We are not covered by insurance. New drugs are being invented that claim they will cure low back pain. Workers' compensation and personal-injury practices are not the cash cows they once were.The profession will not be around for many more years. No, that is not the talk that was the word on the street in 1964 when I started my practice. The naysayers said chiropractic was doomed. Well, here we are in 2008, and we are far from being extinct. Do we have problems? Yes. Are we doomed? No.
Now, do we have to make some changes in an ever-changing health care world? Of course we do. How do we go about this? Well, as I reflect, it seems to me that we have to look back at how we operated a successful practice back when I began practicing and make it adaptable to today's world.
I don't have to tell you that we are being cut by all of the insurance companies for various reasons. Some are legitimate, but most are absolutely bordering on criminal. Some insurance companies are saying, "Yes, chiropractic has research. But it is not enough." Some companies are ignoring the data. The fact of the matter is the insurance industry is trying to cut any area of the health care world that is vulnerable. Chiropractic is vulnerable because we don't have the millions of dollars necessary to fight the legal battles.
I just pulled the stats from our two-year-old clinic here in Phoenix to check the mix of payment. Half of our patients pay cash and the rest of the practice is a mix of good insurance coverage, about ten percent Medicare, and personal injury and workers' compensation. We have seen co-payments in Arizona rise higher than our regular office call. We have been telling those patients that we accept their insurance, but that it's cheaper for them to pay cash for the office call than the co-pay. They consider it a good deal. We have seen HMOs cut payments to the point of having a reimbursement check for 26 cents pasted on the wall. Yes, I said cents!
We are wondering what will happen if we have a national health care plan and what the chiropractor's role will be in it. That is a real unknown. I have traveled the world in the past 10 years and in almost all of the countries I have visited, the doctors have told me they were included in some way in their national health care plan when it began, only to see their role reduced each year until it was eliminated completely. Chiropractic will be one of the first to be eliminated. Remember, all of the politicians in this country have said the most successful national health care plan should be run by the existing insurance companies; the very same ones who are cutting our fees now. What makes us think they will treat us differently if a national health care plan comes to pass?
So it seems to me we are back to square one. Is there patient demand for chiropractic? I believe that is a given, as long as it's truly chiropractic. I was in New Zealand for the New Zealand College of Chiropractic homecoming in September 2007. One of the speakers was a sociologist from a major university. She has studied chiropractic from a sociologist's point of view and says the most important thing for chiropractic to remember is that we should not lose our identity. She equated us to a small fish swimming in a health care pond with a shark (medicine). If we stay in the shark tank we will be eaten alive. If we swim away and stay separate we will be like salmon. Now salmon are used to swimming upstream against all odds. Many die, but we produce a new crop of tough fish that can carry on the care the public needs and deserves.
Lastly, don't think medicine is immune to the problems we face. One day, I was flying to a meeting and happened to sit next to a very professional-looking gentleman. We began a conversation and before he knew what I did he told me he was a financial planner who helped doctors with their finances. I asked him what kind of doctors he advised and I was surprised when he said that he only took two specialties: plastic surgeons and dermatologists. I asked him why those two specialties? He replied that they operated in cash only and they were the only doctors that actually made money in health care.
That got me thinking. The only two other professions prospering are the dentists and the veterinarians, both professions operating outside of the health care system, with the patients paying cash for their services. I believe with a fair office call, hard work and keeping our overheads low, we can stay out of the "health care tank" and prosper in the future. Is it time for the chiropractors to go back to a cash practice? I don't think we need to go completely to cash and not service our good patients that have health care coverage that pays a reasonable fee. But I don't think we should accept the insurance plans that simply do not make economical sense. So use common sense. You have to accept Medicare, so why turn it down? You will want to accept personal-injury cases, so don't turn that down. However, for the patient who wants to stay well, we have been finding many companies are offering health savings accounts (HSAs) for their employees that allow the patient to spend that money wherever they choose. Don't turn that down. For the patient who really cares about their health and wants to maintain it, I believe they are willing to pay a reasonable out-of-pocket fee.
And last but not least, become focused on the needs of our patients as we were taught in school, and be proud of our profession.
Click here for previous articles by Arlan Fuhr, DC.