May 10, 2016


By Dr. Dan Golden In Chiropractic Success, Practice Management

Chirosushi summit

It has come full circle

Prior to mid-1970’s the business end of operating a practice was quite simple.  For the majority, there was one single new patient entry fee which covered the consultation, examination.  Once treatment was initiated there was a single fee regardless of what was done.  Patients had to pay for services out of their pocket.  They could: (1) pay as received, (2) purchase multiple visits (6 or 12) at a reduced fee, (3) prepay for all services recommended in the report of findings at a greater discount.

  Enter third party pay.  Insurance companies began paying for treatment rendered by Chiropractors.  “Health Insurance Equality Acts” were drafted, and laws passed.  On a national level, the Medicare law was amended to include (very limited) Chiropractic care.  Initially dealing with the insurance industry was quite simple…..list a diagnosis, the dates of treatment the total charge, put the claim in the mail.  Within 4-8 weeks money appeared in the mailbox. 

Throughout the 1980’s and well into the 1990’s a large majority of Chiropractors operated  “insurance practices.”  One factor (money) influencing patient compliance had been removed.  Some doctors had a N.O.O.P.E. (No Out Of Pocket Expense) policy wherein the office would absorb that percentage insurance didn’t pay.  A supposed win/win situation.  DC’s could bill and be paid for each service they offered (far better than a single office call fee) and patients didn’t have to pay anything!

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Then things began to shift.  As time passed the business end of practicing became more and more complex.  Codes were required for diagnosis and treatment.  Pre-approval was common.  Paper review audits became the norm.  More often than not some (maybe all) treatment was deemed “unnecessary.”  Doctors were being required to repay a portion or all of what had been paid months….even years before.

At the turn of the century doctors of all disciplines began experiencing less and less compensation from insurance.  HMO’s, PPO’s has become the norm as opposed to the exception.   Doctors, clinics, hospitals were forced to agree to payment schedules established by the insurance company.

It had become so difficult and demanding to practice in such an environment more and more DC’s began opting out of insurance.  Of course, Medicare plays by its own set of rules making it virtually impossible for DC’s to opt out.

Yes….operating the business end of a practice has come full circle.  Even so, good can be found in all things.  Being forced to revert back to the way things were 40 years ago is no exception.  Now, more than anytime in the past 20-25 years, doctors must show the value and necessity of the services they offer.  Doctors are being forced to tell the Chiropractic story.  Inform patients how/why Chiropractic care should be their primary form of health care.  In addition making treatment affordable is imperative.  Offices must resort to being more creative in dealing with the financial aspect of the care offered.    Yes….we have come full circle and that’s not really a bad thing!

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