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In today’s healthcare system, people are trying to adapt a wellness model of healthcare for themselves and their families. Healthcare delivery systems are advertising wellness as a healthier lifestyle. The only problem is no one has defined what wellness is so people have different definitions of wellness as it applies solely to them. Some approach it nutritionally so they seek help to eat better. Some approach it physically and think exercise will give them wellness. Yet others try support groups, stress reduction classes, or spiritual study.
Many chiropractors want to establish a wellness practice, but aren’t sure how or where to begin. They think they need to become nutritionists, exercise trainers, or psychological and spiritual counselors. Then when their practices don’t grow, and their retention drops, they wonder why. Yet, this is the same problem chiropractors have always had. They dilute the principle of chiropractic so people don’t understand how to use it.
To establish a wellness practice as a chiropractor requires an understanding of how chiropractic principles and philosophy play a part in healthcare so the patient sees your uniqueness to their health, and adds you to their wellness team. It does not mean adding different components to dilute chiropractic and confuse the patient. There are seven steps to positioning your practice for wellness.
Have a definition of wellness your patient feels comfortable with. I define it this way, “Wellness is maintaining certain actions to prevent illness and injury”. This is simple, and makes sense to people, because this what they are trying to achieve.
Next, explain how “maintaining certain actions” applies to their health and wellness. I show them my M-P-C poster which explains this fundamental. If something requires maintenance and is neglected, a problem will develop. Problems are always silent. Eventually, the problem will get so bad, a crisis will occur. Symptoms occur in the crisis stage not the problem stage. Therefore, people need to maintain certain actions to prevent the crisis of unwanted illness and injuries.
Now establish what needs to be maintained for optimum health and wellness by explaining the four essentials of health. The body needs food, water, oxygen and nerve impulse for life. If one of these stop you die. If their quantity or quality is reduced, health and wellness suffers. Here is where you can incorporate how to maintain proper nutrition and exercise.
The last essential, nerve impulse, ties chiropractic philosophy and principles into wellness. When the brain impulse stops you die. If you sever a nerve, the function dies to that part of the body. Therefore, a subluxation causes nerve interference resulting in dis-ease, damage and dysfunction to that part of the body. I use the four essential of health pamphlet to anchor this message.
Next, show medical research to support the philosophy and principles. I use our “Medical Research on Subluxation” posters and pamphlets, which dispels any doubt that spinal subluxations need to be maintained or they can affect overall health and wellness to every organ and tissue of the body.
I put up testimonials of patients showing before and after x-rays for all types of health conditions from asthma to endometriosis. This proves to the patient that spinal alignment has everything to do with health and wellness and chiropractic is not just for back pain.
The last step is to summarize these points and give the patient a directive that they need a chiropractor on their health care team for optimum wellness.
We need to position wellness programs as needing chiropractic to be complete, rather than changing chiropractic to be something it’s not. Stick to the philosophy and principles of chiropractic and use the steps that I have outlined here to build your wellness practice with certainty.
Building a stable, high retention family practice is easy, but is dependent on two things. The first is specific communication strategies (which I covered in my last article) so patients value chiropractic enough to put you on their health care team for wellness. The second is great cash plans so they can afford the care for their entire family. There are specific guidelines for establishing cash plans so they are legal.
I have had a cash practice for since 1979. I brought the cash practice seminar to our profession in 1988 while practices were still thriving on insurance reimbursement, but about to enter a new era in cost containment resulting in practice strangulation for those solely dependant on insurance. I had to make sure doctors were getting the best cash plans available to accomplish practice growth, retention and stability. But most importantly, the plans had to be affordable to the patient, yield the doctor the most income without creating a “work for nothing” consciousness and be legal in all states.
Before I give you these guidelines, it is important to mention that many doctors are still using plans that are vulnerable to legal scrutiny. Although there could be gray areas in certain states my attorney’s research resulted in consistent guidelines that are safe for everyone.
The major issue behind having legal prepay cash plans seems to hinge on the question of the assumption of risk (by the doctor for the patient) especially for fortuitous events. In other words, if the plan could be interpreted as providing care for any future injury, accident, exacerbation, pain or even a wellness check, it is construed as providing insurance without a license and is illegal.
