Are You Running a Practice… or a Charity?

Let’s start with a little tough love.

If you don’t know what it costs you to deliver a visit, you are not running a business. You’re running a guessing game. And sometimes? A charity.

I say that with respect.

Chiropractors are generous. They want to help. They want to serve. They don’t want money to be the barrier.

But generosity without clarity can turn into resentment, anxiety, Sunday night dread, a loss of revenue, and a loss of heart.

So let’s simplify this.

There are only two things you need to stay out of the charity lane.

Step 1: Review Your Fee Schedule (At Least Annually)

Many doctors set their fees once… and never look at them again. Most doctors wait years between fee schedule updates.

Meanwhile, Medicare updates reimbursement every year and publishes the update of the Medicare Physician Fee Schedule (PFS).

If Medicare updates reimbursement annually, and you don’t even glance at your fee schedule, what does that say about you, and your business structures? You’re flying blind.

This matters whether you:

• Accept insurance and assign benefits

• Run a cash practice and provide superbills

• Or operate a hybrid model

Your fees should reflect current reality — not what felt right five years ago.

This isn’t about fear. It’s about stewardship. And stewardship requires math.

Step 2: Know Your Cost to Deliver a Visit

Your cost to deliver a visit includes your overhead — doctor pay, staff wages, and operating expenses.

That’s it. That’s the number. And it’s a critical number — because it drives every decision you make about insurance contracts and patient discounts. If you’re discounting services in any way, make sure you’re doing it legally and compliantly. ChiroHealthUSA is a trusted resource that helps chiropractors structure compliant discount programs. Guessing here is not the move.

Let’s say it costs you $45 to deliver one adjustment.

Based on RVUs, that service may be valued around $130–$150.

What if an insurance company offers to reimburse you $41.

That’s a $4 loss per visit.

Not theoretical. Not emotional. Mathematical.

If you see 100 of those visits in a week, that’s paying $400 to work that week. $1,600 in a month. $19,200 in a year.

That’s not “building community.” That’s subsidizing an insurance company.

So you can see that you cannot make empowered contract decisions unless you know your true cost per visit.

The Quiet Trap

Here’s what happens. A chiropractor tells herself it’s just part of healthcare. She doesn’t want to disrupt patients. She assumes everyone else is making it work.

Meanwhile, prices have gone up. Overhead, wages, rent — all of it. If your fees haven’t, you’re absorbing the difference.

That shows up as burnout. Underpaying yourself. Delaying hires. Letting great staff go. Quiet financial stress that follows you home.

This isn’t workable. For the chiropractor, her patients, or her community.

Profit Is Not Selfish

Profit is not greed. Profit is oxygen.

Without a profit margin, your practice slowly suffocates — and so do you.

Knowing your numbers doesn’t make you less caring. It makes you, and your practice sustainable.

And sustainable chiropractors serve longer, better, and with far more peace.

Review your fees annually. Know your numbers quarterly. Lead your practice like it deserves to be led.

P.S. Want to know your cost to deliver a visit? Use the free Profit Engine™ Stats Calculator

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— Inspired by Chris Laping