by ALAN ROUSSO, DC
Going Cash: A Matter of Focus
Do you remember the “good old days,” when patients had
$100 deductible insurance policies, and insurers reimbursed 80 percent of almost
any fee that fell into the “reasonable and customary” realm?
That was only 15 years ago! A lot has changed since then. Insurance
reimbursements continue to decline; deductibles are climbing; and managed-care
programs are eliminating chiropractors from their panels.
You have essentially two choices for dealing with the changes in reimbursements:
You can fight the system and worry about your future; or, you can accept the
change and change with it. Changing means relying less on reimbursements and
more on cash in your practice.
But going cash is either a problem or a solution, depending upon how you value
what you do and who you are. These values are reflected on how the practice is
focused – on medical necessity or lifetime care.
MEDICAL NECESSITY
Managed-care and other types of insurance reimbursements are decided based on
medical necessity. That means that to get reimbursed you must clearly prove that
the patient has a medical problem through diagnosis, orthopedic and neurological
tests, range of motion tests, or other evidence-based method to get reimbursed.
Treatment based solely on medical necessity does not take into account a
chiropractor’s opinion on care after the symptoms have been eliminated.
When the pain is gone and the tests no longer show a need, reimbursements stop,
even though you and the patient both know more care is needed.
Practices based on removing symptoms must attract a constant flow of new
patients who look to chiropractic as an alternative means to alleviate their
pain and suffering. These practices generally have a low PVA (patient visit
average), because once symptoms are gone, patients do not return.
Changing to a cash practice is a problem for chiropractors who base their care
and philosophies solely on medical necessity.
LIFETIME CARE
If you believe and understand that chiropractic benefits go beyond symptomatic
relief and that chiropractic is a lifestyle that is a part of the patient’s
being, then changing to cash can be considered a solution for your practice.
Your first step is to help your patients realize that you and your team do not
make recommendations based on insurance coverage. They need to know that instead
of offering not “sick care” (e.g., care to alleviate symptoms), you offer
healthcare.
Concurrently, you should have a program in place that supports your goals and
objectives for lifetime care, such as a prepayment program.
A prepayment program offers chiropractic healthcare over the course of a year
and breaks payments into manageable amounts paid either weekly or monthly.
You can generally implement the program so that insurance covers the portion
that it normally does. Your patients do not have to worry about paying for care
after insurance stops.
EDUCATING YOUR PATIENTS
Most people enter your office with some type of problem, symptom, or malady.
They come to you because the symptoms are getting worse. Your job is to
influence their thinking and behavior so that they decide what is best for them.
People do not make decisions on information alone, but on emotion based on their
values.
For example: Imagine waking up one morning with a throbbing toothache. You take
some painkillers and gargle with salt water, but the pain gets worse.
Do you wait to see how much pain you can sustain or do you run to the dentist to
find out how to kill the pain as soon as possible? Do you think about how much
insurance you have or don’t have? When the dentist says, “You need a root
canal,” do you say, “Hmm, let me think about it”?
So, imagine that a patient in pain walks into your office. You and your staff
are totally and unequivocally prepared to tell the patient the truth: The pain
is nothing more than the surface of a problem that has been developing over a
long period of time…
The patient’s options include:
- Ignoring the fact that his nervous system is being compromised and the structure of his spine is degenerating slowly but surely, or
- Taking action to resolve the problem and its underlying causes.
You clearly explain how much the insurance carrier will
pay, how much a full course of treatment will cost, the difference in the fees
over the course of a year, and a payment program to accommodate the difference
without compromising care.
When patients accept a prepayment plan, they commit to a course of care that can
allow you and your team to do the kind of work that maximizes results. Neither
you nor your patients have to worry about fees. All you have to worry about is
taking care of the problem and getting your patients well.
You’ll find that patient compliance will rise along with PVA. Going cash is a
win-win situation for all of you.
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