Prepay cash plans in themselves are not illegal, but must be structured as “fee for service”. You must stay away form unlimited care for a fixed fee, cap fees, year long programs or any programs structured around a specific period of time. Although these plans are attractive plans to build “volume practices” several problems occur.
First with any “fixed” or “capped” fee, the patient is not paying for all the adjustments they are receiving. Even if a preset number of adjustments are listed, they are given these adjustments over a specific period of time, most commonly one year. For instance take a plan that lists 80 visits for one year at a prepay price of around $2000. Visits are laid out with a 3-2-1 format. The reality is the majority of the practices using this plan are spinal correction rather than musculoskeletal, symptom based so correction stays at 3x/wk for a long time and 80 visits are used up long before the years is over or total correction is achieved. Hence, the doctor continues to treat the patient (for free) until the time frame of one year is up because the plan agreement stated, “additional visits would be included as determined by the doctor for necessary flare-ups, slow healing, etc…” This can be construed as assuming risk. In essence, the capped fee is the same thing as unlimited service for fixed fee. What it says is the fee is being fixed or capped so the patient won’t have to pay any more for any service needed. If this was fee for service why would the word “capped” even be necessary?
Secondly, a volume trap occurs when volume goes up, but many people are not paying. The doctor’s conscience needs to be OK with this otherwise a burnout occurs from the doctor feeling under compensated for the workload they are doing. This can become a violation of the “fair exchange principle”. Not to mention, as volume goes up more staff is needed, but the doctor’s income has not risen in proportion to the volume as expected.
The best plans that I have been using and teaching for a number of years provides fee for service, fair exchange, are perfectly legal, provide three times the income from other unlimited service or capped fee plans and families are happy to pay. Use these guidelines to prepare your own.
Decide how many adjustments patients can buy at one time and list the retail and discounted amounts. Example 25-50-100 visits.
Prepare a chart they can easily understand illustrating these amounts
Itemize your adjustments, re-exams, re-x-rays or any other service included within this plan. Example: 50 adjustments at 3x/wk will last about three months. The patient will get two re-exams and one re-x-ray during that period of time. After you show the itemized and accumulated retail fees, show the discounted fees (usually 25-30%) for prepaying. Note, it is acceptable to prepay for re-exams and re-x-rays for monitoring progress but it is illegal to provide these services occasioned by fortuitous events.
Never sell a prepay plan based on time, only a specific number of adjustments. The previous example was to show the approximate time it takes to use up 50 adjustments in a structural corrective program. The adjustments would be sold to the patient in groups of 50 without a time frame restriction, expiration, etc…
An understandable refund clause must be written on the plan and given to the patient in the event a patient does not use the prepaid number of adjustments.
If you are billing insurance you cannot have a higher adjustment fee for insurance than for cash. Waiving or discounting deductibles or co-pays (NOOPE - No out of Pocket Expense) is illegal.
The retail adjustment fee and the discounted fee must be on the patients receipt and the discounted adjustment fee is put in the total column.
Check with your state association, attorney general or insurance commissioner to determine if your state requires prepaid fees are to be kept in escrow.
For families, have an increasing discount percentage for each member from the prepaid amount. Example – 10-20% off the second family member, 20-30% off the third etc… Come up with a fee you would be comfortable paying without giving it away.
Stick to these guidelines and regulate your discounts to what you’re comfortable with for families. But by all means, do fee for service to protect yourself and our profession.
Building a stable, high retention family practice is easy, but is dependant on two things. The first is specific communication strategies (which I covered in my last article) so patients value chiropractic enough to put you on their health care team for wellness. The second is great cash plans so they can afford the care for their entire family. There are specific guidelines for establishing cash plans so they are legal.
I have had a cash practice for 23 years. I brought the cash practice seminar to our profession 15 years ago while practices were still thriving on insurance reimbursement, but about to enter a new era in cost containment resulting in practice strangulation for those solely dependant on insurance. I had to make sure doctors were getting the best cash plans available to accomplish practice growth, retention and stability. But most importantly, the plans had to be affordable to the patient, yield the doctor the most income without creating a “work for nothing” consciousness and be legal in all states.
Before I give you these guidelines, it is important to mention that many doctors are still using plans that are vulnerable to legal scrutiny. Although there could be gray areas in certain states my attorney’s research resulted in consistent guidelines that are safe for everyone.
