy of that tissue. So I give them the paper tear analogy, right? We can work on paper that has little, little micro slits in it. [00:24:00] That's fine. But if we keep writing on those paper, that paper that has little razor slits, those razor slits are going to become bigger.

We don't need bigger razor slits because now the paper is not viable anymore. Um, I plant, uh, peptide seeds if that's something they want to do because they got to be competition coming up and we can accelerate their healing by 30 to 50%. So. Now the buy in from the patient, Oh, you have something different than I've.

been offered before. I don't want surgery. I've done cortisone. I've done PT. I've heated, iced Advil beyond. What do you have? So here it is. That's, that's all I talk to them clinically of how it's going to affect their problem. Never even spoke dollars, right? Some people ask, some people don't. I know, unfortunately, 9, 000 papers in the literature and Blue Cross doesn't believe that it's an effective modality to pay for.

So, but there, I think people are also becoming very smart to insurance is not their friend. [00:25:00] It's just something they pay for. If they lose a limb or have a stroke, it's an amazing thing because a million dollar hospital bill is gonna become a $50,000 hospital bill. Yeah, so I think in 2024 it's different than 1999 and people are a little bit more astute that.

Insurance is not their friend.

Dr. Kevin Christie: It's a good point. People aren't shocked anymore that their visit, you know, isn't 20 bucks only, you know, like they're not expecting that they just don't want to break the bank in bad situations, obviously. And so, okay, you've had the great conversation. You educate. Oh, that's one thing I appreciate is like, you're doing a great job.

Great job with them of like communicating and educating, which is so much better than selling. Um, it, it, it inherently has a more credibility enhancing aspect to it and it sells itself. So now they, you know, someone walks into the, to the front and it's, it's time to, to pay. Do they just go over what the cost is directly or are they giving them options?

Dr. David Rudnick: Yup. The people that ask me, obviously I'll tell them what the cost is, [00:26:00] right? We're just, we're being humans. We're having a conversation. Um, If they don't, then, you know, Hey, you know what, talk to Karina about packages. It'll save you a little bit of money. But the other thing is, is we're not doing this 15, 20, 25 visit thing.

If they're not improving in a few weeks, just pain wise, a range of motion wise, it's not the modality for them. So I think they appreciate that of, we're not drawing something out. If we're not seeing clinical efficacy in 3, 4, 5 weeks for something that's acute to subacute, we're on the wrong track. So, hey, we have a package of 5 or a package of 10.

Our 10 packages are reserved for OA, complex issues, maybe multiple areas that we're going to be working on, and they're going to, you know, buy a 10 package so they can save a little bit more money. But I don't think people get shied away from 5. Right. 5 is not scary. 5 is 3, 4, 5 weeks, right? [00:27:00] 1 to 2 days a week for 3, 4, 5 weeks.

People aren't scared with that. Um, no, it's true. That's the other thing is presenting it in a very palliative manner so they're not getting scared. But again, we didn't talk to them from a sales perspective. We talked to them as a clinician to a patient. Um, there's no minute, uh, laminated form that I put in front of them and go pick package a through C, right?

I don't go to an ortho and they go pick your surgery package. They go, this is what we're going to do because this is how it's going to help you. And there is no form. There is no sales thing. I have literally one and I think I've sent it to you. I have one little thing up front that shows our three cash services that we offer.

And then our IV services, but our three cash services, acupuncture, dry kneeling, shockwave, it's up there. It's spelled out to the patient with a little thing underneath that says a package of five and a package of 10. We're not hiding anything from anybody. This is what it is. There's no, [00:28:00] there's no hidden fee.

There's no anything. It's, If you want these things, here's what they cost. And that's it.

Dr. Kevin Christie: No, I like it. It makes it easy. I think we're, we're the packages. Things have struggled in the past for, for people is that a lot of times it's been tied into crazy length of period of time, right? Six months, a year. Uh, so that's been, been.

