Welcome to CONA! We begin yet another year with renewed hopes and expectations that the New Year offers. This year’s no different. The challenges that await us are unique to many of us in private practice, yet for many it is a repeat of years past. As providers in an ever-changing healthcare environment we are charged with the tasks of providing quality care in a model where third-party reimbursement continues to diminish. Doctors of chiropractic have had to overcome prejudices of a medical model reimbursement system. With lower reimbursement, caps on services, gatekeepers, and limited access to a variety of patient populations, we need to explore all options.
The chiropractic profession in years past, postured ourselves to be part of the mainstream insurance reimbursement systems. We were so eager to gain access, that we entered into many these agreements with inherent flaws. Medicare was written in such a way that we got our foot in the door, but with so many restrictions, regulations and requirements, it feels like they just keep slamming the door on our foot. Workers compensation (as in California) is a pendulum that has swung to extremes. A little more than a decade ago we had complete access but through misuse, it was essentially taken away. PPOs were 30 years ago or so, the most equitable relationship chiropractic had with the insurance industry in our history. The advent of the HMO created the structured fixed fee for service and limited access of the patient to the chiropractic provider. Med-pay for auto insurance carriers continues to provide a reasonable reimbursement for services rendered; however like workers compensation, inappropriate or excessive treatment, or worse unwarranted treatment keeps the PI patient subject to scrutiny. Care needs to be given as to not participate in secondary gain motives, or this to may go by the way of Worker’s Compensation system.
The problem lies not with chiropractors alone, our allied healthcare providers are feeling the strain; it lies in whole, or in part with the insurance carriers themselves. This is a huge industry that has wedged themselves between the providers and the patient’s. They demand large premiums, deductibles and co-pays from the patient/consumer, and in turn structure reimbursement fees to contract providers at significantly lower fees; that continue to diminish, nor keep pace with inflation. All the while, the insurance company, being a business, profits. Now I realize that insurance is necessary, and they are for profit. So am I! However, insurance was never intended to be a “pay all” for services system. Our society is spoiled with the belief that “someone else should pay for this”. I’ve had patients state “I can’t see your any more. My insurance won’t pay for you”, “You’re not a preferred provider”, “couldn’t get authorization”, etc. Wow!, so who is dictating care? Reimbursements for “Services Rendered” by chiropractors are additionally hindered by a philosophical approach to treatment. Chiropractic philosophy does not always mesh with insurance reimbursement because insurance is based on a medical model of treatment and coding. Back to our desire to belong to a reimbursement system we have found ourselves often trying to fit square pegs into round holes to satisfy insurance coding requirements. That said; the chiropractic profession is not wrong in our approach to healthcare; especially in the field of neuro-musculoskeletal conditions where patients have outstanding response to our care at an affordable price. There is also a misconception within the insurance industry, and to society in general that all chiropractic treatment care is identical. We are a group of physicians that are as diverse as our medical counterparts. Our approach and treatment methods vary within our codified scopes. As chiropractic orthopedists we took extra steps with post-graduate education and training to enhance our skills and treatment methods to focus on those orthopedic conditions that we all know respond so well. I would be remiss to not include the subluxation-based practices, as I know the impact of a dysfunctional motor segment that responds to the skill of a chiropractic manipulative adjustment. If “wellness” or “prevention” are not just trending phrases, then a proactive model of care should not be frowned upon either. Insurance companies use these words to sell policies.
Opt in, or opt out. Sounds like the Hokie Pokie to me! With the pending implementation of “Obama care” and the uncertainty that surrounds it, I would simply plea that we entertain and reintroduce health insurance in a model that is similar to your automotive insurance. What that means is that catastrophic damage is covered by insurance, but the day-to-day costs are incurred by the owner, i.e. oil changes, tires, tune-ups, and normal wear and tear are paid for by the owner. What that really means is that insurance should be for catastrophic care only, with a higher deductible and an affordable premium, with day-to-day conditions being paid out of pocket. HSA’s (health savings accounts) offer tax incentives that really makes sense and were designed for this model. Truth said; I probably spend over $2000 year on car maintenance. If I were to propose to a patient that they spend half that much money on their own personal care in a year, I would be met with a stare of disbelief. Educating the patient that if they are willing to spend that much money on a car, that they may own for only five years, why would they object to investing in their own health and body needs to serve them a lifetime. This is where the doctor needs to hone his communication skills; and patient education really can pay off. Proactive approaches to health; versus reactive, is understood by many. Ralph Waldo Emerson’s quote “the first wealth is health”. Resonates that there is great value in the services we has chiropractors provide, both therapeutic and palliative.
How you approach your practice in the future is certainly your choice, however, dependence on insurance reimbursement, to me, sure lacks the confidence needed for a financially lucrative future. Cash models are out there and may be worth exploring. Returning to a system that our chiropractic forefathers started with may be in the end, the best answer. It will certainly take some educating of the patient but, providing a valuable service at a fair and honest value seems to be a path worth exploring in an insurance driven third party world. Just my thoughts!!
I look forward to our meeting again in June this year for our annual seminar and convention. We welcome all to our organization. Please feel free to contact us. Your input is welcomed!
Stephen Fullmer, DC
President: Chiropractic Orthopedists of North America