The major issue behind having legal prepay cash plans seems to hinge on the question of the assumption of risk (by the doctor for the patient) especially for fortuitous events. In other words, if the plan could be interpreted as providing care for any future injury, accident, exacerbation, pain or even a wellness check, it is construed as providing insurance without a license and is illegal
Prepay cash plans in themselves are not illegal, but must be structured as “fee for service”. You must stay away form unlimited care for a fixed fee, cap fees, year long programs or any programs structured around a specific period of time. Although these plans are attractive plans to build “volume practices” several problems occur.
First with any “fixed” or “capped” fee, the patient is not paying for all the adjustments they are receiving. Even if a preset number of adjustments are listed, they are given these adjustments over a specific period of time, most commonly one year. For instance take a plan that lists 80 visits for one year at a prepay price of around $2000. Visits are laid out with a 3-2-1 format. The reality is the majority of the practices using this plan are spinal correction rather than musculoskeletal, symptom based so correction stays at 3x/wk for a long time and 80 visits are used up long before the years is over or total correction is achieved. Hence, the doctor continues to treat the patient (for free) until the time frame of one year is up because the plan agreement stated, “additional visits would be included as determined by the doctor for necessary flare-ups, slow healing, etc…” This can be construed as assuming risk. In essence, the capped fee is the same thing as unlimited service for fixed fee. What it says is the fee is being fixed or capped so the patient won’t have to pay any more for any service needed. If this was fee for service why would the word “capped” even be necessary?
Secondly, a volume trap occurs when volume goes up, but many people are not paying. The doctor’s conscience needs to be OK with this otherwise a burnout occurs from the doctor feeling under compensated for the workload they are doing. This can become a violation of the “fair exchange principle”. Not to mention, as volume goes up more staff is needed, but the doctor’s income has not risen in proportion to the volume as expected.
The best plans that I have been using and teaching for a number of years provides fee for service, fair exchange, are perfectly legal, provide three times the income from other unlimited service or capped fee plans and families are happy to pay. Use these guidelines to prepare your own.
Decide how many adjustments patients can buy at one time and list the retail and discounted amounts. Example 25-50-100 visits.
Prepare a chart they can easily understand illustrating these amounts
Itemize your adjustments, re-exams, re-x-rays or any other service included within this plan. Example: 50 adjustments at 3x/wk will last about three months. The patient will get two re-exams and one re-x-ray during that period of time. After you show the itemized and accumulated retail fees, show the discounted fees (usually 25-30%) for prepaying. Note, it is acceptable to prepay for re-exams and re-x-rays for monitoring progress but it is illegal to provide these services occasioned by fortuitous events.
Never sell a prepay plan based on time, only a specific number of adjustments. The previous example was to show the approximate time it takes to use up 50 adjustments in a structural corrective program. The adjustments would be sold to the patient in groups of 50 without a time frame restriction, expiration, etc…
An understandable refund clause must be written on the plan and given to the patient in the event a patient does not use the prepaid number of adjustments.
If you are billing insurance you cannot have a higher adjustment fee for insurance than for cash. Waiving or discounting deductibles or co-pays (NOOPE - No out of Pocket Expense) is illegal.
The retail adjustment fee and the discounted fee must be on the patients receipt and the discounted adjustment fee is put in the total column.
Check with your state association, attorney general or insurance commissioner to determine if your state requires prepaid fees are to be kept in escrow.
For families, have an increasing discount percentage for each member from the prepaid amount. Example – 10-20% off the second family member, 20-30% off the third etc… Come up with a fee you would be comfortable paying without giving it away.
Stick to these guidelines and regulate your discounts to what you’re comfortable with for families. But by all means, do fee for service to protect yourself and our profession.
Building a stable, high retention family practice is easy, but is dependent on two things. The first is specific communication strategies (which I covered in my last article) so patients value chiropractic enough to put you on their health care team for wellness. The second is great cash plans so they can afford the care for their entire family. There are specific guidelines for establishing cash plans so they are legal.
I have had a cash practice for 23 years. I brought the cash practice seminar to our profession 15 years ago while practices were still thriving on insurance reimbursement, but about to enter a new era in cost containment resulting in practice strangulation for those solely dependent on insurance. I had to make sure doctors were getting the best cash plans available to accomplish practice growth, retention and stability. But most importantly, the plans had to be affordable to the patient, yield the doctor the most income without creating a “work for nothing” consciousness and be legal in all states.
