The expansion of the Affordable Care Act has made insurance policies with $10,000 to $15,000 deductibles commonplace.
Savvy healthcare consumers are making more cautious decisions about where to spend their discretionary healthcare dollars than ever before. This leaves many chiropractors struggling with the choice of being a cash- or insurance-based practice.
This leads many to question if the increased demands upon their and their employees’ time that come with accepting insurance is a viable business model for their practice future. Many chiropractors facing this dilemma feel that they must choose between either cash or insurance as an “all-in” or “all- out” strategy, but this doesn’t have to be the case.
The either-or scenario
Chiropractors who choose to opt out of insurance panels do so because they think removing the burdens of dealing with third-party reimbursement will reduce their level of stress and free them to offer patients more affordable payment options. Many times, these practices offer services at reduced fees. Due to their lower fees, seeing a high volume of patients is often the only way that these chiropractors can generate a level of income that supports their overhead and lifestyle.
DCs who choose to focus solely on the insurance-based model of care confront a different set of problems. With increased limitations on chiropractic coverage, including the number of visits allowed, these practitioners often tailor their patient recommendations to the level of services covered by third-party payers. Practicing to meet the requirements of insurance payers takes the focus away from patients’ health needs.
Some chiropractors end up placing themselves and their practice in jeopardy because of their lack of knowledge of the significant regulatory and compliance requirements that remain in place whether they decide to accept insurance or not. The “let’s-make-a- deal” payment plans offered by both cash-only and insurance-based practices walk a fine line between legal and illegal. Offering the same service for different fees is considered a dual fee schedule and is not permitted.
Blend the best of both
It’s no wonder chiropractors are confused, but it is possible to create a practice that blends the best of both cash and insurance reimbursement. Your practice can deliver affordable care to a high volume of patients, while still meeting the requirements of insurance billing. This may be easier to achieve than you think.
The first step is to establish a compliant fee schedule that allows you to accept limited insurance coverage while still offering your patients legal discounts. This can only be done by joining a recognized Discount Medical Plan Organization (DMPO) and creating a cash-based fee schedule that is published and available to all patients regardless of their level of (or lack of) insurance coverage.
A DMPO allows you to blend covered and uncovered services into an affordable payment plan that fits the financial requirements of care into a patient’s family budget. It also allows you to inform patients what their financial responsibility will be from their very first visit. This removes stress from providers, practice employees, and patients alike.
Moments of truth
A blended practice has a system of compliant patient-care procedures that begin with a new patient’s first inter- actions with your practice. How your team handles these moments of truth is essential to your success.
Patients make both conscious and subconscious decisions as to how much they are willing to spend when they purchase care from you. You can build the perceived value for your care by creating an extraordinary first visit for your new patients.
To consistently achieve this high level of perceived value requires you to take a fresh look at the services you provide on a patient’s first visit. These include your consultation and examination procedures.
Build value with your examination
New-patient procedures begin with the consultation, during while you let patients know that you’ll be listening closely to the answers they provide to the questions you ask them while taking their history. Let them know that their answers will guide you in the choice of tests you perform and instruments you use during their exam. Make them aware that this allows you to customize their examination to determine the cause of their condition.
Custom-designed items and services carry a higher perceived value than off-the-shelf generic counterparts. By informing the patient they will be receiving a customized exam, you increase the value they will place upon your service.
You can add tremendous value to your examination procedures simply by recording them with a digital recorder. Inform the patient that you record all of your examinations and get their permission for the recording.
As you examine the patient, call out your findings to the recorder. Rather than the typical silence on the part of the examiner, which can be confusing and unsettling to the patient, you’ll be providing value-building information. A patient undergoing a straight leg raise (Lasègue) test may think you are simply lifting their leg until it hurts.
Calling out the finding “Lasègue test positive on the right-hand side at 45 out of 90 degrees for L5 nerve root tension,” lets the patient know you have found something amiss.
This will limit much of what is covered in a traditional report of findings (ROF) because the patient has listened to your report during the examination process. This also raises the value of the entire procedure and shows the patient that you are actively examining them to uncover the cause of their problem.
Build value with your report of findings
I counsel my clients to avoid adjusting new patients on their first visit. But providing palliative therapies to decrease pain and inflammation is encouraged. Adjusting the patient immediately following their examination decreases the perceived value of your care exponentially. How significant could the patient’s problem be if you deter- mined the cause and applied the correction within minutes of meeting them?
If you must deliver an adjustment on the patient’s first visit, it would be beneficial to send the patient home for several hours to rest while you review your exam findings and create your plan of care. Have the patient return later in the day for their report.
Having the patient return for their ROF and first adjustment gives your practice team time to verify insurance benefits. You will know the patient’s level of coverage and have created an initial plan of care. You can now estimate the patient’s financial responsibility for their course of care and create a payment plan without the stress of having to do it on the spot. You can then deliver a financial consultation to the patient immediately following their ROF.
Begin your ROF by confirming to the patient that your examination uncovered the cause of their condition and that you have the ability to provide them with the care they need. At this point, patients will be concerned with two primary questions: how long will it take and how much will it cost?
A blended practice, using a compliant DMPO fee schedule, can make a recommendation for care based on what the patient needs and not what their insurance does or doesn’t cover. This allows you to give the patient your recommendations for care based upon your estimation of how long it will take for their condition to resolve and not their financial circumstances.
Increase case acceptance
Add these steps to your new patient procedures and you can increase the value of your care. By handling patient finances skillfully and upfront through a blend of insurance and cash into a unified payment plan, you can decrease stress and increase case acceptance.
Patients are more likely to follow through with your recommendations when their financial commitment has been taken care of in advance and their perceived value of your service is at its highest level.
Mark Sanna, DC, ACRB Level II, FICC, is a member of the Chiropractic Summit, the ACA Governor’s Advisory Cabinet and a board member of the Foundation for Chiropractic Progress. He is the president and CEO of Breakthrough Coaching. He can be reached at 800-723- 8423 or through mybreakthrough.com.
