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It’s not as difficult as you may think to thrive outside of managed care.
The best way to compete against managed care organizations (MCOs) is not to compete for the care they cover. If you try to compete with MCOs on the price of an adjustment, you will lose. You will either price yourself so low you will go out of business, or you won’t reduce your fees enough and will lose patients to the MCOs with cheaper plans.
Instead, consider the patient services that you can offer that the MCOs don’t.
Here are some examples of the various types of services you could offer in order to diversify and thrive in today’s managed-care environment:
- Scoliosis care: This is a health problem that most MCOs totally disregard. Correcting scoliosis requires many adjustments, which can take a period of years. Typically, managed-care plans will only allow you to treat the patient for five to six visits, almost never authorizing enough care to fix the problem. However, a well-informed adult, or a child’s parent/guardian, may be willing to pay for adequate treatment of the problem. Therefore, those DCs who educate their patients and treat scoliosis will have a competitive advantage.
- Sport injuries: Many MCOs only pay for “Band-Aid®”-type chiropractic care when someone is injured playing sports. When it comes to corrective care, FORGET IT. Rehabilitative care, NO WAY. When people have a true desire to be an athlete, young or old, amateur or professional, they will usually pay whatever it costs to get back to, and excel in, their athletic choice, whether it’s jogging, weightlifting, football, golf, etc. Therefore, when a DC is competing against MCOs for expert sports injury care, the doctor (and his or her patients) usually wins.
- Rehabilitation: In order to sell their plans, most MCOs say they include coverage for rehabilitative care. However, what they don’t say is that they do not cover rehabilitation. There is a distinct difference. Rehabilitative care coverage from MCOs typically falls way short of the rehabilitation needed by the patient. How lasting or effective can two weeks worth of rehab be? However, if patients understand why they need rehabilitation and the potential consequences of not getting it, they will be more willing to pay for it.
- Correcting spinal curves. Returning cervical curves back to normal, or as close to normal as possible, usually requires a significant amount of specialized care. Will most managed-care plans pay for it? Heck no! Will patients pay for it? YES, if they understand their health problem and are made aware of how not properly treating a problem now may cause them to suffer worse and more debilitating problems in the future.
- Natural healing for intervertebral disc problems. Many people will happily choose corrective, non-invasive chiropractic surgery over surgery to correct a disc problem. Do managed-care plans normally pay for this kind of care? Nope. The patient presented with a clear picture of surgery vs. chiropractic care will almost always choose chiropractic.
- Nutrition. Nutritional counseling and products are another aspect of care that MCOs typically won’t pay for. But if patients are educated about the important role proper nutrition can play in making them feel better, it’s likely that many will be willing to pay out-of-pocket for diagnostic blood tests, or to receive a substantial regimen of vitamins to correct their health problems.
- Kinesiology. This is another chiropractic treatment that most insurance companies won’t pay to have done correctly. When done right, this treatment is highly beneficial to the patient, but takes time and consequently is not an inexpensive form of treatment.
- Upper cervical chiropractic. This is a technique that goes beyond the understanding of most insurance companies, and therefore tends to be greatly restricted by the MCOs. Again, the doctor who practices upper cervical chiropractic and educates his or her patients about the value of receiving this care has an opportunity to treat more cash-paying patients.
- The MD/DC practice. This is another type of practice that some DCs are using to compete with MCOs. An MD/DC practice, when set up and operated properly, is very beneficial to the patients and the doctors.
These ideas, as well as other means of diversifying or carving out niches in healthcare, can help chiropractors thrive and contribute to the positive advancement of our profession. Without this diversification, chiropractic is in grave danger of losing all credibility and becoming a casualty of today’s managed-care environment.
As chiropractors, we need to educate people so they understand chiropractic is not purely a pain relief profession, and pain relief is not what keeps this profession growing.
Chiropractic is highly successful in fixing disc problems without surgery, and subsequently saves the insurance companies (and patients) tens of thousands of dollars in surgical and post surgical expenses. And chiropractic care can help most scoliosis patients avoid very expensive and agonizingly painful operations that involve placing steel rods into their spines. Not to mention, all the post-operative health issues and expenses that these patients typically experience.
Regardless of these benefits, most MCOs are not about to allow chiropractors to give the 30, 40 or 50 adjustments necessary to help a disc patient avoid surgery, or for a scoliosis patient’s spine to be straightened. Instead, they often cut the DC’s care to five or six visits. By educating patients about the value of the care you can provide them while working outside of managed care, you will benefit and so will your patients.
In order to succeed in chiropractic, we must use all of our professional resources to their maximum potential and learn to effectively care for as many health conditions as possible. Chiropractors need to promote and provide those chiropractic services that managed care doesn’t.