How to renew your clinical practice perspective

If you’re fretting about cash versus insurance, refocus your practice.

When you hear doctors talking at conventions, the conversation often turns to the frustrations of dealing with insurance companies and the nirvana some seem to have found with an all-cash practice. What’s interesting, however, is that the discussion rarely covers one of the most important points: What difference does it make? Or, better yet, what difference should it make?

Thinking back to chiropractic school, you won’t recall one anatomy textbook for cash patients and another for those with insurance. (The titles Neurology for the Insured and Radiologic Interpretation of the Cash-Paying Patient probably don’t ring a bell.)

Somewhere along the line, our profession began focusing on the wrong things. It started taking insurance reimbursement into consideration as if it were a critical decision-making tool when developing diagnoses, treatments, and care plans. To make matters worse, DCs started shaping their treatment recommendations based on what insurance covered rather than what the patient needed clinically.

In time, patients bought the lie that if insurance didn’t cover their care, they didn’t need it. Many DCs started recommending only the treatments that insurance companies deemed medically necessary.

My perspective was profoundly influenced after I practiced in a VA medical center where all care was paid for. When I knew money was no longer an issue, I didn’t hesitate to recommend care that patients needed. It was liberating as a practitioner and drastically changed my private practice.

Old habits are hard to break, but over time, my patients have had better outcomes as a result of my treating them rather than trying to treat their pocketbooks. I have tried to instill that mindset into our staff doctors and our practice has grown significantly as a result.

What are you thinking?

So rather than thinking, “Should I be an all-cash or an insurance-based practice?” instead ask, “How can I be a patient-centered practice regardless of who is paying the bill?” Clinically, is there a difference between a cash-paying and insured patient, both of whom are diagnosed with sciatica? Is there a “cash-based migraine” or “insurance-based cervicobrachial syndrome”? It sounds absurd, but when you allow payers to determine your treatment recommendations and clinical care, you are effectively making those types of distinctions.

Long ago the chiropractic payment system was a box on the wall that allowed patients to offer what they could afford in exchange for treatment, aka the “honor fee system.” At the opposite end of the spectrum, today there are many practices fully immersed in third-party reimbursement. Although the profession has come a long way, you also don’t want a world where insurance companies dictate what can and can’t be done on behalf of patients.

Overlook the labels that separate the cash-only practice from the insurance practice in favor of the chiropractic practice, an entity that unabashedly tells patients exactly what they need based on clinical findings and experience. Never hesitate to tell patients that their insurance is not designed to cover them from cradle to grave, and that what their insurance covers and what they need have nothing to do with each other. Begin educating your patients like chiropractors had to do long before insurance existed.

Wants versus needs

Your challenge is to find a way to position chiropractic as a means to live a happier, healthier, more functional life at every stage. But often people buy what they want, not necessarily what they need. So when patients say they can’t afford care, what they are really saying is, “You haven’t made me want it.”

Whether patients have insurance or not, the biggest roadblock they face isn’t always the overall cost of care. Rather, it’s how you present the treatment plan that makes the difference. Make your care a “want” by focusing on what’s important to patients, like playing with their grandkids or getting back into their favorite sport. Prevent money and insurance from interfering with the best course of action by having flexible but sound financial policies that keep you compliant and profitable.

So, should you be cash-based or insurance-based? Neither. Shift your focus back to the patient. In a perfect world, when patients fill out their intake forms, it wouldn’t matter what they write down. Your consults, exams, and treatment recommendations should be free from financial bias.

Perhaps at the next conference you attend, when a fellow doctor asks what kind of operation you run, you’ll feel inclined to simply say, “A chiropractic practice.”

Ray Foxworth, DC, is president of ChiroHealthUSA and a certified medical compliance specialist. He maintains his practice on NewSouth Professional Campus, home to a large multidisciplinary spine center, offering services ranging from chiropractic to neurosurgery. He is in the trenches on a daily basis facing the same challenges with billing, coding, and compliance issues as any DC does. He can be reached at info@chirohealthusa.com or through chirohealthusa.com.