Either way, his patients gave him immediate feed-back: They paid in cash.
As the saying goes, that was then, this is now.
Today, there are numerous ways a patient can "pay." Health insurance, workers' compensation, personal injury, PPO, HMO, and yes, some even pay cash. This not only influences the patient/doctor relationship, it forces you to have to satisfy an organization that has never met you, never been treated by you, probably never met your patient (their policy holder), and may be more concerned with the financial "bottom line" than optimal health. But this is the reality.
Fortunately, you have choices.
You can still have a cash practice. Many DCs still do and probably relish the simplicity of such a practice. Personally, even though our company's health care program includes chiropractic, I prefer to pay cash. I've been with the same chiropractor since my father passed away, and I wouldn't trade him for anything.
While managed care appears very threatening to some DCs, it is merely the current installment in the development of health care by insurance companies. Some companies are better than others, and you as the DC can choose which managed care organizations, which insurance carriers, which attorneys, and what types of patients you want to work with.
Chiropractic should be represented in every aspect of health care. From the 100 percent cash practice to the salaried member of an HMO, there should never be a place where patients are and chiropractors aren't.
The most important question in every aspect of health care is what part chiropractors should play in the management and administration of the health care offered. If DCs are relegated to specialists who would be called upon like a "Maytag repairman" on the odd chance that an MD will recognize the value of chiropractic, chiropractic's potential contribution to that organization will be negligible. Likewise, if DCs refuse to work within _reasonable_ guidelines that many health care organizations have, chiropractic is no longer cost effective, the profession will cease to exist, and patients/policyholder will pay too much for less-than-optimum care.
Health care in the '90s and beyond will be delivered by a team, and like it or not, the insurance companies (or some other administrator) is part of that team.
We must demand full partnership on the health care team. Proper administration of chiropractic care requires the involvement of DCs and administrators and reviewers who have not lost the insight necessary to properly care for patients. Patient satisfaction must become just as much a driving force in health care as cost efficiency. What good is cheap health care if the patient is not cared for?
How you choose to practice and what types of patients you treat should be a combination of where you live and your own personal preferences. This is a new era in health care in the United States. Many other countries have traveled this way: We can learn many lessons from DCs in countries like Canada, Britain, and Australia.
Patient satisfaction, integrity of care, chiropractic representation, and proper integration should be the issues we consider as health care goes through the present metamorphosis. We must never forget that despite all that Clinton and Congress are doing, the most important part of health care takes place after the patient walks into your office.
DMP, Jr., BS, HCD(hc)
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