I was awakened from a deep sleep by a text message from a trusted leader in the chiropractic profession this morning.
"Can we chat?"
"Sure," I sleepily tapped out.
Soon the phone rang. After the pleasantries were exchanged, I ask why the urgency of such an early morning call.
"We've got a lot of chiropractors who are going broke," he practically whispered. "Reimbursement is getting less and less and there's a whole bunch of doctors wondering how they're going to make next month's rent. I've gotta help turn this thing around. So, I'm calling you for some ideas. Can you help?"
"I'll try," I replied, still without my first cup of coffee. "I'm keenly aware of this problem. It's the one thing I've been thinking about, talking about and writing about for the last couple of months."
"So, what's the answer?" he asked eagerly.
"The problem is, many chiropractors have 'eaten their seed corn.' So they don't have much margin to accomplish the changes they need to make," I said stating the obvious.
"That's probably true, but it is what it is," he admitted. "I need some solutions."
Apparently my colleague was demanding a checklist of things that chiropractors could implement this afternoon that would restore their chiropractic practices to a place they were a decade or two ago. Oh, and one more thing, make it snappy!
Can't be done. And few seem interested in the reasons the profession is in its current state. However, the way out of this mess is a reversal of the way we got in. Think of it as a form of professional "retracing."
Step One: Take an Inventory
You can't leave a place you've never admitted to having been. So the first task is to get a lay of the land and create a clear assessment of the situation. Because until you can clearly articulate (and accept) what the problem is, solutions will remain elusive. You want to make sure you have identified the real problem and not a convenient proxy. Such as these:
1. Not enough new patients.Based upon your preferred hammer, you might go after one or more of these nails. But these are all distractions that would keep you busy, but wouldn't get you any closer to actually solving the problem facing individual practitioners.
2. Too many chiropractors.
3. Reduced reimbursement from third parties.
4. A lack of scientific evidence proving chiropractic.
5. The economy.
6. Need to enlarging the scope of chiropractic.
7. Integrate chiropractic into the health care mainstream.
If any of these convenient excuses were true, how do you explain the fact that some chiropractic practices are booming? Having their best year ever? How do you pin your hopes on one of these seven when some chiropractors are helping lots of patients? In your state. In this economy. It would seem to disqualify the victim mentality, finger pointing and acquired helplessness exhibited by many who are struggling.
So, what's the real problem?
The problem isn't "out there." The problem resides within the cerebral cortex of the chiropractor. Between the ears. What they think is true but isn't. The subluxation above the atlas. In a word: headspace.
Step Two: Replace the Lies With the Truth
Changing headspace is far more difficult than implementing a new procedure, reciting a new script or establishing a new policy. Changing someone's thinking is a most wonderfully difficult thing to do. You may have noticed this as you've attempted to change a patient's way of thinking. Same thing here.
That's partly because most patients don't visit a chiropractor in the hopes of having their worldview changed. Similarly, most chiropractors, even those who are struggling, aren't exactly open to a mind shift. Instead, they want success on their terms. Instead of changing the position of their sails, they wait for the wind to change.
One such wind, actually just a faint breeze, is the hope that national health care reform will somehow save their practice. It won't. There are at least seven reasons why Obama Care won't help you.
But what has even greater implications is the beliefs chiropractors have about chiropractic. Many of the chiropractors I speak with who are struggling have great clinical skills, but have a distorted idea about what chiropractic is and what it isn't. They have made it in their own image, making chiropractic fit their particular skill set or perspective. They have the "doing" of chiropractic down pat. But they lack clarity about where chiropractic ends and medicine begins. Blur this boundary and you not only reduce chiropractic to a spinal therapy for a limited range of neuromuscular-skeletal conditions, you end up assuming blame when your adjustments don't seem to "work." Because even if you don't think your adjustments are treating their headaches, the patient does and their insurance carrier demands it.
And that's a huge problem. Most chiropractic practices in the profession have created a legacy of being perceived as neck and back pain specialists who expect to be paid by insurance carriers.
Even more troubling is a more subtle belief held by chiropractors who aren't sure they offer a service valuable enough that a patient would reach into their own pocket or purse to pay for.
Step Three: Begin
So, what is the solution?
1. Admit the current reimbursement trends are unlikely to reverse. In fact, they are likely to get worse.I know. Not especially sexy. Or easy. Or quick. But you have to decide whether you love chiropractic enough to fight for it.
2. Accept that you cannot look to an outside entity to rescue you. Especially not the government. And certainly not the prospect that insurance companies will suddenly become enlightened and value chiropractic care appropriately.
3. Communicate chiropractic principles with clarity, confidence and certainty. Make sure every patient understands that you aren't treating their ache or pain, but rather reviving their ability to self heal.
4. Time to go to the mattresses. Reduce your personal overhead to bare minimums. Make sure every staff member understands what's at stake and get him or her on board. Reduce your practice overhead where possible.
5. Begin the process of slowly discontinuing taking insurance assignment. Pick the carrier for whom you have the least number of patients using and give those patients notification that in 90 days you will no longer be taking assignment. Work your way up the list over the course of a year or so. Begin the process of converting to cash. Go slow!
6. Make chiropractic care attractive to people who value their health enough to pay for it and not expect reimbursement.
Remember back in the day when virtually any practice problem could be solved by getting more new patients? The old solutions aren't going to work. But you're going to have to want it. Want it bad.