The fastest way to infuse cash into any practice is by becoming what I call a Health Care Advisor or HCA. What's an HCA? It's a concept I've been teaching since I taught my first nutritional boot-camp some 15 years ago, in October 1996. A Health Care Advisor is a doctor that besides offering chiropractic also "Advises" patients of all health related services and products that may improve outcomes regardless of it being covered by insurance. Far too often chiropractors choose to not recommend ancillary products because they know they're not covered by insurance, even though they may help reduce pain or lessen treatment duration.
The End of Insurance
There is very little doubt that having an exclusive insurance-dependent practice puts chiropractors at serious risk and makes going to work every day very stressful, clearly undermining the passion we all have for practice.So what is the best way to infuse our practice with cash as fast as is reasonable and even more importantly establishing a game-plan for staying there?
Adding cash-based products and converting to more cash treatment plans within chiropractic practices is happening in large numbers in the chiropractic profession, in fact more chiropractors converted this past year than at any other time in our professions recent past. How do I know that? A recent survey this year of chiropractors showed that cash just might be "king" after all.
With insurance companies tightening their belts and reimbursement rates to chiropractors dropping to a three-year low, more chiropractors are turning to some type of cash-based practice philosophy. By the way, the survey revealed that the chiropractor today that is moving towards cash is not a new doctor recently out of school. The typical cash-converting chiropractic respondent was 51 years old, with 90% of them owning a solo clinic and the average time in practice was 21 years!
What that clearly tells me is the seasoned chiropractic "vets" have had enough! They see the writing on the wall and are taking the "bull by the horns." BRAVO! What are we to do, sit around and go out of business? Most chiropractors that have been in practice for twenty plus years also heard the stories from our founding chiropractic fathers before chiropractors were ever on the insurance "soup-line."
Many old-time chiropractors went on record and said that the inclusion of chiropractic in the insurance world is the worst thing for our profession and may eventually lead to its downfall. Well, I don't want to predict that type of a disaster, but things in the insurance world for chiropractors do look bleak to say the least.
The Cash Advantage
One of the major reasons doctors are switching to cash products and fees is the troubling trend in insurance reimbursement. In 2011 chiropractors who billed insurance companies their average fee of $71.00 found that they only received $45.00, an unbelievable 63% reduction! However chiropractors that charged the same $71.00 in a cash practices reported netting $68.00, which was a fantastic 96%! Come on, what more do we need to know to begin the transition?
The New Game Plan
I have been teaching chiropractors for years to establish a business plan that has a majority of their revenue in "retail" sales products. I use to say you should plan on 40% from retail sales and 60% from your chiropractic services. But in light of the insurance slide, I strongly now feel the numbers should be reversed to 60% from retail sales and 40% from your services, or at least begin the transition to a much higher percentage. I know of chiropractors that have in excess of 80% of their cash flow in retail sales. This is not to say there not doing chiropractic, they are, it's just to say they have figured it out and would rather "switch" then fight and go down in flames.
Chiropractors Are Making This Way Too Difficult
My wife goes to an esthetician that does facials in her private 600 square foot salon. The lady charges $150.00 cash for one facial treatment or if you buy a package of 10, you get a 50.00 cash discount and only pay $99.00 each. Get this, she writes out a check to her on a regular basis for $990.00 right on the spot. Why? She wants the facials and she wants to save $500.00. And of course there are the creams and oils that she needs that she can purchase right in the reception room, along with, believe it or not, nutritional products that help slow down the aging process. I know you might find this hard to believe, but this person makes 60% of her revenue from retail product sales and only 40% from her services. She is putting chiropractors to shame by generating a whopping $50,000 to $70,000 cash every month, all without the hassle of insurance reimbursement.
What Ancillary "Cash" Product Will Increase Cash Flow The Most?
I think it's fair to say that the most recommended ancillary product in the past in the typical chiropractic office was the cervical pillow (See Page XX). Even though that product is still a valued cash item to recommend, how many pillows can a patient purchase? You need to at least do what the esthetician does and recommend something that compliments your services and is a consumable, reusable retail product. By that I mean a product that your customer buys, consumes, and repurchases every month from you.
