July 2004

Contained...

Next step elimination

by William D. Esteb

Assuming that the forces interested in containing and eliminating chiropractic gave up after the Wilk trial is merely an illusion. If it were only true. While overt attempts have disappeared, covert efforts continue. These forces have simply become more creative. Along the way, they have unknowingly received help from a far greater power to destroy chiropractic: insurance companies, HMOs and state legislatures.

Whether it was part of a grand design, or merely a convenient accident, insurance "equality" is now producing the desired outcome as countless chiropractors have become the lap dogs of third parties.

After getting drunk on minimal deductibles and huge office visit fees, most DCs adjusted their lifestyle, self‑esteem and "head space" to resonate with the apparent validation offered by insurance policies geared to symptom‑treating. A decade later, the headaches being experienced by a majority of chiropractors is far worse than a hangover. Wouldn't it be ironic if this was the "stroke" that detractors had always attempted to link to chiropractic?

With the third party collar affixed around the necks of chiropractors, the profession became easier to control. Like breaking a young, headstrong horse, DCs became increasingly docile, cooperative and less threatening to the medical‑industrial complex. With lifestyles to protect, the 30 pieces of silver offered by the insurance companies slowly compromised the sacred trust.

If this rope‑a‑dope strategy we're witnessing was all part of an orchestrated plan, it was a brilliant strategy, beautifully executed. Who would have thought financial validation would have been such an effective Trojan horse?

I remain hopeful, but with the rebel mindset weakened and the "I'd‑rather‑go‑to‑jail" gene apparently skipping a generation, rescuing the profession will be difficult. And if you're convinced that despite the frustrations of working for third parties (after all, MDs are having their claims cut too!) it's just the price the profession has to pay to leave the children's table and sit with the adults, imagine how all this is likely to eventually play out: bankruptcy. Not necessarily for you. Yet. But for our country.

We ended the Cold War by outspending the inefficient Soviet Union and it imploded from weight. Similarly, if the aging baby boom generation taxes our so‑called "health care" system as they are projected to, our economy will implode from the burden.

We spend more, but rank worse than 20 other industrialized nations in the metrics used to measure health. Like throwing money at any problem, it rarely fixes it. In fact, it usually serves to obscure the real problem, which as I see it, is a crisis of self‑responsibility.

It's not just health professionals that got sucked into the third‑party trap. The public is equally guilty.

Have you noticed the yellow page ads for lawyers these days? Today's, who‑can‑I‑sue? mentality has created a culture of victimhood. You're either a victim of abusive parents, bad genetics, skin color, corporations or some other force making your life unfair. After all, isn't life supposed to be fair?

If you'd like to regain your independence and remove that collar from around your neck, there is much to do. The price you'll pay may be considerable, making it unattractive for all but the bravest. Besides time, courage and persistence, here are some issues to consider:

1. Admit to the writing on the wall. A whole bunch of very smart people are working 24/7 on ways not to pay you. Accept that it is more likely to get worse then better. In this case, the light at the end of the tunnel is actually a train.

2. Get your financial house in order. Reduce your personal overhead so you can withstand the reduced income that's around the corner. Do this purposefully, because as painful as it might be, it will be considerably more painful when you have to make cuts because of some new whim of an HMO clerk or insurance claims adjuster.

3. As practical, extricate yourself from as many plans as you can. When chiropractic coverage is capped at $200 a year or some arbitrary, single‑digit number of visits per year or you get to keep the patient's co‑pay, they don't really have chiropractic coverage. Why even bother?

4. Lower your fees or increase the perceived value of your services. You've allowed the influence of third parties, who see health care as short‑term symptom‑treating, to set your fees. Would you pay what you're asking patients to pay? Then your fees are too high. It creates a hardship for families and pushes away those who want wellness care.

5. Reduce visit time. You'll need to see more people. To do so, you'll reduce the time you spend with patients. You'll be more focused, more specific and less inclined to adjust every segment in the hope that you can justify to yourself that you're worthy of the fee you're charging. Of course, you'll need to make sure patients understand they're buying your talent, not your time!

6. Educate patients. Patient education is a professional obligation, but you'll be expanding your education overtures into "financial" education. You'll implement strategies to effectively explain why you're not "in their plan" and communicate the motives of their insurance company. Yes, you're put in the unenviable position of telling patients the coverage they thought they had is an illusion, but welcome to the future.

7. Good riddance. You'll get over the emotional abandonment that comes from the least responsible patients thumbing their noses at your office and going down the street to someone who'll take their four visit coverage and the 12 pages of documentation needed to collect a fraction of the billed services.

Too scary? No problem.

Seek out personal injury cases, worker's compensation cases or auto accident cases. You know, people not really interested in true health. Learn ways to get your case fees up above the threshold and cozy up to a lawyer or two‑at least until the legislature puts an end to it all with a stroke of a pen.

That's already happened where you practice?

Hmmm. If this makes you feel like excrement, it's probably because they've contained you. And the next step is elimination.

(William Esteb is the president and creative director of Patient Media, Inc., a company providing state‑of‑the‑art, visually‑based patient communication tools from a patient's‑point‑of‑view. To receive a free copy of his 64‑page catalog, and subscribe to "Monday Morning Motivation," a free, weekly e‑mailed practice tip or patient communication idea, visit www.patientmedia.com or call 800‑486‑2337.)

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