Thursday I completed a new, one-day program in New Jersey called the Cash Patient. I generally find East Coast seminar audiences generous and attentive, and the program in Saddle Brook was no exception. During this program, I tried to make the point that a cash practice is an effect, not a cause; a symptom of making the practice relevant and meaningful to patients willing to pay for their own care. Proclaiming that yours is a cash practice is often done out of frustration and is more about eliminating insurance hassles for you, rather than making the practice attractive to those who value their health enough to pay you, and if they have a policy, file the claims and wait to get reimbursed.
Naturally, if you don’t see the chiropractic care as something valuable enough that a sufficient number of patients would reach into their own pocket or purse to pay you, then you have a more serious problem than the arbitrary claims cutting that makes it impossible to predict your cash flow.
After thinking about the questions, the underlying fear and the uncertainty expressed by the least bashful in the audience, I’m struck by the following observations:
You’ve been overcharging. If an insurance company or HMO will pay you for what you do, but a patient won’t, maybe you’re gouging the corporate interests, running a scam or deliver a service that the carriers you dislike so much appear to value more than the patients receiving it. Could the claims cutting you complain about actually be a way to reduce your fee to something more fair? After all, if most patients don’t value chiropractic care enough to pay $50 for an adjustment, why should their carrier?
You’ve been working for the man. If you’re merely a technician, paid for by the patient’s carrier, and you lack the communication skills to have successful direct patient relationships, you have reason for concern. Lacking this ability, you will remain in bondage to those who control the money or will need to work for someone who can make a compelling case for chiropractic to patients. It may appear that you have an independent business, but if you’re afraid you couldn’t sustain a viable practice without taking assignment, your boss is the policy issuer, not the policy holders.
You’ve been kidding yourself. You claim you’ve been educating patients, but you must have doubts. Because educated patients would remain under care longer and reactivate themselves when they suffer their inevitable relapse. But the fact is, most patients are made to feel so much shame for dropping out (letting you down), that they’d rather try acupuncture, get a massage or see your “competitor” down the street than show up in your office for the smug look and the I-told-you-so scolding. (Best to change this tendency immediately or you’ll forever remain on the new patient treadmill.)
If you’ve known nothing but reimbursement, you may be under the same spell as patients who wave their ID card issued by their carrier, thinking all will be taken care of. Actually, this is an issue of responsibility. And while the current situation may be unpleasant, the prospect of losing your pimp sounds even worse!
Maybe you’re not cut out for being an independent agent. That’s okay. Nobody can tell that they’ve clipped your wings so you can’t fly and living in a cage with your little mirror, parrot toys and cuttle bone isn’t such a terrible existence. Your domestication means you’re unlikely to reproduce in captivity. Based on the decreased enrollment among chiropractic colleges who promote this limited-vision-mechanistic-cookbook notion of chiropractic, the effects of emasculating chiropractic is already well underway.
It’s not too late. If enough chiropractors break the chains of captivity and assume the feral nature of a previous generation, there’s hope. Extricating yourself from the bondage of third parties is just part of it. You’ll need to fortify yourself with the principles of chiropractic. You’ll want to accept that the unseen world is more real than what we perceive with the five senses. You’ll want to look beyond the spine and see the whole-body effects of nerve interference. You may even want to bring back the word subluxation that you had to avoid using on the insurance claims you filed for patients. While you’re at it, you could discontinue using manipulation and adjustment interchangeably and drop the word treatment from your lexicon. Heck, we may find that jettisoning the short-term, episodic, symptom-treating mentality of third parties could restore the biggest subluxation in chiropractic!