How to become an all-cash chiropractic practice

Insurance reimbursement for musculoskeletal medicine is at an all-time low.

Many of the most commonly performed procedures have had their reimbursement rates drastically reduced over the last three years. Every practitioner has been affected to some extent. Orthopedic surgeons, physical medicine and rehabilitation (PM&R) physicians, neurologists, and chiropractors alike are feeling the pain.

There has been no escape for physical therapists either, with the last three years also including cuts in benefits for physical therapy in many insurance plans.

In the past, you could make up for some of these losses by adding medical services to your practice. By adding physical therapy and some physical medicine and rehabilitative (PM&R) services, especially nerve conduction and electromyography (EMG) studies, a typical chiropractic office could triple or even quadruple its collections.

Unfortunately, it is now nearly impossible to quadruple your income simply by adding more insurance- based services. Integrating your practice will definitely still be profitable, but the gains are far from what they used to be.

To give but one example, neuro-diagnostic exams such as EMG and nerve conduction velocity (NCV) testing used to be reimbursed at $2,000 to $3,000 per upper or lower study.

Now, reimbursement is running around 25 to 35 percent of that.

Given that you face a hostile economic environment, what kinds of strategies can be implemented to preserve your current income level and allow for future growth? The answer is to think in terms of adding services that are cash-based and not covered by insurance.

Less struggle, less stress

Once you get off the insurance merry- go-round, you will find a new world of practice opportunities and a more rewarding, stress-free practice.

One of the chief benefits of going all cash is that you won’t need a billing person anymore (nor will you have complex collections statistics to review every month). That’s because you will get paid for the work you do at the time of the visit. You will practice in a world where there is no precertification, no threat of recoupment or review, and no surprise denials that make financial projections difficult to calculate.

If you have decided to move toward an all-cash practice, what services can you add? Before looking at the pros and cons of the most commonly added services, first be aware of a few warnings.

First of all, don’t expect a lot of patients requesting cash-based services if you aren’t located in a first-class neighborhood. People have to be able to afford to pay out of pocket for elective medical services. If you have the wrong patient demographic, consider opening a satellite office to see cash-only patents.

In addition, your office should be comfortable, clean, and professional- looking. Get some honest appraisals from friends and family members who can speak freely to you. This may be a good time to think about remodeling.

Success with services

The services that most people add to a cash-based practice can be divided into physical medicine, wellness, functional medicine, and aesthetic medicine.

As insurance reimbursements continue to decline, you may want to consider providing adjustments as a cash-only service. Your volume, however, will have to increase and you may not want that additional physical load at this stage of your life.

Other cash-based services to consider in physical medicine are spinal decompression and cold-laser treatments for musculoskeletal pain and peripheral neuropathy. Both of these can be highly profitable, but they have been in the chiropractic arena for a long time, meaning there is likely to be a lot of competition.

If you have an MD in your practice, you can do platelet-enriched plasma (PRP) and stem cell injections. These are used for tendon repair, joint restoration, and a host of cosmetic procedures—there is even a PRP face lift and breast lift. These services are quite profitable and relatively inexpensive to implement (training for MDs is available).

Under the heading of wellness and functional medicine are many procedures and treatments you can also add. These include food and inhalant allergy testing and treatment, nutritional testing and supplementation, hormone balancing, and implantable testosterone pellets. Note: Although some of these can be performed by a chiropractor, you will have a more profitable practice if an MD provides them. In addition to being profitable, they don’t require special equipment or large amounts of space, and training is available for MDs and DCs.

Also, note that while insurance may cover some of these, such as low testosterone (Low-T) testing, they only cover mainstream treatments and will not pay for the more sophisticated tests and procedures under discussion.

Therefore, these should become cash-based services.

There is a cachet about aesthetic services that patients and doctors find appealing. When used in conjunction with anti-aging medicine and regenerative medicine (stem cell and PRP therapies), it may be possible to postpone aging and even help turn back the clock.

Profit centers include facials and peels, skin fillers and Botox, non- surgical face and breast lifts, micro- dermabrasion, laser hair removal, and skin tightening. You can start with low-overhead procedures and work your way up to more expensive offerings that require dedicated space, such as CoolSculpting.

The time is now to start adding cash-based services to your practice. You stand to not only make more profits, but have more fun, too.

Marc H. Sencer, MD, is the president of MDs for DCs, which provides intensive one-on-one training, medical staffing, and ongoing practice management support to chiropractic integrated practices. He can be reached at 800-916-1462 or through mdsfordcs.com.