Avoidance in Practice – Is it Costing Us Money?

One of the great joys of being a doctor is waking up every morning and heading to the practice to help improve the quality of life for our patients. Like most of you, I became a chiropractor to help people. I suppose I understood that I’d also be the owner of a small business, but I didn’t really understand everything that being an entrepreneur would entail. Even if I had, I surely couldn’t have predicted how complicated and highly regulated chiropractic would become with the changes in Medicare and OIG compliance, private insurers and records requests, coding and documentation requirements. I never imagined the complexity that would be involved in setting up my fees nor the multiple fees that would be allowed or required with the various payors.

In chiropractic, we tend to sabotage ourselves despite our desire to be successful business owners and chiropractors. Often we forget that we are regulated by a healthcare “system,” and we must comply with ALL layers of that system. What I have learned over thirty years is that there are three common mistakes that can make it more challenging to achieve a profitable and successful practice.

1. We Lack a Simple and Compliant Financial Policy. Our financial policies, our billing and collection procedures, and how we present payment options for our patients, can be some of our greatest areas of RISK in practice. These policies can be used as a weapon against us if they are not compliant with all the layers of regulations we face today. You are MORE likely to face financial problems from audits, fines, and penalties than you are from malpractice claims. That’s not my opinion. It’s a fact. One of the top reasons complaints are filed with Boards of Examiners is not over our clinical care but over our financial policies. More importantly, despite having the best, most legal, most enforceable financial policy known to man, always stop and ask yourself, “Is it simple enough that anyone on my team can explain it clearly and concisely?” If your financial policy is so complicated that only one person on your staff can explain it, then it doesn’t matter that it is compliant. As our old friend Albert Einstein said, “If you can’t explain it simply, YOU don’t understand it well enough.” Keep it simple.
2. We Lack Structure in our Fee Systems. I remember hearing Dr. Larry Markson speak early in my career. I will never forget him saying, “My fee is my fee is my fee.” Meaning, we should only have one fee, our actual fee, in our offices. Your fee system reflects the range of fees you accept as part of your managed care agreements and your participation in mandated programs (Medicare, Medicaid, PI, WC). While all of these fees may be different, they are all discounted off of your ACTUAL FEE or mandated by the state and/or federal government. Do you have a cash fee, family fee, or a “buy-10-visits-get-one-free” fee? Take a step back and stop thinking of your fees based on who is paying the bill. Your fee system should be structured in layers made up of your Actual Fees/UCR Fee Schedule, Contracted Fees, Mandated Fees, and Hardship Fees.
3. We Avoid Discussing Finances with Patients. You already know that a Clinical Report of Findings is key for patients to understand the need for care. Equally important is the Financial Report of Findings (FROF), since, like it or not, patients DO make healthcare decisions based on dollars and cents as well as the clinical need for care. I am surprised to hear that many of my colleagues skip this step. Today’s patients are healthcare consumers and want us to help them feel and function better physically without hurting them financially. In fact, many insured patients walk into a chiropractor’s office under the assumption that their insurance is going to cover all of the care they need with minimal out-of-pocket expense. Even patients who are your raving fans can turn angry when they receive bills several months later for care that was not covered by their insurance. The best way to keep patients happy, improve clinical outcomes, and enhance collections in your practice is to clearly and openly discuss your fees and payment policy upfront. By conducting a formal Financial Report of Findings (FROF) in your office, you can simply outline the treatment plan as well as the patient’s estimated out-of-pocket expense. If you provide ways to make the care affordable and offer payment options that your patients can fit into their budgets, you have a win-win situation.

Being a Doctor of Chiropractic is a privilege. I can’t think of anything that I would rather wake up and do every morning. All of these risks in your practice can be managed and even eliminated if you carve out time to work ON your practice instead of just IN your practice. Focus on one task at a time, and don’t forget to ask for help. There are consultants across the country that can help you become more compliant and more profitable. Before long you will be practicing with peace of mind.