Tricky for sure for us to overcome that as a profession. And then I think on the other end, sometimes if it's a, uh, if it's a real large package, um, you know, it's four or five, 6, 000 and it's, and it's a short period of time, it's only eight, nine, 10, 11, 12 visits. Now you got a lot of money per visit. If they're not getting better.

Uh, after that, they, they get a little frustrated for spending, you know, five, six, 7, 000, uh, different things. But, um,

Dr. David Rudnick: this is everything is based on clinical efficacy and literature. Um, so some people ask me where, where are the studies they want to see it, right. And everything's based on one to two days a [00:29:00] week for three to six weeks.

Yeah, we see it. I'm not making it up. I'm reading the studies and just regurgitating that to a patient. So there's clinical rationale. There's clinical efficacy. There's an algorithm that's built around it. Not. Well, I don't know where 6 months to a year comes about when you. Bill, the treatment plan for somebody, I don't know where it comes from.

We got God bless the people that actually buy into that. And, but you know what? I probably don't want that patient

Dr. Kevin Christie: either. No, I get it. Um, so, you know, I, part of this. Conversation was a couple fold. It was brought up a couple of times to me. And then, and then selfishly, I got my first shockwave, which I'm excited about.

Thank you for, for helping me make that decision. And, uh, you know, it was great to, to work with Keenest medical on that. Um, you've been having a, um. Big role in the education shot side. I do want to take a minute to, to talk about Shockwave, um, on the education side. So tell us a little bit about that.

You're, you're traveling with [00:30:00] that. You're educating. It's been pretty cool to see how did you get involved in that and how are you liking it?

Dr. David Rudnick: Yup. So, um, back in, uh, 2016, I think I was out at, um, um, ACBSPs, American Academy Board of Sports Physicians, um, one of their symposiums out in Utah. And I was actually out there to, uh, Get my CEs for my diplomate, but I was also out there to buy a new laser.

And I sat in a couple of. Um, seminars there on tendinopathies and, and some other sports injury things. And they were actually both speaking, they were both orthopedists that were speaking. And one primarily was with the Utah Jazz team orthopedist. And he was talking about Achilles tendinopathy and some other ankle chronic impingement syndromes.

And I never heard him talk laser. And previously laser was, you know, huge in the redundant market and the And sports medicine, and he kept talking about a real shockwave, which I was vaguely [00:31:00] familiar about but not to a clinical aspect. And I sat there on my phone and my laptop and I'm typing in extracorporeal shockwave studies as he's talking.

And I walked out of that seminar and I went to the vendors and I started like searching for the shockwave ones. And. I went up to a couple and they were really salesy and I really wasn't too keen on it. And there was several different types of shockwaves. Walked up to Keenest's booth and the owner is there.

He, it's a mom and pop company. Um, and he was That, that humanistic side, right? But we're talking about how I talk to patients. He was talking to me as a clinician and not as a salesman talking to, to me. And I, I, um, I, uh, grasp onto that very quickly. Um, so anyway, um, they were very kind and I said, I'm not really sure.

He goes, look, read about the different types of shockwave. You have to know what's best for your practice and we'll [00:32:00] talk. So I called them back like a week later. I said, I really want to try this. He goes, look. I'm going to send you a unit. It goes, try it for five days. If you don't like it, put it in the packaging, send it back, pay for the shipping.

I go, great. So I booked a bunch of patients that week on the first five patients that day, I was already sold that this was a modality that I wanted to incorporate, right? Because the clinical efficacy, I was improving range of motion, reducing pain and, uh, and improving inflammation in like a session or two.

So, um, that's how I got into using shockwave. I became highly educated in it because I wanted to teach my patients of why it was going to be beneficial. I didn't just plug something in the wall. And say, hopefully it works. And then tell my staff, this is how you use it. I used it on every patient. I didn't even have my staff do it.

