Confusion, turmoil, fear ... I see many articles stating, "The good times are gone, better pull back, lay off staff, it's all over, sell your big house, get rid of your cars, go to a 700 sq. ft. office, one employee, and worse than that, go to a cash practice." Also: "You had better get there quick before it's too late." Isn't that the message you're getting from practically all of the consultants? The sky's falling, Henny Penny is out spreading the word, better put your head under the covers and turn out the light.
I disagree with all that malarkey, times have changed, we cannot think, act, or perform as we did in the past, however I believe with massive change there is also great opportunity for growth and for dramatically increasing your income. It sure sounds like I'm going against everyone else doesn't it? Well, I am. When there is change, the worst possible thing you can do is stop, wait, pull back, hesitate, withdraw from the game, and become less aggressive. The answer: Learn the new game and get ahead of the new crowd. I hear many people say go to a cash practice. That advice is about as good as telling someone to go to a total MediCare practice. Unless I'm blind, cash is the bottom end of the market.
I believe everyone needs care, so why give up and aim only for the bottom? Working twice as hard and twice as many hours for half the income doesn't sound very inviting to me. I think there are better alternatives, however, before we leave the discussion of the cash practice, let's look at what President Clinton has said. His major, number one priority is that everyone will have insurance. Where will all those cash patients be then? There will be no cash patients at all.
If you put together a team using this model and market it to just the small businesses in your community (200 employees or less), you will be so busy now and in the future you won't know what to do. Negotiate pre-employment physicals or job evaluation physicals. They are now called eye exams and drug screenings. Perform all of the companies' workers comp., get them back to work as soon as possible, and negotiate a program with the company to handle their other group health insurance at a discount rate, wave the deductible and establish a flat $10.00 co-pay per doctor visit.
Interestingly enough, this is perfectly legal if it is done on a contract basis, company by company. The market is there, the need is there -- chiropractors have survived on 10 percent of the market. When you bring on board a medical doctor and a physical therapist to your facility, you now are marketing to 99 percent of the population and in a much better position to go to companies with a full service program. The nice thing about it (and I've helped put 47 of these clinics together in the last three years), it brings chiropractic care to many more people in your community, i.e., people receiving chiropractic care who would not otherwise try it unless there were this multidisciplinary practice approach.
The sky is not falling, the game has changed. Do you want to quit playing or do you want to learn the new rules and place yourself right in the middle of it? I prefer the latter. I have been working with many clients doing just what I've described and their results have been fantastic. I have recently hired a registered nurse whose specialty is occupational medicine, and she has marketed and negotiated contracts for one of the largest medical chains in California. She has considerable experience negotiating contracts with companies, and helps acquire contracts with these small companies.
I practiced many years before insurance was available and practicing was no problem. People had no problem choosing a doctor. Now I see people that have insurance that does not cover chiropractic care or has very limited coverage say, "I'll go to the kind of physician that my insurance will pay for." I believe the cash patient market will completely dry up. One woman recently told me she received a letter from her insurance company stating she could go to any pharmacy for her prescriptions and she could pay her deductible plus 20 percent, or she could go to a specific pharmacy and have no deductible and only pay $10.00 per prescription. Now, where do you think she will go? Where would you go? Where do you think your patients will go if they get that kind of letter from their employer or insurance company? Do you think doctor loyalty will keep them with you or will they go where it is practically free?
Everyone, according to the president, will have health insurance. The cash patient market in my opinion will be gone, so how about company contracts? I think that's a great idea but I have seen thousands of chiropractors try to get company contracts and practically all fail. Why? Many reasons, but just to touch on a few: Industry is very medically oriented. The only place industry has come into contact with chiropractic care is in workers' compensation claims and we were on the patients' side, so to speak, against the companies, so industry doesn't like chiropractic as a rule. What's the answer? I believe the answer is to develop a multiple discipline practice approach. MDs, chiropractors, physical therapists, occupational nurses, and exercise physiologists working together with a very sharp marketing person who has negotiated contracts with companies for medical occupational clinics.
As I previously stated, I believe our market is 200 employees or less. It's great, it's profitable, it gets the practice busy. I have seen a 66 percent increase in income (net) over the last 18 months for clients who are taking this approach.
There is a new game with a new set of rules and take my word for it, times are never good or bad, they're merely different. The sky is not falling.
Ron Halstead, DC
Scottsdale, Arizona
