It's Not In The Payment Plan Anyway

Over the last several months I sat back and watched chiropractors scramble to figure out the prepay plan dilemma. Oh no! They’re taking this away too? What next?

I have to applaud the many consultants however who, although never having had cash practices themselves, offered helpful and obviously well thought out suggestions to give comfort to the many wounded by the threats of the NAIC.
As I dripped with anticipation to write this article, my attorneys plugged away at contacting attorney generals, and insurance commissioners around the United States. We wanted to gather the data necessary to create a booklet that would help the chiropractic profession put these questions to rest. My plan was to have prepay guidelines for every state of the union so doctors would be certain about the laws in their respective states. The problem my attorneys ran into was as they were making confirmations on the information given to them a month earlier, the opinions given to them had already changed. It appears that the Insurance Commissioners were unclear and almost confused about the whole prepay situation more than we were. It seems that their main concern, believe it or not, was that doctors were going to take prepay money and then “skip town.” Erroneous, but a real concern nevertheless.

My attorneys advised me to forget about the booklet because it would raise undo concern and force the Insurance Commissioners to have to come up with some ruling that puts this situation at the forefront of their focus. It almost appears that the Insurance Commissioners were reticent to deal with the whole issue.

The following are some basic guidelines for prepay plans:

1. List the specific number of adjustments and discount offered. You must have fee for service. You cannot state a period of time that the adjustments must be used in. Nor can you provide an unlimited amount of adjustments over a period of time.

2. Prepay plans must be refundable without penalty if the number of adjustments in their plan is not received.

3. Provide a formula for the refund so it is understandable to the patient. i.e.: The discounted adjustment fee multiplied by the number of adjustments not used.

4. Dual fee system means you have a different fee for insurance than you do for cash payment and is illegal. If you use the superbill system presented in the CERTAINTLY seminar, the doctor writes the normal adjustment fee in its appropriate space and have the CA write the per visit, discounted adjustment fee (based on the plan they chose) in the total fee space. This way, if the patient wanted to bill their insurance themselves, the insurance company would never be charged more than the patient.

5. Check with your state association, attorney general, and or insurance commissioner to determine if prepaid fees must be kept in escrow.

6. Lastly, since opinions are changing so rapidly, check out any concerns with the aforementioned people.

With all that out of the way, let’s get to the real issue. The success of your practice is not in the payment plan anyway! If this was the case, my seminar would only be one hour instead of one and a half days! The key to a cash practice is in your ability to educate the patients on your uniqueness so they place a high enough value on chiropractic that they pay cash for it regardless of insurance reimbursement. The unique selling principle in chiropractic is its philosophy where the chiropractor states that the function of the body can be changed by adjustments to the spine.

The problem is many chiropractors are weak in their principle because they have doubts in the philosophy or have never learned it, understood it, or know how to apply it in practice. As a result, chiropractors have started practicing musculoskeletal, back pain philosophy, which simply means you go to a chiropractor if you have a back pain and the chiropractor fixes your back pain. With this philosophy goes all the gizmos and gadgets to help relieve back pain (and add a little more to the insurance bill). As D.C.’s drift closer to this musculoskeletal philosophy they begin to limit their practice. They have to satisfy insurance company requests (which are strictly musculoskeletal) and become more dependent on insurance reimbursement for their income. When the insurance stops paying or the musculoskeletal pain stops the patient stops chiropractic. Patients don’t get the full benefit of chiropractic and neither does the chiropractor. All the D.C. gets is frustration and paper shuffling!

I’ve often wondered what the musculoskeletal D.C. says to patients when functional problems like visceral disturbances start to clear up. Coincidence? I don’t think so and neither does the research available to us. And what about kids? How does a musculoskeletal D.C. promote chiropractic for kids? If they don’t have back pain why should they see a D.C.? The problem is chiropractors have taken one segment (back pain) out of chiropractic to treat and have educated the public only on that segment of chiropractic.

The truth is chiropractic is a profession that corrects the spine for nerve integrity, weather its nerve root compression, spinal cord interference or proprioceptive and mechanoreceptive reflex disturbance or various kinds not just back pain! An opthamologist by the name of Frank Gorman said, “The art of chiropractic is not in the procedure, but in the ability to contemplate the philosophy, where the chiropractor stands alone in the claim that it is possible to change the function of the rest of the body by manipulation of the spine.”

1. In an address given by Freimut Biedermann, M.D. to a medical convention in Hamm, Germany, “Any part of the spine can become diseased and thereby become the curative factor for the disease. We medical doctors who have studied and used chiropractic techniques and have proven its undisputable value cannot understand the negative attitude of medicine towards chiropractic.”
2. Gutzeit M.D., in his article, “The Spine as Causative Factor of Disease.” “Changes in the spine can be the cause of vegetative and nerve root irritation and inhibitory phenomenon (as we find described in the chiropractic concept of a subluxation). Furthermore, the following diseases are possibly caused by and can be related to vertebral disturbances; primary disease symptoms, colic of the gall bladder, vomiting, paroxysms, kidney colic, cramps of the bladder, disturbances of sex organs, and neurohormonal regulatory function. Every organ of the body can be subject to the ill effects which can be expressed in functional disturbances as well as changes in their structural make-up and histological changes. Here a doctor of medicine has described changes in the spine which seem to correspond closely to the chiropractic subluxation.
   
   
3. What about kids? G. Gutman M.D., a prominent specialist in manual medicine in Germany contends: “Blocked nerve impulses at the atlas may cause many clinical features from central motor impairment to lower resistance to infections especially ear, nose and throat infections. With developmental disturbances of every kind the atlanto-occipital joints should be examined and in each case be treated manually in a qualified manner. The success of this treatment eclipses every other attempt at treatment including, especially, the use of medications.
4. There is more and more research to substantiate the principles of our philosophy. By understanding this, there is more certainty and value for adhering to our principles and not just pretending chiropractic is only for back pain. This is the value we have to lead with in our mission statements. It is this value that we have to interpret in our practice with specific patient education. When people understand the dynamics of chiropractic philosophy and the implication of not adopting chiropractic as part of their health care lifestyle, they value using it for themselves, their families and friends. Regardless of what payment plans you have or how they are structured, people will find a way to pay for something they value. Doctors seem to keep missing this concept and therefore, put their emphasis on the administrative side of practice more than on educating people on the principles of our philosophy. The patient will figure out where and how to pay for care when they commit based on their values. The big idea because increased value and all else follows.

My next article will be on how to integrate the philosophy in a specific, unique way during patient management. This will increase patient value and reposition patients from a limited back pain focus to a broader functional appreciation of chiropractic.

1. Gorman, R.F. (Franz vonKuvbel) Chiropractic medicine for rejuvenation of the mind. Academy of Chiropractic Medicine (8 Budgen St., Darwin, Australia) 1983.

2. Biedermann, F. Fundamentals of Chiropractic from the Standpoint of a Medical Doctor ICRC 741 Brady St., Davenport, Iowa 1959.

3. Gutzeit, K. “The Spine as Causative Factors of Disease” A research paper presented at the convention in Hamm, Germany. “Fundamentals of Chiropractic from the Standpoint of a Medical Doctor. ICRC 741 Brady St., Davenport, Iowa 1959.