Assuming the Risk
by William D. Esteb
In ancient Rome, a major purchase for many people were the earthen jars and storage vessels needed for cooking and preserving foods. Turned on a potters wheel, the price that could be charged for these practical works of art was based upon the smoothness and lack of imperfections due to foreign objects in the clay and other factors.
One way dishonest crockery merchants were able to sell less than perfect containers at a high price was to use colored wax to fill in, smooth out and "touch up" the flaws. This practice became so widespread, that honest merchants began stamping their products with the word "sincere," which in Latin means, "without wax."
A more relevant experience in contemporary times is purchasing a used automobile. So pervasive is the abuse, those who sell used cars are heavily regulated. In many states a licensed dealer must prominently display in the car window whether the car is sold with a 30 day warranty or "as is," without any type of guarantee or warranty. Those who buy a car from dealers who do not stand behind their cars assume the most risk. As do more and more of today's chiropractic patients.
As patients discover they've been duped by their HMO, or have assumed the risk of minor health problems by having an insurance deductible higher than a typical chiropractic case average, they are showing up in chiropractic offices as cash patients. What they encounter is a conscientious chiropractor who truly cares about helping the patient, but is still clinging to a financial policy that only barely made sense in 1985 when practically everyone had $100 deductibles.
Besides office visits that cost more than dinner out with a friend, and multiple therapy treatments that cost as much as a nice bottle of wine, patients are forced to assume all the financial risks of the success of their chiropractic care. In other words, the doctor gets paid whether or not the patient perceives any benefit from chiropractic care.
It's easy for doctors to forget this simple fact after taking insurance money for years. After all, the patients weren't "paying" for their care, the "sugar daddy" insurance company was. With a cushion of 30 or 40 visits paid by the insurance company with no questions asked, it was easy to overlook the accountability, the desire for measurable progress, and the proof that today's cash-paying patients demand, but rarely get.
Forcing patients to assume the risk for whether or not chiropractic care will work for them, places an unseen barrier in front of virtually every chiropractic office. This transparent obstacle forces many patients to wait until they are in so much pain they can't even hear your report of findings or appreciate your unique philosophy. It's bad enough that patients walk into your office on their first visit with notions about painful adjustments, thinking they might get sucked into having to return for a lifetime of care, or fearful of encountering some alternative unscientific cult healer, they must also agree to pay for an expensive examination and other diagnostics before a single therapeutic function is performed! In other words, chiropractic is new, it's different, it's unlike anything you've ever encountered before, and we're going to ask you to pay for it out of your own pocket before it works--and even if it doesn't.
If you want to reduce this barrier, reduce the patient's financial risk. Perhaps the easiest way to do this is to offer a money-back guarantee.
That's right! Give your usual report of findings and explain...
"Our office is based on the simple truth that if we satisfy and delight our patients they will get well faster and be more likely to tell others about our office. This avoids costly advertising and helps keep our fees reasonable.
"Since patient results vary, we can't guarantee results, but we can guarantee your satisfaction. If at anytime within your first 3 office visits you're not completely delighted with your decision to consult our office, we'll happily refund the money you've paid us and make other care recommendations.
"While many more visits will usually be necessary, during this introductory period most patients enjoy enough progress to know that consulting our office was a wise decision."
Radical? Sure. Do other types of doctors do something like this? Don't need to. But there are some exciting benefits from adopting this approach and letting your patients know about it:
It removes the financial barrier: Ironically, many doctors already have an unpublished policy to refund the patient's money if a patient expresses dissatisfaction. So, let the world know! Remove one of the most significant barricades positioned in front of your office, especially these days as third-party reimbursement continues to dwindle.
It enhances the referral process: Guarantee patient satisfaction and now you've got something extraordinary for your patients to tell others about! Remember, you're not guaranteeing a cure. Or even relief! You're guaranteeing that they will like the experience of being in your office or they don't pay. Big difference.
It improves compliance: Now, instead of a skeptical spouse at home who talks your patient out of care, roaring, "You're going to spend how much?!?," you have tamed a major reason that patients discontinue care. Patients will be more willing to suspend judgment and cut you some slack if they still feel uncomfortable after the first or second visit.
It enhances the healing process: All this confidence that you project by assuming this risk is interpreted by patients as reason to have hope and optimism in your care--critical components of the healing process. Remove the risk of spending money and not being helped and you're more likely to find your patients more responsive and open-minded. Gone will be the crossed-armed "prove it" attitude that is often exhibited by patients who are asked to pay regardless of their satisfaction.
It keeps the doctor focused: If you're bored, if practice is too easy, or you frequently lament that you're "so good I just get 'em well too fast," then put your money where your mouth is. Start assuming more of the financial responsibility. After all, we don't pay the house painter, the auto mechanic or the contingency lawyer unless the job meets with our approval.
It produces delighted patients: Even in those rare instances when chiropractic doesn't show promise in the first couple of visits, the patient to whom you refund money will have a high regard for you and your integrity. Contrast that with the word-of-mouth spread by patients who are badgered into paying an outstanding balance for care that they perceived didn't work.
When doctors are first confronted by this elegant and simple way to serve their patients, they immediately look for ways to discredit the idea or try to come up with ways in which they might be taken advantage of.
Obviously, reduce the risk of fraud by having the patient pledge that they don't have insurance so they won't file your bills and then be reimbursed by their insurance company should they later claim they weren't helped by you!
Of course the greatest concern most doctors have is that a patient would get well, claim that they hadn't been helped and then want their money back. Are there people out there who would do that? Sure. Maybe 1%-2%. We sometimes forget that the great overwhelming majority of people are honest. Instead, we've oriented our practices, our policies and sometimes our entire lives, around the minuscule minority who might take advantage of us. Let them. (They already are. Check out the receivables you're never going to see!) Instead, be so busy helping so many more new patients than before, you'll hardly notice. Abandon the scarcity outlook and embrace an attitude of abundance and service.
Instead of improving the access to chiropractic, we've thrown up big blinking arrows pointing to the "approved" provider down the street. Instead of being empowered by our rightful confidence, we've hidden behind our financial fears. Instead of adapting to a new practice environment, we've clung to the past, afraid of change. Instead of taking a leadership role, we've come with hat in hand in the hopes of getting crumbs off the managed care table. The price? Countless patients who have submitted to surgery or some other obscenity because their HMO would pay for it. If chiropractic is so effective, if you're so good, if patients have nothing to fear--then sincerely prove it.
Excerpted from
Making Change
Originally published in 1995
240 Pages
US $24.95
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