Let’s rethink how we deliver and charge for chiropractic care.
For nearly 15 years, I subscribed to the traditional insurance model—accepting most health plans and navigating the daily grind of billing, treatment codes and documentation, like so many other DCs. I spent more and more time—mentally and administratively—dealing with insurance companies. My staff and I were stuck on the phone with payers, managing denials and tweaking notes to meet external treatment code requirements.
I wasn’t documenting to become a better clinician; I was documenting to satisfy insurers.
The low allowable reimbursements left me feeling like I had to rush through visits and see a high volume of patients just to make it work financially. That meant sacrificing time, quality and ultimately, satisfaction—for both my patients and me. The longer I practiced under this model, the more I realized how far away it had pulled me from the kind of care I wanted to deliver.
Year after year, it became increasingly clear that most of our revenue wasn’t even coming from insurance companies—it was coming directly from patients through copays or unmet deductibles. Eventually, I hit a breaking point. I’d heard other DCs talk about how freeing it was to go out-of-network, but I was still hesitant. Would it work for me? Would patients stay if I no longer accepted their insurance?
Time to make the jump
I had plenty of fear, self-doubt and second-guessing my decision. But I finally made the leap. I dropped every insurance contract—not because I was ready, but because I knew I couldn’t continue practicing in a system that dictated my care, stole my time and drained the life out of my practice one treatment code at a time. I wanted to devote myself entirely to patient care and running my business on my own terms.
One of the biggest shifts was restructuring how we scheduled and billed for care. We transitioned from a treatment code to a time-based model, where patients pay based on the length of the session rather than the specific procedures. This change allowed us to stop thinking in treatment codes and start thinking in patient outcomes. Being reimbursed for time feels fairer—not just to us, but to the patient as well. Whether I’m adjusting, performing a detailed evaluation, doing soft-tissue work or teaching individualized rehab exercises, it all fits within the time they choose.
Under the old system, spinal manipulation was often the highest-reimbursed service—and the fastest to deliver. But the moment I spent extra time on a complex evaluation, myofascial release or exercise instruction, the reimbursement dropped drastically. I was doing more work for significantly less pay. That kind of math doesn’t work long-term.
Our new structure
Patients’ needs fit nicely into one of three predefined time slots:
- Comprehensive Visit (40 minutes): Ideal for new patients or those needing more extensive care. This time allows for evaluations, orthopedic testing, movement screening and hands-on treatment without feeling rushed. We begin with a thorough diagnosis and a targeted plan.
- Focused Visit (20 minutes): Best for follow-up care that requires more than just an adjustment—such as myofascial work, acupuncture or rehab. It’s enough time to fine-tune treatment or work on individualized stretches and movement strategies.
- Tune-Up Visit (10 minutes): Designed for wellness or maintenance patients who want a quick adjustment and minor soft tissue work. It’s fast, efficient and transparent.
Benefits of a time-based model over a treatment code model
First, this model brings predictability and clarity to the care process. Patients know exactly what to expect, and we know how much time we have to deliver what they need. It eliminates the pressure of trying to fit complex cases into limited time slots—or falling behind when someone suddenly presents a new complaint.
I’ve also found we’re more present. We diagnose more confidently, communicate more clearly and build stronger relationships with patients. As a result, compliance has increased, outcomes have improved and patient satisfaction is at an all-time high.
An unexpected benefit was how this model redefined my personal sense of success. Like many DCs, I used to measure success by the number of patients I saw in a day. That number became a stress point—a badge of honor that felt more like pressure than purpose. With a time-based model, I started seeing fewer patients per day, but I was making more money and feeling more fulfilled. My days became less about volume and more about impact—and that mental shift has been one of the biggest wins.
Final thoughts
Switching to a time-based, cash model wasn’t easy—but it was worth it. This shift has allowed us to practice with greater clarity, efficiency, purpose and efficacy. Patients appreciate the transparency and flexibility. The practice continues to grow—not through gimmicks or hacks, but through meaningful outcomes and word-of-mouth patient referrals.
If you’re feeling stuck, undervalued or overwhelmed by the system you’re in, know this: A better way is possible. And you don’t have to lose your mind—or your mission—to find it.
Jeffery O’Guin, DC, is a practicing doctor of chiropractic and clinic director in Kirkwood, Missouri, where he has provided chiropractic care since 2008. He has taught advanced biomechanics, rehabilitation and myofascial techniques at Logan University and regularly lectures through the Missouri Chiropractic Physicians Association. Drawing from his experience as a US Marine and his own injury recovery, he integrates strength training, soft tissue therapies and functional movement into care to help patients live stronger, more resilient lives. Learn more at chiropractorkirkwood.com.
