Charging Reasonable Fees for Your Services

Here's a question I received from a DC recently:

"How much do you think I should be charging a cash patient for a simple adjustment visit? I'm thinking about going to an all-cash practice and need to restructure my fee schedule. What do you think about joining one of those cooperatives that gives you a legal way to offer lower fees through a nationwide organization?

I can count on being asked some variation of these questions or this theme every time I do a presentation at a convention or get into a conversation that lasts longer than five minutes! Let me preface my reply with the statement that I'm not an attorney and don't give legal advice. This topic also makes me crabby. I'll limit my answer to the "lower fee" portion of your question. My reply may get a few readers upset. All I ask is, the more upset you are, the more I would ask you to think this over: "Why do you find charging a reasonable fee for your service so disturbing?"

In my work, I see far too many DCs who are barely making it. They aren't excited about what they are doing. They feel that most of what's wrong with their practices are the result of "outside forces." Some who have never practiced "before insurance" haven't developed the skills of making a good report of findings/case presentation, and/or resent having to "sell the need" for their services. They feel disillusioned and wonder about their career choice.

And yet, there are many doctors who thrive in chiropractic because they love what they do. They can explain the patient's problem and the need for care in a way that motivates the patient to follow their advice. They truly understand and believe in chiropractic and that belief shines through. They can "deliver the goods." They know how to adjust and their patients see results. They have reasonable fees, and expect to collect from nearly everyone.

They understand that even though they are in a "serving profession," they are entitled to be paid. They feel "the laborer is worthy of his or her hire." They do some reduced fee or charity work for genuine hardship cases, but don't reduce fees for people who can afford their care but would rather whine their way to a lower fee. They are not embarrassed or ashamed to charge for what they can do for the patient.

A doctor's standard fees are a reflection of experience, training, costs, economic area, UCR, etc. This is true whether it's a cash case or an insurance case. I'm not going to touch the insurance fee/cash fee debate today; I'm talking about every kind of case. So, knowing that this successful, ordinary, everyday DC exists out there, I have a problem when I see businesses outside of chiropractic suggesting "wholesale pricing."

I was at a convention recently where a few of those attending though we should charge a fee that was $3 more than what was charged in our area in 1970! Where is this thinking coming from? We're not talking hardship cases here, we are talking about "yuppie practices." Nothing else has stayed the same price since 1970; why would anyone want to roll back their fee to that level? Can you, the DC, buy a car, a home, or a hamburger for what it cost in 1970? I just don't "get it" when people want to charge a fee way out of kilter with the cost of living for patients who can easily pay a "normal" fee!

If this approach was concurrent with some sort of massive PR campaign to break open the health care market to increase our share of the health care "pie," I might see some logic or purpose there. But what I see is a "for profit" business coming along encouraging us to cut the present "chiropractic share of the market" into ever smaller pieces. The problem is if you build a practice only on low fees, someone else will eventually take the patients that are only interested in going to the cheapest DC!

I've become firmly convinced that the "wheel of fortune" approach to fees is some sort of professional inferiority complex masquerading as "service to mankind." If these groups really want to serve mankind, they should be encouraging and teaching their members to "sell the sizzle," charging a reasonable fee and then plowing the profits back into public education, the purchase and/or rental of key politicians and a general forward movement to greater public acceptance of, and inclusion of, chiropractic.

A financially successful profession is in a far better position to change the world.

P.S.: Will the class president I talked with recently call me? I've forgotten your name. Also, to the DC named "Doc Paul," my e-mail burped and I lost your note.

Dear Readers:

I am always interested in hearing your thoughts and questions. I want my column to reflect your real life. You can talk to me or write me at the address below.

For those of you who would like to contact me by e-mail, I will need your full name, city, state, age, time in practice and normal weekly patient load. Also include your hours, number of staff and other pertinent facts that you think I'll need to answer your question. I don't answer nonspecific questions like, "How can I improve my practice?" I may ask you to call me if your question is long or complex.

Kiki Herfert
15852 Jefferson Avenue
Grosse Pointe Park, Michigan
48230-1445
Tel/fax: (313) 822-9199
kikiherfer-aol.com