As the data show signs of modest financial growth in the chiropractic industry, multiple waves of change stand to impact future reimbursements. But healthcare reform that increasingly favors low-cost effective care plays right into the profession’s innate strengths.
Defined as something’s degree of excellence, quality already describes the status of your job as a healthcare provider. It represents the extensive education required to become a doctor and the relatively high income you earn. This elevated status actually worked against you when the 2008 recession caused the economy to shrink, and lower-wage (and arguably lower-quality) positions were the first to re-enter the workforce.1 We saw this reflected in the industry’s declining reimbursements from 2009 to 2013.
The economic conditions now are such that you might be starting to feel the effects of higher-wage job recovery, even if it has materialized in your practice as “two steps forward, one step back” over time. The results from our 2015 survey support a trend toward financial growth, as we saw average reimbursement rates rise by four percentage points to 66 percent. In addition, fee and reimbursement values ($66 and $43, respectively) mostly held steady or registered slight improvements, though not to the same extent as reported by MDs. These numbers, of course, reflect data recorded before the ICD-10 switch.
Then, there’s the public’s perception of chiropractic, a subject on which Palmer College of Chiropractic in conjunction with Gallup shed further light with a first-of-its-kind national survey (P-G Survey).2 Released in September 2015, the survey results showed that more than half of U.S. adults have a positive view of DCs and agree that they’re effective in treating neck and back pain. And although previous data had estimated chiropractic use at around 8 percent, 14 percent of the P-G survey respondents reported using chiropractic care within the past 12 months.
Several keys to reaching more of the population were also revealed in the P-G Survey, one of which was educational outreach. The more likely respondents were to opt to access chiropractic care, the more likely they were to perceive DCs as trustworthy and effective. This simply shows that people get real—and quality—results from the treatment you provide. But first, they have to walk through your door (and understand what you do).
Finally, the shift toward value-based reimbursements may soon be the new normal when working with Medicare patients and those payers that follow suit. That means the fee-for-service model you see displayed across the following pages may look different next year and the years to come as we reflect those changes, as well as the transition to ICD-10.
Fundamentally, the goal of a value-based payment model is to refocus on quality rather than patient volume and service duplication, and to lower costs. DCs are capable of delivering on this expectation in the form of conservative nonsurgical care, and have been since the dawn of chiropractic.
Time will tell if the profession can take full advantage of the demand for quality. Disguised in documentation and the uncomfortable nature of change, it may be actually be a blessing for those who can stake their claim in evidence-based results and proven patient outcomes with EHR software.
To be adept in this evolving realm, though, you must also be adaptable. Here are several key takeaways from this year’s Fees and Reimbursements Survey:
The more, the wealthier?
Our Chiropractic Economics survey may further support findings from the P-G results: Areas more densely saturated with chiropractors are associated with a higher use of chiropractic, and a more favorable perception of DCs.
In our survey, 31 respondents (9 percent) hailed from California, the state with the highest employment level for chiropractors.3 Respondents from California made up a large portion of the Western region, which reported the highest reimbursements and reimbursement rates in the nation. It’s possible that your competition isn’t undermining you but rather raising the credibility of your practice, and therefore your earnings.
All together now.
This year, 24 percent of survey respondents reported working in a group practice, and these doctors indicated higher fees and reimbursements ($69 and $47, respectively) than the overall average. In addition, the 54 percent of doctors who reported having specialists on staff also fared better financially than those without.
A decline in cash overall, but not for women.
In 2014, 19 percent of total respondents collected cash only for their services. That number decreased to 16 percent in this year’s survey. One reason for this could be that the absence of insurance coverage is a major barrier for those patients seeking chiropractic care.2 Still, 23 percent of the women polled reported operating a cash-based practice, compared to 14 percent of men. Last year, that percentage was equal for both genders at 19 percent.
Doing away with payment plans.
The number of DCs offering payment plans declined again, this year by 7 percent, perhaps reflecting a lower patient demand for such financial assistance.
Caroline Feeney is the associate editor of Chiropractic Economics. She can be reached at firstname.lastname@example.org, 904-567-1559, or through ChiroEco.com.
1 Puzzanghera J. “Economy has recovered 8.7 million jobs lost in Great Recession.” LA Times. http://www.latimes.com/business/la-fi-jobs-20140607-story.html. Published June 6, 2014. Accessed September 2015.
2 Weeks WB, Goertz CM, Meeker WC, Marchiori DM. Public Perceptions of Doctors of Chiropractic. JMPT. Published September 2015. Accessed September 2015.
3 Bureau of Labor Statistics. “Occupational Employment Statistics.” http://www.bls.gov/oes/ current/oes291011.htm. Last modified March 2015. Accessed September 2015.