By Phil Mancuso, D.C.
(Reprinted from Chiropractic Showcase Magazine, April, 1994)
"Pat, whadaya mean, the insurance checks
aren't coming in like they used to?" I asked in a panic. "Why,
there's insurance equality, and the Wilk case, and...and..."
Everything was so much simpler years ago: there
wasn't much paperwork and rigamarole to alter your healing consciousness.
During the 80's, with the arrival of major medical benefits, things were
really cooking, weren't they? I ran a family practice with about 90% of
our patients on assignment. I'm sure you know that story. But now it's the
90's and it's HMO's PPO's Medicare, Managed Care! In these fast changing,
uncertain times, who can concentrate on running a practice?
I'm sure you've all heard the death knell of insurance
benefits - "Doc, my insurance ran out and I don't want to spend the
money!" Or how about,"You're not in my network." Ouch! That
really hurts, doesn't it? And this, many times from patients that have been
coming in for years. Have you noticed that the deductibles are getting more
and more outrageous, while smaller and smaller checks are taking longer
and longer to come in? If your patient volume and cash flow are heading
south, you're not alone. Instead of being held hostage by the insurance
companies, maybe it's time to take the giant leap to a cash practice.
The Secrets Of Practice Growth In These Troubling
It's now fashionable among the management 'gurus'
to be promoting the concept of switching to full fee cash practice. "But,"
you say, "how will I be able to get all my patients to come in and
plunk down cold hard cash when they've been used to paying almost nothing
for all these years?" Oh, ye of little faith.
Remember, the early chiropractors didn't have insurance
benefits and most of them thrived in spite of all the organized medical
opposition and bad public relations. Many early D.C.'s had to keep moving
their offices so that spotters from the medical boards wouldn't arrest them
for practicing medicine without a license. I know it for a fact: my Dad
was one of those early Chiropractors. How would you have liked to try to
build a practice under those conditions? And what about public relations?
Chiropractors were rarely mentioned, except in derogatory terms. In fact,
until recently, one of the few movies that even mentioned the word Chiropractor
was made back in the McCarthy Era (the early 50's for all you youngsters
out there.) The Chiropractor (who looked remarkably like B.J. Palmer) turned
out to be a communist spy!
So Dad and all his cohorts made it in spite of
all the adversity because they embodied an exquisite faith, confidence and
belief in Chiropractic. Now many of you are in a panic because you don't
know what the future holds, and are looking for the solution to your dilemma?
Let me digress...
In 1987, we switched from assignment to full fee
cash overnight! "It's financial suicide!" my friends said. "Patients
are spoiled and nobody's going to want to pay!" they admonished. When
we actually made the shift, I felt like Neil Armstrong about to put his
foot on the moon: "That's one small step for man, one giant leap for
mankind!" On Monday morning, without fanfare or prior notice, simply,
(and elegantly) switched. Now I think I know how the Manhattan Project physicists
felt when they were about to detonate the first atomic bomb - we knew something
monumental was imminent, but weren't quite sure how it was all going to
We were able to go from a 90% assignment practice
with a high overhead needed for claims processing (read that chasing down
our money,) to a cash practice with a low overhead and a 98% collection
To survive in the 90's, you need to take bold steps
- the old stuff just doesn't work any more! If you're one of those D.C's
who charges $150 to $200 a visit, this procedure may not be for you. If
you're interested in charging more earthly fees, then you can't help but
prosper with full fee cash practice now and into the future.
It's been my experience that one of the best ways
to implement a cash procedure is to have one person in the office responsible
for all financial arrangements with patients. As clinic director, I'm not
even allowed to make financial arrangements! We never hear, "Dr. Blank
says I only have to pay this much." or something similar.
All too often, confusion about payment with assigned
benefits became a stumbling block to much needed continued care or family
care! We have found that patients are much more compliant when they understand
(and agree to ) their financial obligations right from the get-go. Since
we instituted the one person rule at our office, our collection rate has
been between consistently between 95-98%! Compare that with the 'cooperation'
you get from the insurance companies. In effect, our personal 'hostage crisis'
has been solved!
The transformation was so easy we couldn't believe
it! The fear that patients would balk at paying for services rendered was
totally unfounded. Oh, sure, we had the few who said "I'm going to
Dr. Knuckles down the street. He takes my insurance." We found that
the core patients we kept (95%) were glad to pay full fee for services rendered.
The Paralysis Of Analysis
So, are you just going to keep doing the same old
thing the same old way? Remember, insanity can be defined as doing the same
thing over and over and expecting different results. If you don't feel a
compulsion and abiding belief that Chiropractic care is as important as
breathing, drive a truck or do something else. Or, maybe you'll just hang
on to the blind hope that nothing is really changing and everything is going
to be O.K. Definitely don't try full fee cash practice. Stop agonizing over
it and just do it!
You too, can switch to a full fee cash practice
if you firmly believe that your service is worth the fee you charge. Although
we approached the transformation to cash with much consternation, we did
it! You can do it, too!
From Forbes Magazine:
"People are divided into three groups:
those who make things happen,
those who watch things happen,
and those who ask, "What happened?"
Which one applies to you?"
Are you going to be one of the ones who makes
things happen, or will you be asking, "What happened?"
NOTE: The switch to cash doesn't mean your staff will never have to handle another insurance
form ever again. To the contrary, in many cases it will be imperative that your staff become even more efficient at producing insurance forms. Here's how it works: when you accept assignment, you wind up chasing insurance
companies for payment . With the change to full-fee cash practice your fee is paid by your patient, and your staff is available (and well trained) to fill out their insurance forms for them. It then becomes the responsibility
of the patient to chase down their payment from the insurance companies, helping to keep your overhead and fees down!
The success of this system is a combination of a flexible payment schedule and the ability to file insurance forms for
our patients quickly and efficiently! The devil is in the details!
Some of you may be afraid to make the switch, but, hey, wadda ya got to lose?
*Please check with individual state insurance and Chiropractic board regulations before instituting any procedure in your