I wanted to know that it was working. Um, so long story short, because I was having success with it and I was becoming very educated, I Um, and they were seeing that there was a lack of [00:33:00] education in the shockwave market. They created a, uh, a company called the America, the, um, uh, Academy of shockwave excellence, which is an education company to educate clinicians that have shockwave.

We generally don't even educate on people that don't have the, uh, uh, the technology and it's not a company thing. It's not a brand thing. You could have PISA wave. You could have electro hydraulic. You could have electromagnetic, which is what, um, starts and key and keenest sell and what I have. Um, so it was an education thing to provide the clinician with more hands on training, to be able to give that information to the patient.

You go, how do you sell it? Here, here's education. We get clinicians from all over the country and the world to teach the doctors the most recent literature and how to provide hands on technique and training to their staff, to themselves, to provide efficacious treatment. So I've been doing that with them for about two years now.

Um, it's obviously made me a [00:34:00] clinical expert in, uh, the modality. Um, and I, I highly enjoy it cause I love educating. Um, and I love educating on a modality that has transformed my practice that then I get feedback with it's transformed yours. And I can't wait till you see, it's going to do the same thing to your patients.

It's amazing. Yeah.

Dr. Kevin Christie: We're excited. And, you know, it's, it's just cool to see how, you know, you, you come at this from a clinical mindset as an educator as well, now you've, you know, I don't know if you've ever had it or have overcome it, but you don't have that kind of poverty mindset where you're just like worried about what the patient's going to say about the cost of it.

And ultimately it's help you build a, just a really awesome, phenomenal practice. And I want more of that from chiropractors. I just think too many. Of the ones that are in the clinician slash educator role. They have this negative mindset that, well, you, you can't be good at business or you can't have this big practice unless you're doing something wrong.

[00:35:00] Um, and, and I got into a, a Facebook back and forth, not that long ago about it, where there are some evidence based chiropractors that are convinced that the only ones doing well, um, in practice are the ones doing, uh, pseudoscience and doing things wrong. And I just. I know it's not the case. And, and that was ultimately why I wanted to bring you on.

I'll tell you another quick story.

Dr. David Rudnick: Um, actually that gave me more confidence in it. So, um, my middle brother, he's a pediatrician. Okay. So I had already started my practice. I was probably in practice for about six, seven years prior to him opening his. And most pediatricians take insurance. You would write like 99.

9 percent of them. And he never did. He wanted to create this concierge pediatric model, right? He's right down the road from you. Um, both of the pediatrics and I go, you are out of your mind. No new parent is going to pay 2, 500, 3, 000 a year and then pay for 2 kids. You are crazy. I said, but all the [00:36:00] best to you.

You'll be a network of blue cross in no time. And he proved me wrong. He's open to practices. He's hired six doctors. Um, he's going to be expanding, expanding. And, um, he proved me wrong because he took a very big model that you think is fairly insurance based. And he created the concierge model of high quality care, right?

You want to take a picture of your kid's poop at 3 a. m. and text it to them, they're going to answer you back, right? And he created this, this high clinical efficacy and standard of care and not, there's no sales, they're pediatricians, right? I mean, you can't sell anybody anything, but he created a high standard of care that didn't involve the insurance model that lowers that.

And I took that and I go, look, if you can do it at the pediatric level to a new parent. Then you can do it to a group of people that, um, are, are, are not that. So

Dr. Kevin Christie: that's cool. That's cool. And I just think a lot of [00:37:00] chiropractors need to really consider this because I, you know, I did make the decision when insurance got back, cause I did build my practice in network, which I've mentioned on here a lot.

And I decided to go to the out of network route once it got. Bad. Um, and that's been positive. There's always some drawbacks to it. Uh, being in Boca Raton helps it's very affluent. So it does definitely help. I get a lot of chiropractors in areas where it might not support that. It is a lot harder to build a cash or at any work practice.

Um, it can really be a good thing to be in network with insurance. So I'm not one of those, uh, that scream from the rooftop. Don't take insurance. But if you are in network with insurance. I do think you need to look at some of these great services that are going to get your patients better. Um, but also going to help you a little bit to avoid that commoditization trap that the insurance company wants you to be in.

