With all the uncertainty surrounding “what’s next” in healthcare coverage, whether it be “repeal and replace” or a scaled back version of the Affordable Care Act, or a new model entirely, the reality is the same.
People do not always buy what they need, but they always seem to find a way to buy what they want.
And they often buy more than they need, and more than they can afford when presented with ways to make that possible. Just look around the typical parking lot: You see cars and SUVs with price tags two to three times more than the average person makes in a year. Or you see kids with cellphones that can cost nearly as much as the first car you bought.
What does this have to do with chiropractic care? A lot. Chiropractic has always been paid for by those who have the need for it. And some will pay for ongoing care because of the value they discover after undergoing treatment.
Chiropractic, much like dental care, may not be perceived as a necessity until someone is in pain long enough or unable to function and all else has failed. And while you’d like to see patients asking for care to help keep them healthy and functioning optimally, that tends to be the exception.
Pain vs. payment
Statistically, you know a high percentage of your patient population arrives in pain and a smaller percentage stays around for the benefits of chiropractic care for prevention, wellness, and improved function. When you factor in whether insurance covers chiropractic or not, you see many patients making decisions based solely on that basis.
This is also true in the dental world.
It’s always sad to hear a patient say they are opting for surgery because it is covered by insurance instead of pursuing a course of chiropractic treatment that could help them avoid an operation. But people sometimes make bad decisions.
What is at the core of decision-making when it comes to chiropractic care? Often, it’s dollars and cents (or dollars and sense.) Many people simply don’t know the risks of medications, opioids, and poor outcomes from surgical procedures.
Regardless of what comes next for the healthcare system, keep in mind that it is your job to educate your patients on the benefits of chiropractic treatment versus their other options, and to find ways to make it affordable for all who choose to accept your recommendations.
To that end, have a conversation with your staff about how people make purchasing decisions, what motivates them to make those decisions, and how to position your services as being not only necessary but something the public should find desirable. If you can help patients make this mental transition, you’ll see more of them choosing and paying for your services, regardless of what insurance covers.
What’s in it for them?
The American Academy of Cosmetic Dentistry estimates Americans spend about $2.75 billion each year on cosmetic dentistry. Two thirds of cosmetic dentistry patients are female—twice the number of males. According to the American Dental Association, a person’s smile outranks their eyes, hair, and body as the most important physical feature.
Why are these patients so willing to spend their money? Because of how it makes them feel about themselves (and the importance they place on the perceptions of others).
Chiropractors must find ways to communicate the “What’s in it for me?” factor to patients. Why do they need chiropractic care and why should they want it? How can it help improve the quality and enjoyment of their lives?
Finding and tapping into these deeper desires, and learning how their complaints are affecting their lives, is usually a better place to start than talking about the relief of pain.
Obviously, eliminating or avoiding pain isn’t enough. That is also true in the dental world. More than 50 percent of uninsured and 30 percent of insured Americans skipped necessary dental care visits last year due to financial issues, according to a Harris Interactive/HealthDay Poll.
Other statistics also show people make decisions based on what they want versus what they need. In 2015, over $13.5 billion was spent in the U.S. on cosmetic procedures. Liposuction surpassed breast augmentation for the first time in 2013, with a slightly greater than 75 percent increase in the number of procedures over the prior year. And, believe it or not, there was also a 55 percent increase in buttock augmentation.
So, there is apparently money out there for what people want. If DCs can figure out how to position their services as something the public wants, then more people will be willing to pay for them.
A range of options
Once your services are a want and not just a need, the easy part is finding ways to make them affordable. And the more options you offer your patients, the higher the likelihood they will accept your recommendations for care.
When offering options, keep them to the top three best options for your practice cash flow, but have several others to fall back on. A quick search for ways to finance cosmetic surgery yields the following list of payment options for patients, which makes it clear that people always find ways to purchase what they want.
- Medical credit cards
- Regular credit cards
- Bank loans
- Home equity loans and lines of credit
- Cash savings
- Unsecured medical loans
- Doctor payment plans
- 401(k) loans
- Loans from family and friends
Regardless of what you think people can afford, they do spend substantial amounts on healthcare. American families spent an average of $6,000 on out-of-pocket health insurance and other medical costs such as co-pays and deductibles in 2009, according to the National Coalition on Health Care, which estimated that number would be at $9,000 by 2012. The Centers for Medicare and Medicaid Services estimates out-of-pocket spending in the United States was nearly $340 billion in 2013.1
Have the talk
Following the passage of the Affordable Care Act, costs have trended higher and you are no doubt seeing more patients with deductibles in the thousands and co-pays higher than ever before. The likelihood of this changing with the next iteration of our healthcare system is slim to none since much of the talk is around health savings accounts and insuring only for catastrophic events.
While this is a challenge, it doesn’t mean you can’t position yourself and your practice for success.
Start embracing conversations about cash and patients being more responsible for their own health. Educate your staff—particularly those at the front desk and in the insurance department—about how much people willingly spend in other doctors’ offices and find ways to finance almost anything they perceive as a need. Put the cost of chiropractic care in perspective for patients by talking to them about the real costs and devastating effects of medications—particularly opioids.
As you probably know, opioids don’t just kill pain, they kill people and destroy families. That is powerful. And have conversations about the outcomes of unnecessary spinal surgeries and the costs, not only in dollars but in the loss of productivity and why chiropractic should be the first choice for care, even if a patient has to pay out-of-pocket.
Conversations about money have been a taboo in many circles and they have long been avoided in most healthcare settings. Only in the last decade or so have hospitals and doctors’ offices started collecting “up front” or at the time of service.
And, if you hire team members for your practice who are involved with collecting fees, deductibles, and co-pays, are you setting them up for success by providing training on how to collect, work with patients on finances, and how to cover their options? As a doctor, you know the importance of a great clinical report-of-findings, but do your team members know how to give a great financial report-of- findings? Pull a chart and ask them to review the financial options with you.
Ideally, you’ll be amazed at how well they do. But if their performance makes you want to crawl under the desk, take responsibility for teaching them or find someone who can train them in how to have financial conversations. This is a special skillset that doesn’t come naturally to a lot of people.
So, have the cash conversation with your team, set them up for success, and stop worrying about “what’s next.” People will always pay for what they want.
Ray Foxworth, DC, 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 can be reached at or through chirohealthusa.com, where you can learn more and register for webinars.
1 The Centers for Medicare and Medicaid Services. “National Health Expenditures 2015 Highlights.” https://www.cms.gov/Research-Statistics- Data-and-Systems/Statistics-Trends-and- Reports/NationalHealthExpendData/Downloads/highlights.pdf. Updated Dec. 2016. Accessed March 2017.