To help you enhance your practice and increase your bottom line, we ask practicing doctors of chiropractic, like you, for ideas and solutions that have been tested in real-world environments. Earlier this year, we asked what you were doing to prepare for the Affordable Care Act ("Obamacare"). In this issue, after almost a year of implementation, we asked: "How has 'Obamacare' helped or hurt your practice this year?"
Based on your responses, there is a fairly even split between practices that have seen improvement and practices that are not happy with the health care mandate. The responses cover both sides of the spectrum, from allowing chiropractors to establish thriving case-only practices to forcing others into bankruptcy, and everything in between. See where you fall among the following responses.
Much-Needed Stability and Opportunity
For some chiropractors, "Obamacare" has helped to stabilize cash flow and strengthen their practice bottom line. Dr. Ralph Krutulis from Jamesville, N.Y., said that the Affordable Care Act has solidified his practice as a cash practice.
"In this part of upstate New York, most of the plans my patients have carry a $50 co-pay. That $50 is what I happen to charge for a 98942 service visit for patients submitting to insurance. This automatically gets me cash flow, long before the insurance companies can down code and delay payment, and allows my patients to see my value and the farce their insurance coverage is becoming as being relevant to their health care. It has them seeing the insurance for its limited, sick-care use.
"My collections are now above 97%. If the patient wants to get reimbursed, we show them how and give them a form with all the information they need. This has allowed me to reduce the billing staff to a single, part-time position from a full-time one."
According to Dr. James Lehman from Bridgeport, Conn., "Obamacare" has allowed the University of Bridgeport to offer chiropractic services, education and research within community health centers in Connecticut.
"All patients are referred by primary care providers to the chiropractic specialists for evaluation and management of their chronic pain conditions. We are permitted to offer any services within the scope of practice in Connecticut. Internal marketing to medical staff is the only 'practice building' effort necessary, which creates a waiting list of new patients. The community health centers purchase all required equipment, and supply and hire all staff. The chiropractic members of the medical staff are fully integrated with EHR.
"There really is no need to worry about patient retention. The question is how soon can we resolve the patient's condition in order to take care of the next patient. The chiropractic profession will thrive with integration into coordinated care organizations."
Las Vegas chiropractor Dr. Lawton Howell believes "'Obamacare' is a watershed event for the chiropractic profession, as it [has] forced the profession to reinvent itself. Solutions include transition from a practice to a business model; cash or concierge model; merger and acquisition opportunities; and expansion of service mix and product offerings. When the MD model collapses, people will seek chiropractic simply because they can get an appointment today."
Negative Impacts
While helping stabilize some practices, the Affordable Care Act has actually hindered some practices from maintaining profitability. According to Dr. Heather Wright from Texas, "'Obamacare' has made it actually more difficult for some of my patients, as pretty much across the board they were already paying higher monthly premiums with less coverage and higher deductibles."
Dr. Bryson Langel from Olympia, Wash., agrees that his patients and his practice have been hindered by 'Obamacare.': "Patients that used to have good insurance now have bad insurance and the patients who used to pay cash come in less often because they have to pay for overpriced poor quality insurance that they don't want and don't need."
Dr. Edward Chudzikiewicz from Marlboro, Mass., believes his practice has been hurt tremendously by 'Obamacare.' "There have been more job losses. Major companies have changed to cheaper health insurance policies that cover fewer procedures. There are more patients on state Medicaid, which takes 6 to 8 weeks [for patients] to get paid. I have seen a decrease in new patients and higher deductibles and co-pays.
"I have been in practice for 36 years and I am now making major changes in patient care and management. My first change was filing bankruptcy last week for protection and to start over. This past year, my income dropped $47,000 from 201,2 all because of 'Obamacare.' I find it very sad that all our state associations are doing nothing to help get the HMOs to give us an increase in fees."
But perhaps Dr. Robbie Killingsworth from Kansas City, Kan., has the most creative response to the 'Obamacare' impact. "It is like trying to catch a balloon after tossing it straight up while wearing a blindfold during rapidly changing high winds that are coming from various and unpredictable directions. It reminds me of Bob Dylan's words in his song 'Subterranean Homesick Blues': 'You don't need a weatherman to know which way the wind blows' may be true, but it is still a major challenge to catch the balloon."
And Dr. Bruce Kniegge said he "has decided to retire a bit early in order to not have to upgrade my computer and programs to deal with electronic issues. I will let my younger peers deal with the rough waters ahead while I play lots of golf after 38 years in practice."
So, the next question becomes, will 'Obamacare' help or hurt chiropractic in the long run? It will be interesting to see how many doctors follow these trends in the years ahead. What do you think? You can always send us an email at editorial@mpamedia.com with 'Obamacare' in the subject line.
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