Before I give you these guidelines, it is important to mention that many doctors are still using plans that are vulnerable to legal scrutiny. Although there could be gray areas in certain states my attorney’s research resulted in consistent guidelines that are safe for everyone.
The major issue behind having legal prepay cash plans seems to hinge on the question of the assumption of risk (by the doctor for the patient) especially for fortuitous events. In other words, if the plan could be interpreted as providing care for any future injury, accident, exacerbation, pain or even a wellness check, it is construed as providing insurance without a license and is illegal.
Prepay cash plans in themselves are not illegal, but must be structured as “fee for service”. You must stay away from unlimited care for a fixed fee, cap fees, year long programs or any programs structured around a specific period of time. Although these plans are attractive plans to build “volume practices” several problems occur.
First with any “fixed” or “capped” fee, the patient is not paying for all the adjustments they are receiving. Even if a preset number of adjustments are listed, they are given these adjustments over a specific period of time, most commonly one year. For instance take a plan that lists 80 visits for one year at a prepay price of around $2000. Visits are laid out with a 3-2-1 format. The reality is the majority of the practices using this plan are spinal correction rather than musculoskeletal symptom-based, so correction stays at 3x/wk for a long time and 80 visits are used up long before the year is over or total correction is achieved. Hence, the doctor continues to treat the patient (for free) until the time frame of one year is up because the plan agreement stated, “additional visits would be included as determined by the doctor for necessary flare-ups, slow healing, etc…” This can be construed as assuming risk. In essence, the capped fee is the same thing as unlimited service for fixed fee. What it says is the fee is being fixed or capped so the patient won’t have to pay any more for any service needed. If this was fee for service why would the word “capped” even be necessary?
Secondly, a volume trap occurs when volume goes up, but many people are not paying. The doctor’s conscience needs to be OK with this. Otherwise a burnout occurs from the doctor feeling under compensated for the workload they are doing. This can become a violation of the “fair exchange principle”. Not to mention, as volume goes up, more staff is needed, but the doctor’s income has not risen in proportion to the volume as expected.
The best plans that I have been using and teaching for a number of years provides fee for service, fair exchange, are perfectly legal, provide three times the income from other unlimited service or capped fee plans and families are happy to pay. Use these guidelines to prepare your own.
Decide how many adjustments patients can buy at one time and list the retail and discounted amounts. Example 25-50-100 visits.
Prepare a chart they can easily understand illustrating these amounts
Itemize your adjustments, re-exams, re-x-rays or any other service included within this plan. Example: 50 adjustments at 3x/wk will last about three months. The patient will get two re-exams and one re-x-ray during that period of time. After you show the itemized and accumulated retail fees, show the discounted fees (usually 25-30%) for prepaying. Note, it is acceptable to prepay for re-exams and re-x-rays for monitoring progress but it is illegal to provide these services occasioned by fortuitous events.
Never sell a prepay plan based on time, only a specific number of adjustments. The previous example was to show the approximate time it takes to use up 50 adjustments in a structural corrective program. The adjustments would be sold to the patient in groups of 50 without a time frame restriction, expiration, etc…
An understandable refund clause must be written on the plan and given to the patient in the event a patient does not use the prepaid number of adjustments.
If you are billing insurance you cannot have a higher adjustment fee for insurance than for cash. Waiving or discounting deductibles or co-pays (NOOPE — No out of Pocket Expense) is illegal.
The retail adjustment fee and the discounted fee must be on the patient’s receipt and the discounted adjustment fee is put in the total column.
Check with your state association, attorney general or insurance commissioner to determine if your state requires prepaid fees are to be kept in escrow.
For families, have an increasing discount percentage for each member from the prepaid amount. Example – 10-20% off the second family member, 20-30% off the third etc… Come up with a fee you would be comfortable paying without giving it away.
Stick to these guidelines and regulate your discounts to what you’re comfortable with for families. But by all means, do fee-for-service to protect yourself and our profession.
Get more of Dr. Nikitow's exclusive Video Tips, Video Q&A and Access to all Past Videos in Our Member's Only Area. Contact us for more information about a lifetime membership!