You didn’t sign up for clinical care options and recommendations limited by medical coverage or insurance whims
While working as the staff chiropractor at the G.V. Sonny Montgomery VA Medical Center in Jackson, Miss., I learned a few things that opened my eyes when it came to my private practice. At the VA, there were no concerns about costs or insurance coverage, and I had the freedom to recommend clinical care options and recommendations that my patients needed, not what they could afford. It made me realize that at some point in my career, I had begun to buy into the narrative, “if it isn’t covered, it isn’t medically necessary.”
Cutting costs or care?
Increasingly insurance companies are overruling physicians’ recommended treatment plans in the name of cutting costs. This dynamic is problematic because in chiropractic, as trained and educated professionals, we base our decisions on the best available data, and apply what we know to be most useful to each clinical setting and patient. Insurance companies, on the other hand, are most concerned with risk and cost estimates (Campbell, 2016).
Is your practice missing an opportunity to grow? Mine certainly was. How often are providers around the country selectively providing care for patients based on their insurance coverage? But more importantly, how many patients are not receiving beneficial treatments that would help them to heal more quickly and efficiently because insurance does not cover a service or product?
Orthotics are a great example. There are significant benefits for many of our patients to wear custom orthotics. When covered by insurance, it’s easy for us to make the recommendation. When it’s not, we don’t even bring them up. I’ve heard so many of my colleagues say that they’re too expensive, and patients won’t pay for them out-of-pocket. In my experience, that is far from the truth. The problem isn’t insurance or our patients. The problem is us.
When it comes to what patients want, money is rarely an issue. In 2018, patients spent more than $16.5 billion on elective plastic surgery (American Society of Plastic Surgeons, 2019). In 2020, consumers will spend $11.9 billion on orthodontia (IBIS World, 2020). Orthodontists have mastered the art of getting patients to pay for clinical care options and recommendations that have little to no insurance coverage.
The reality is that we are neglecting to conduct the two most important conversations that take place in any chiropractic office: the clinical report of findings and the financial report of findings. This is where orthodontists have excelled in their practices.
Clinical report of findings
The clinical report of findings is your opportunity to establish clear communication between you and your patient and set appropriate expectations of care. I am not talking about a sales pitch.
This is your opportunity to address the very problem that brought them to your office, state how chiropractic care can help, establish a plan to resolve their problem, and help them understand the healing process and factors the speed of their recovery.
Financial report of findings
The financial report of findings, in my opinion, is the most overlooked and underutilized conversation in chiropractic offices. One of the biggest concerns for patients today is the cost of health care. We are failing our patients, and our practices, by not addressing these concerns and eliminating confusion head-on.
I strongly recommend that chiropractors conduct the clinical reports of findings with patients and then turn them over to a trusted staff member to conduct the financial reports of findings. During the financial report of findings, your staff will review the clinical care options and recommendations, what the patient’s insurance will cover, and what the patient’s out-of-pocket responsibility will be. This is also an excellent opportunity to discuss payment options such as auto-debit, financing, and a Discount Medical Plan for non-covered services.
The power of patient reporting
In one 30-minute visit to the orthodontist with my boys I signed up for $7,000 in orthodontia and didn’t think twice about it. They showed me a picture of their teeth, explained what would happen if we didn’t address the problem, then made it affordable by providing me with the options of a pre-payment plan or auto-debit. We never missed an appointment and never considered not getting them braces.
The process for new patient visits in orthodontic offices is similar all across the country: exam, clinical report of findings, financial report of findings, payment options, and you’re out the door. That level of consistency is what works.
When offering orthotics, you need to have every patient scanned and make the recommendation regardless of what insurance will cover. It is that simple. What other product or service are you able to provide at a 100% margin and still be very affordable to the patient? How much are you losing by not recommending orthotics to your patients regardless of what insurance will cover? My guess is that it’s a lot.
We have one patient in our office who was referred to us for stability issues and was told about our three-arch supporting custom orthotics by a friend. She ordered five pairs in four months, and her insurance didn’t cover a single pair! We even received a call from our representative, Wayne, who was concerned there might be a problem with the ones that she had received. He thought we were ordering more to find the right fit or comfort level. We had to assure him that she was their biggest fan and loved them so much she had ordered multiple styles and colors. She has since sent three new patients to the clinic to have their feet scanned.
Review your clinical care options and recommendations
For me, the realization that I was making clinical care options and recommendations for my patients based on what they could afford and not on physiology, was a tough pill to swallow. I challenge you to review your last five new insurance patients and evaluate your treatment recommendations. Would you have done something different had there been no insurance limitations? For me, the solution was clear. As a doctor, there is no reason for me to know the payer source for any patient in my office. Why should I care who is paying the bill? By not identifying the payer and simply treating the patient, my team and I can make recommendations based on what a patient needs and not what their insurance deems medically necessary.
Kevin R. Campbell, MD, author of “Losing Our Way in Healthcare,” said it best: “When we involve for-profit entities, such as insurers, in clinical decision making, we cloud the picture and create the opportunity for bias — and, ultimately, patients suffer the consequences physically.”
Ray Foxworth, DC, FICC, MCS-P, is a certified Medical Compliance Specialist and president of ChiroHealthUSA. A practicing chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. He has served as president of the Mississippi Chiropractic Association, former staff chiropractor at the G.V. Sonny Montgomery VA Medical Center and Fellow of the International College of Chiropractic. He can be contacted at 888-719-9990, info@ chirohealthusa.com or the ChiroHealthUSA website, chirohealthusa.com. Join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind. Go to chirohealthusa.com to register today.