April 2006

Is the cash practice a way of the past?

by Dr. Dennis Nikitow

I recently saw a doctor advertising a seminar in a journal with the following headline: "Do You Think the Cash Practice is a Way of the Past? So Do We." The ad went on to explain the course content of essentially diagnostics, neuro/ortho exams, outcome assessments, and insurance coding, all components of a musculoskeletal practice ‑‑ not a family, wellness practice.

If this young doctor would have looked at the history of chiropractic, it would have revealed the pattern of insurance and cash practices, and he would have re‑thought the positioning of the seminar.

First of all, chiropractic needs to be repositioned to the public as a part of the health care team for overall wellness, not as a back pain treatment for musculoskeletal conditions and symptoms. Evidenced‑based parameters are essential because a subluxation‑based wellness practice should be geared to restoring the spine to its normal spinal model for maximum nerve integrity and optimum health potential.

If doctors are being taught to focus on the components of treating the musculoskeletal framework and its use as a vehicle for insurance reimbursement for mere profitability, then we have positioned ourselves to have revolving door practices again that are used by people with only musculoskeletal conditions and symptoms.

Although outcome measures are evidenced, patients perceive this as merely an alternative way to accomplish mobility and pain relief. They never understand the true value chiropractic has for the overall health and wellness of their family (that may be asymptomatic).

Is there a solution? Yes. Have I mentioned the word repositioning? In another column, I emphasized the need to reposition cash vs. insurance practice to a "healthy practice." There's nothing wrong with billing insurance companies for rehabilitating the spine to its normal spinal model, but there must be a cash component to every practice. Insurance will not pay forever and if history dictates, eventually insurance will claim over‑billing for rehab, regardless of how justifiable it is in our minds.

Insurance companies do checks on their reimbursement expenditures and go through cycles of cost containment. As procedures are eventually deemed non‑reimbursable, the doctor is forced back into a model where patients are given the responsibility to pay, i.e., cash practice. In addition, doctors get frustrated, and burnt out because they get tired of trying to keep up with the changes in insurance protocols rather than having the peace of mind of working with quality, committed patients and their families who are willing to pay cash for their care.

The insurance industry is also emphasizing a new "consumer‑ driven" model of insurance, where deductibles are very high ($2,000‑5,000 per family), premiums are low, and coverage is more limited. This forces the consumer to examine prices more closely because they're being moved to pay for certain aspects of health care out of pocket.

Developing a "healthy" practice starts by learning to communicate the principles of chiropractic to people. By repositioning chiropractic from a treatment for back pain to a necessary part of a health care team for wellness, people will value it enough to bring their family and pay.

Next, establish a fair fee structure for individuals and families that they could pay regardless of insurance reimbursement. Make sure patients understand the uniqueness to your treatment and outcomes.

Establish "retail fees" and "pre‑pay cash fees." If you want to bill insurance for reimbursable rehab fees, bill retail, but establish a fair limit to this kind of practice. Don't over bill or try to get insurance to pay for everything. Stay under the radar. I believe they should pay for everything we do, because what we offer is worth way more than they will ever know. The reality is, they won't.

Remember, if you establish an effective communication system to first reposition chiropractic for wellness, so patients understand the damaging effects of subluxations, and then explain your method of correction so it's unique and the outcomes can be evidenced by the patient, they will follow through with your plan for spinal correction.

Be careful about your positioning of a cash practice. It can never be a way of the past unless insurance reimburses everything 100%. It's better to understand how a cash practice fits into your future so you can use it appropriately to develop a healthy practice.

(To learn about the Certainty System, Certainty Practice Products and Dr. Dennis Nikitow's upcoming seminar schedule, call 800‑544‑3884. Outside the US, 303‑721‑6202.)