A Healthy Practice Starts with a Cash-Based Practice
by Dennis Nikitow, D.C.
Several years ago, when managed care seemed to be the answer to traditional insurance fallout, I saw a doctor advertising a seminar in a journal with the following headline: "Do You Think the Cash-Based 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. The truth is a cash-based practice should always be the foundational block of every practice, regardless if insurance, with its limitations, is being billed or not. Patient Education must promote enough value for chiropractic that the patient is willing to pay beyond what insurance covers. This includes the use of orthopedic supports, home rehab, and nutrition.
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 around restoring the spine to its normal spinal model for maximum nerve integrity and optimum health potential.
The patient first needs to be introduced to the four essentials of health; i.e. food, water, oxygen and nerve impulse. If they are lowered in quality or quantity, health potential is lowered too. This leads to the importance of why they need to correct their spine and how it applies to their overall health and wellness. This comes in a solid explanation of chiropractic principles and philosophy, followed by showing medical research to support it.
Once this understanding is established, the use of orthopedic supports, home rehab and nutrition becomes easy and does not distract the patient from the core of spinal correction. Instead, ancillaries will enhance the ability to reach the spinal correction goal and improve overall wellness and will be embraced by the patient.
Use cervical and lumbar support pillows not only to establish proper curves, but to maintain them. Extension cervical traction units will also aid in reducing forward head posture (FHP) and improving cervical curves. Foot orthotics are essential for overall postural balance and spinal correction and should always be recommended, if foot imbalance is detected. Carpal Tunnel Syndrome supports should also be a part of your practice as well as necessary nutrition.
For years I emphasized the need to reposition the thinking of a cash vs. insurance practice to a "healthy practice." Insurance will not pay forever and, if history dictates, eventually insurance will get wise to overbilling 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-based 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 ($2000-$5000 per family), premiums are low, and coverage is more limited. This forces the consumer to examine prices closer, because they are being moved to pay for certain aspects of health care out of pocket. With the recent economic downturn, insurance reimbursement has struggled too.
Next, establish a fair fee structure for individuals and families that they could pay regardless of insurance reimbursement. Make sure the patient understands the uniqueness of your treatment and outcomes.
Establish "retail fees" and "prepay cash fee discounts." If you want to bill insurance for reimbursable rehab fees, bill retail, but establish a fair limit to this kind of practice. Don’t overbill or try to get insurance to pay for everything.
A cash-based practice can never be "a way of the past," unless insurance reimburses everything 100 percent. It’s better to understand how a cash-based practice fits into your future so you can use it appropriately to develop a "healthy practice."