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The Future of Chiropractic: New Models

Dear Editor:

Unfortunately, no one in the health care industry really knows what the landscape will look like in the next 3-5 years. Whatever happens at the White House, one thing is almost a certainty: Medicare and major medical insurance will continue to cut reimbursements. This practice has been in effect for many years, as everyone knows. Unless a practice is all-cash, this scenario is of major concern.

A chiropractic practice is just like any other small business. There are incomes and expenses, coupled with fluctuations in the marketplace, staff, governmental regulations, etc. The key is to hover over the entire practice landscape like a GPS satellite and adapt to the changes. Most of the time, adaptation takes a back seat to procrastination. In the latter scenario, a failure to re-evaluate the practice creates opportunities to not only have a "bad" day; a DC might find that many "bad" years have crept by, leaving a trail of stress and resentment.

One easy method for creating an internal litmus test is to ask the following question: Is maintaining income important? Sounds like a silly question, right? But how many DCs do you know who are still practicing the same way they did 10, 15 or even 40 years ago? The analogy of the GPS satellite works perfectly with this example.

Pretend that you are looking down from the satellite and see your car driving down a slow, almost unnoticeable slope. At the end of the slope, there is a huge cliff. With this knowledge, would you change directions and move away from the cliff? Of course you would! The problem is that sometimes when you are driving along in the car, you do not notice the subtle decent; just like in practice.

The bottom line is this: The amount of money you collect from third-party payers is dropping. Increasing volume might be a great idea, but more visits equates to increased overhead, as well as added stress on you and the practice. Additional staff, equipment and other resources may be needed.

If your desire is not to work harder, you might want to consider different models of practice to maintain your quality of life and level of income – which is what led me to the medically integrated model.

These were the considerations I faced after 10 years of practice: I found myself working harder and making less. My wife and three kids barely saw me during the week. My two clinics and 10 employees could tell I was mentally exhausted. I was doing my best to serve my state chiropractic association as an officer and the chair of the political action committee. I could not remember the last time I flew an airplane or went scuba diving. I was burning out.

After reviewing many options, I chose to change the practice model. I recognized that patients want comprehensive health care under one roof. Many were expressing displeasure with the attitudes of their primary care physicians and increasingly turned to me for answers. Thus, with my business education and experience I decided to integrate both of my clinics simultaneously.

My desire was to offer the very best chiropractic care anywhere and provide quality medical care at the same facility. My beta test included polling hundreds of patients and friends. There was an overwhelming positive response. Literally everyone thought the idea was long overdue.

After the decision was made to move forward, the complexity of the model became apparent. I knew I would need information. The process of finding out how to develop the model was difficult. I gathered an advisory team and learned some very expensive lessons from coaches and attorneys. (What I would have given for someone to just tell me what I needed to do, when I needed to do it, and not charge me tens of thousands of dollars for the counsel.)

There are some lessons I can share with colleagues. The first is to do it right. You need to determine correct legal structure. Everything builds off of the structure. Get a written estimate from your health care attorney of the costs before you begin. Verbal estimates are worthless. For example, the estimate for developing the structure was $6,000 to $8,000. Legal fees approached $15,000 just to develop the structure.

You do not have to pay $2,500 per month for coaching. You can get excellent coaching for half of that fee. You do not have to pay a percentage of your collections. You do not have to sign up for two-year contracts.

Second, if you have contemplated adding medical, physical therapy or other specialty services into your office, I assure it is possible to still remain "pure" to our chiropractic profession and beliefs. I would argue that your patients will value your services even more when you are part of a collaborative team that manages their broader health care needs.

Since the integration model was introduced into my practice, I can say that the outcome has been better than expected. Patient satisfaction, referrals, visits and compliance are at an all-time high. I am working less hours and collections have skyrocketed. My scuba gear is getting wet again and my family is starting to leave me a place at the dining-room table.

Doug Giles, DC
Athens, Ga.

Adjusting Our Terminology Is a Great Place to Start

Dear Editor:

I want to thank Dr. John R. Bomar for his Sept. 9, 2012 article in DC ["Biomechanical Lesion: A Better Diagnostic Term for the Profession"], in which he lays out the case for a more comprehensible diagnostic term for the condition we treat with spinal adjustments/manipulation. I strongly agree with his reasoning that the term spinal biomechanical lesion is a much better description and a more understandable term than subluxation, which is currently used and also has another meaning in medical terminology.

We all say it would be better for all concerned if chiropractors were better integrated into the health care community. Improvements in terminology would be a good start, and the chiropractic colleges would be a good starting place. Again, thank you Dr. Bomar and thanks to all the leaders in our great profession.

Tom Fontenot, DC
Groves, Texas

Dynamic Chiropractic encourages letters to the editor to discuss issues relevant to the profession and/or to respond to a previously published article. Submission is acknowledgement that your letter may be published. Submit your letter to editorial@mpamedia.com; include your full name, degree(s), as well as the city and state in which you practice.