There’s no doubt that things are changing rapidly in the healthcare world.
As costs continue to escalate beyond affordability, many chiropractors sit motionless in their offices like those on the Titanic, hoping everything will be OK. But your future success in the chiropractic market will be guided by the decisions you make today regarding the economic model of your practice.
Unfortunately, for many chiropractors, this decision will be based on fear rather than strategy. As costs continue to climb, many chiropractors choose the path of least resistance and decide to get rid of X-rays (insurance doesn’t pay for them), get rid of staff (constant cost regardless of weekly income fluctuations), and stop taking insurance (too much work with billing, must have malpractice insurance, too stressful with patients). All of these choices are made out of fear and lack of business maturity, and in most cases will lead to a struggling or failed practice.
The key to succeeding in the practice of the future is to build two boats, one that participates with the available insurance coverage out there, and the other that builds the cash-based, out-of-pocket practice. Both require significantly different attitudes and guidelines, but both can lead to a more secure future in an unstable industry. And these strategies can also lead to long- term practice and personal success.
Cash-only practice
Most offices that have become strictly cash-based generally reached this state out of fear and the lack of a good business plan. It’s easier just to get rid of the insurance CA, stop the pain of getting rejections from insurance companies, and make people pay on the spot for their services so the office doesn’t have to wait for reimbursement. It’s not unlike someone getting out of a contentious marriage who vows to never marry again. They just don’t want to go through that type of pain any more. So, they sit alone the rest of their life thinking it is best option available.
The truth is, this practitioner needs a developmental program that teaches the laws of business and the guidelines required for a successful practice relying on both insurance and cash relationships. Giving up the insurance pipeline, when so many people are covered for so many services, is shortsighted and not recommended if long-term future success is your goal.
Likewise, building a practice that depends 100 percent on inflated third-party pay is like playing musical chairs. It can change by the minute, and if you’re left standing (i.e., dependent on them for all your income), there is a high risk your practice will seriously suffer if the industry makes a major change. This is also not a recommended approach to long-term future success.
The good, the bad, and the ugly of a cash-only practice
At first glance, a cash-only practice seems like a great idea. Never having to deal with frustrating insurance companies is a tempting proposition. Dropping malpractice insurance premiums will certainly help the bottom line. Less stress, a smaller staff, and an end to rejections would make life a lot easier. However, the major downside of this type of practice is also less income.
The insurance industry pays rates much higher than what the general population can afford. Assuming there were no stress in filling out insurance forms, mailing them in, and having them reimbursed, any office would welcome the greater rate of pay (albeit the rates are lower today). But the stresses of working with insurance companies cost every practice. They affect the mood, workload, and motivation of an office, among other things. So you have to weigh the benefits versus the costs to determine if participating with insurance is worth the headaches.
Good organization and clinical procedures will help make participation with insurance companies more palatable.
Offices that have weak procedures and poor documentation will always have a stressful relationship with insurers. But offices that have strong procedures and good documentation have far fewer problems with insurance companies.
In addition, honesty with patients regarding their liability and the responsibility of their insurance company also helps to make an insurance practice workable. The practice that can only work with people who have superb coverage, and doesn’t know how to work with people who have high deductibles and high co-pays, will never find it easy to work within insurance guidelines.
An example of how not to do it is the practice that only suggests custom orthotics when they see the patient has some type of coverage for them. This is a backward and failure-oriented strategy. The successful practitioner examines patients and determines their needs without regard for what the patients’ insurance covers.
Recommendations are based on patient needs, not patient coverage. For something like orthotics, the best way to do this is by using visual evidence, such as a digital scanner. This way patients can see and understand the imbalances in their feet and the detrimental effect it has on their total musculoskeletal system. You can then describe the eventual effects of these imbalances if they are not corrected.
Because they then understand the need for orthotics, they may be more willing to pay out of pocket for them.
Public perception in seeking care
The number one question the public asks when they call your office is, “Is it covered by my insurance?” To say “No” ends most relationships before you ever have a chance to build one. The public is oftentimes willing to accept sub-quality care if their insurance only extend that far. So rejecting insurance, especially in these hard economic times, should not be a consideration— especially by new practitioners.
Once you get the patient in your office, anything is possible. They may end up spending an exorbitant amount of money out of pocket because they’re giving you a chance to show them why you are the preferred provider in their area.
The insurance practice
This is a component of a practice that requires skill, patience, dedication, communication, organization, and resilience. All of these qualities are needed to be successful in life. Your office should not flee from working with insurance companies to avoid the hassles. Instead, accept the challenge of developing this business model and help more people.
Yet a major problem with offices that accept insurance is that they don’t spend time on improving their skills at developing the cash-based, out-of- pocket portion of their practice.
Don’t take the easy road. Use all possible programs available for more patients to come into your office. This is the key to building a secure practice for the future.
Tim Maggs, DC, has been in practice nearly 40 years, and is the developer of the Concerned parents of Young Athletes (CPOYA) network, with the goal of offering every middle and high school athlete a biomechanical exam prior to each sports season. The network, in partnership with Foot levelers, provides training, resources, networking opportunities, and more for DCs interested in working with youth athletes. Maggs can be contacted at runningdr@aol.com or through CPOYA.com.