[pb]Chiropractors are finally getting it. The survey showed that among doctors that offer retail products the overwhelming most popular item sold today by nearly 68% of the chiropractors responding, was nutrition, a consumable, reusable cash product. The next most popular cash item listed, at only 38%, was electrotherapy. I'm not surprised to see "elective" electrotherapy that unpopular. Let's face it, most patients will pay cash for a nutritional support product instead of an additional therapy modality because they think their insurances should pay for therapy, but they know they have to pay for nutrition.
So offering a nutritional "cash" product that improves patient outcomes makes great sense. This might come as a surprise to some chiropractors, but certainly not to me. Offering a nutritional product designed to use on the first visit to help with pain and inflammation is the best nutritional product to recommend because it deals with almost 100% of chiropractic first visit patients, those who come to us suffering with these two symptoms.
Offer Nutrition or Let Them Use NSAID's?
I think it's fair to say that the overwhelming majority of new patients that visit chiropractors are self-medicating with some type of over-the-counter NSAID. Why? Patients have learned that NSAID's help reduce pain, so they figure why not give it a try. Unfortunately most patients don't know that NSAID's may also cause stomach bleeding, liver damage and a host of other concerns which might have prompted the American Heart Association to issue a scientific statement suggesting physicians change the way they prescribe over-the-counter pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment. (AHA Statement 2-26-07). NSAID's are typically recommended for pain and inflammation because they inhibit the COX-2 enzyme. As chiropractors know the COX-2 enzyme converts arachidonic acid to PGHS-2 and is typically unexpressed under normal conditions, but becomes elevated during inflammation. NSAID's are made to target directly the COX-2 enzyme but unfortunately most also target the COX-1 enzyme which helps to protect kidney and stomach cells and seems to prevent ulcers. So if chiropractors could help their patients on the first visit move away from dangerous NSAID's to a safe and natural nutritional alternative that may help to support minor pain relief, I feel they are obligated to share this information regardless of the product being covered by insurance or not.
Why Not Have An Insurance and Cash Practice Blend?
Typically most chiropractors agree with this concept but most do it all wrong by trying to combine them together without any game plan which usually backfires. The only way to be successful is to start getting patients use to paying cash for something that's not covered but that they want, like "out of pain quicker" on their first visit. Doctors owe their patients their best advice and should not withhold any recommendations that will improve outcomes, regardless of it not being covered.
Offering patient's specific advice on supportive products to improve conditions is not being a salesperson, it's the duty of a doctor. Tell the patient the best plan and let the patient decide. The key to conversion from Insurance/PI to Cash is to get patients to accept some financial responsibility on their first visit so they get familiar with paying cash for uncovered items. This will make the job easier when it comes time to convert patients from their 12 visits to either wellness or maintenance; they become more accepting and understanding of the "cash model." Of course I teach this concept and call it becoming a "Health Care Advisor", (HCA).
A HCA should tell patients everything that could help them get well sooner, regardless of their ability to pay or the insurance coverage. I get asked constantly from chiropractors who know that insurance coverage is in decline how they can add some type of cash product that really makes a difference in outcomes that patients would be willing to pay for.
First of all in my opinion a high antioxidant fruit and vegetable powdered drink mix is a great example of a non-insurance covered product that can improve outcomes. In addition it's very important to offer an all-natural cox-2 inhibitor type product that can help to reduce minor pain and stabilize the inflammatory response. Some chiropractors wait to offer nutrition after the patient is out of pain and their insurance has run out thinking its best recommended as part of a wellness program. Even though it can be used that way, they've forgotten how important free radical quenching and natural cox-2 inhibiting nutrition is for reducing inflammation and reducing pain.
To infuse your practice with cash without sacrificing accepting the patient's insurance consider becoming a Health Care Advisor and use the position to improve your patient's outcomes. Let's face it in most cases patients are going down the street and purchasing nutritional products to help them get well sooner. You as their trusted health care provider at least owe them the right to know of products you recommend to accomplish the same thing.
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
