The chiropractic year, from FSA deadlines to backpacks

Thanksgiving is behind us, and for a chiropractic practice the next three weeks behave differently from the rest of the year. Many of the people calling now are not in fresh pain. They have money left in a flexible spending account, or a deductible they finally met in the fall, and a sense that both run out on December 31.

Then Christmas week goes quiet, and January arrives with the opposite problem: deductibles back at zero, resolution patients, and in the northern states, snow on the driveway.

That is the calendar we plan chiropractic marketing around, and most of its swings are set by benefit rules rather than by symptoms.

December is the use-it-or-lose-it month

In Publication 969 the IRS describes flexible spending accounts as generally “use-it-or-lose-it” plans. An employer may soften that in one of two ways, never both: a grace period running as long as two and a half months past the end of the plan year, or a carryover of unused money into the next year, capped at $660 for 2025 plan years. Plenty of plans offer neither.

That changes what your front desk should say. A patient on a plan with the full grace period has until mid-March, one with a carryover keeps up to $660 and forfeits the rest, and one with neither loses the whole balance at midnight on New Year’s Eve. Your office cannot know which plan a patient holds, so the honest message is a prompt rather than a promise: check your balance and your plan’s deadline, and if you have care to finish, here are the open times before the holidays.

The numbers move again next year. On October 9 the IRS announced that the FSA contribution limit rises to $3,400 for the coming plan year and the carryover cap to $680. Patients making open enrollment elections now can set aside more, so a January note about fresh balances is worth sending too.

Two cautions before anything goes out:

• Medicare is not a use-your-benefits story. Medicare.gov says Part B covers only a chiropractor’s adjustment of the spine to correct a subluxation, and does not cover other services or tests a chiropractor orders, such as X-rays, massage therapy or acupuncture. The CMS benefit policy manual adds that maintenance therapy is not payable. A year-end email implying Medicare pays for a care plan misleads older patients.
• A reminder from the practice is allowed. HIPAA’s definition of marketing excludes a provider describing its own health care services, unless a third party pays for the message, so your own patient list is fair to write to. Keep clinical detail out anyway: “the care you started” reads better than a body part.

January brings full deductibles and frozen driveways

HealthCare.gov defines the deductible as the amount you pay for covered health care services before your insurance plan starts to pay. On a calendar-year plan it resets on January 1, so the insured patient who paid a copay in November pays the full visit again in January. Some put care off. Some ask about your cash rates for the first time. A plain page on what a visit costs before the deductible is met answers that before it becomes a canceled appointment.

The other January driver is physical. A Nationwide Children’s Hospital study released in January 2011 counted an average of about 11,500 snow shoveling injuries and emergencies treated in emergency departments each year from 1990 to 2006, with the lower back the most frequently injured region at 34%. In our experience the strained backs that never reach an emergency room turn into “chiropractor near me” searches the next morning, often before the office opens.

That search is settled on the map and on your Google Business Profile. A profile that shows a 9 am opening, no photos of the entrance and a reply gap on recent reviews loses the person holding their lower back to the practice that looks open. Sun Belt practices miss the snow bump entirely, and their winters run steadier.

After January, a date for every season

Once winter breaks the swings shrink, but each still lands on a predictable week.

February and March run on the grace period clock

Where an employer offers the grace period, the two and a half months on a calendar-year plan end around March 15. That sets up a second, smaller push in late February, aimed only at patients who mentioned unspent money in December. That note belongs in your CRM, not in someone’s memory.

Spring holds, summer thins

April and May bring yard work, gardening and weekend sports back, and the schedule usually holds. June and July thin out as patients travel, and July tends to be the slowest month of the year. Two jobs fit that lull, and neither needs ad money: reactivating patients who have not been in since spring, and asking the regulars who are still coming for a review.

August is backpacks and the school calendar

Back to school is a dependable bump. The American Chiropractic Association’s guidance is that a fully loaded backpack should come in at 10% of the child’s body weight or less. In 2019 the ACA cited Consumer Product Safety Commission figures estimating that about 7,800 children aged 5 to 18 were treated in emergency rooms in 2017 for backpack-related injuries.

For a practice, that is a reason to talk to parents who already come in, not to advertise to children. An August newsletter note with the 10% rule, plus an invitation to bring the bag to the next family visit, does more than a paid campaign. Fall sports and preseason training land in the same weeks.

October and November: the observance and the deductible sprint

October is National Chiropractic Health Month, which the ACA holds every year. It gives a local paper, a school newsletter or a chamber event a reason to feature a practice, and it arrives just as patients who have met their deductible start trying to finish care before the reset. That sprint runs into early December, where this calendar began.

What to do this month

• Send one email or text to active and recent patients before December 12: check your FSA balance and your plan’s deadline, then book before the holiday weeks. No clinical detail, no Medicare promises.
• Put holiday hours on your Google Business Profile now, including the days you close, so a January shoveling injury is not sent to a locked door.
• Write a short page on what a visit costs before and after the deductible, and link it from the January reminder.
• Tag patients who mention a grace period in your CRM, and schedule the late February reminder today.
• Reread your three newest review replies; none may confirm that the reviewer is a patient.
• Pencil in August now: the backpack note, the send date, and who writes it.

The practices with the calmest January are the ones that sent their reminders in December, and those reminders work best from a system that knows who is partway through a plan and who has lapsed. That is how we set up GoHighLevel for a practice. The rest of how we approach the trade, from offer disclosures to review replies, is on our page for chiropractors.