And so you get a little more of a well rounded practice with it. And it's obviously something that you've done. So [00:38:00] I commend you for that.

Dr. David Rudnick: It can, it can be done seven out of 10 of our patients are insurance based and two thirds of those Utilize a cash modality in our office.

Dr. Kevin Christie: That's I'm glad you brought that set up.

Cause that's so seven out of 10 are insurance. And then two thirds of those seven are using some kind of cash paying for, for an add on. And then obviously the three out of the 10 are already cash services. So you've, you've kind of, in a sense, escaped the insurance. Model

Dr. David Rudnick: beyond. Yeah. I have a very few amount that are just a copay that you're getting your 45 bucks, right?

Cool, and they'll transition themselves to that. When they don't see the, the improvement that they're looking for that we, you know, told them they may not experience. So

Dr. Kevin Christie: awesome. Plus, you know, it just opens you up and I'll kind of leave it at this. It opens your practice up to a whole other level of conditions that you may not have been able to treat before, which is in itself a [00:39:00] practice builder.

Dr. David Rudnick: Yep. You see another market. You talk about getting more patients in the office. If you have something that can help another group of patient that automatically filters in more people, right? If you don't treat, um, chronic Achilles issues because you don't have the means to do it. There's a modality out there, um, to do that.

Dr. Kevin Christie: Or you're treating the Achilles and not getting the results and then you're not getting the referrals.

Dr. David Rudnick: I'll tell you what, fracture. Um, I, we never treated fracture before, right? And then no modalities to treat acute fracture. Well, focus shockwave treats acute fracture because you get a mesenchymal stem cell activation and an osteoblastic.

Activation and we can reduce healing time by 30 to 50 percent in acute fractures. So, um, I wasn't seeing fracture patients now and now I do.

Dr. Kevin Christie: No, it's good. And then I think the other thing to, to, you know, there's a lot of different companies out there, but a lot of times people look at the costs of [00:40:00] different things, lasers and shock waves and this and that, and it can be a big price tag, but many of them have very competitive financing options for you where it just gets worked into your, into your, Cashflow, um, you'll, you'll end up bringing in more revenue that can easily pay the, the monthly payment for it.

So, um, don't, you know, I'm not saying don't pay cash for it. If you have the cash, great, but don't let that be a barrier. Uh, you know, sometimes when you own a business, you do need to take on some business debt to grow. And this could be one of those where it's a pretty fair financing situation for it.

Dr. David Rudnick: Yes.

If you take your, if you take your, your profits from. Uh, from that modality. My first shockwave I paid off in less than six months. Mm-Hmm. Um, I didn't take, if there was somebody that paid for it that went into a pot and that went to payments, I didn't draw any of that off for business expenses or anything else that went purely to the payments.

And I paid it off in just under five and a half months. Um, my first one, it doesn't have to take me three years. ,

Dr. Kevin Christie: that's a very, that's a very smart [00:41:00] business move. You know, it's like, 'cause you might have six to 12 months before you actually have to pay on it, and then you just pay it off . So, yeah. Cool.

Awesome. And then, uh, this is recorded before we'll see each other in Nashville for our mastermind. I'm excited to have you join us for our mastermind group this year. It's going to be great. Uh, you'll be doing an each one teach one to our group on, on a shockwave, which will be awesome. I know this episode will come out after that weekend, but, uh, looking forward to hanging out with you and learning.

Dr. David Rudnick: Yep. I'm really excited for that, uh, mastermind group. I'm looking forward to meeting everybody in it. Thanks for putting it on.

Dr. Kevin Christie: Of course, man. Well, listen, this was phenomenal. I really appreciate your efforts in, uh, no, not just, uh, you know, on this podcast today, but what you're doing to educate the profession and then obviously what you're doing in your community.

Dr. David Rudnick: Same with you, doc. Really appreciate it.