Remember the adage, "Don't put all your eggs in one basket?" Well, that's what you do when you count 100 percent on insurance reimbursement to sustain your practice. You never seem to get ahead, even when you add new patients, because you are taking in with one hand and giving away with the other. And if it appears you can never catch up, you're right – you can't. That is, unless you make some changes.
The trouble is, insurance companies seem to be tightening the screws when it comes to chiropractic care and medical review policy; and soft chiropractors are being hit hard by state legislation that negatively affects reimbursement as well.
You may be keen to switch to a "cash-only" practice before it's too late, and while this idea does have its merits, it certainly isn't something you can put into place tomorrow, next month or even by the middle of 2019. However, there are ways to transition your practice to cash that are relatively pain-free and allow you to avoid the sting of constantly changing insurance regulations that take bigger and bigger bites from your reimbursement pie.
Embrace Cash Profit Centers
There are plenty of ways to increase cash-based profit centers within your practice, and it's a fact that practices which offer products and add-on services have higher gross revenues. Patients expect us to be whole-body practitioners and, when necessary, these create cash profit centers that benefit the practice and services to help your patients stay healthy.
Profit centers range from orthotics to nutritional products, rehab equipment and various other services. The magic is in the implementation. When providers include these items in the treatment plan, and team members execute that plan with dispensing and collection of payment, the process becomes seamless. Then it's easy to include them with the care plan. Here are some simple suggestions that can enhance the implementation of these types of profit centers.
1. Create a health questionnaire to be added to the intake history of every new patient. Focus the questions toward items you provide in the practice. If you have a nutrition focus, for example, include nutrition-based questions that can be addressed during a later nutritional consultation. If you focus on orthotics, include questions about shoe wear, etc.
You may elect to supply this questionnaire as homework in the first week of care, and, when it's returned, set it aside until the patient is out of the acute phase. At that time, schedule a 10- to 15-minute consult on the next visit, and then review it and make your recommendations.
2. Market your products and services. As an example, you can select a "Product of the Month" and feature a different product along with parallel condition-of-the-month marketing, etc. If you are focusing on children in a given month, make your children's fish oil or multivitamin your featured product. If you are doing low back pain in a given month, feature custom orthotics. It's very easy to do creative things when you put your mind to it. Just make sure every patient knows about your featured product / service and understands why they need it!
3. Incorporate the products / services into your treatment plan. If you provide active treatment in practice, surely the patient needs to have tubing or equipment to perform home exercises. If you find pronation on a foot scan, incorporate custom orthotics into the treatment. After all, when the foot hits the ground, everything changes. If you are treating a neck condition, make it a habit to inquire about their pillow. Same with lower back issues for folks who routinely sit: recommend a lumbar cushion to help provide support. And who doesn't need a topical analgesic in the acute phase of care? Simply prescribe it ... the patient will comply.
4. Remember that not all services are ideal for insurance reimbursement. Consider adding more cash-based services to the practice such as true massage, instrument-assisted soft-tissue mobilization, and laser. Most third-party payers don't cover these services, but patients will pay for what they value.
For example, roller table traction is considered experimental and investigational by most carriers. But patients love it so much, they will happily pay an extra $10 or $15 per visit for a session on the roller table. See for yourself!
A Win-Win for You and Your Patients
If you make cash products and services part of the patient's treatment plan, and if the patient understands why they need them, they are usually willing and able to follow your recommendations. Demonstrate the connection between these services and the patient's condition and care plan, and you will be well on your way to increasing your revenues through profit centers and increasing the patient's health and wellness experience at the same time.
Kathy Mills Chang is a certified medical compliance specialist (MCS-P), certified chiropractic professional coder (CCPC) and certified clinical chiropractic assistant (CCCA). Since 1983, she has been providing chiropractors with reimbursement and compliance training, advice and tools to improve the financial performance of their practices. She also serves as Foot Levelers' insurance advisor. Kathy leads a team of 30 at KMC University and is known as one of our profession's foremost experts on Medicare, documentation and CA development.