The ‘lifestyle choice’ and pros and cons of a chiropractic cash-only doctor and practice
Life is fragile and fleeting; that is the universal connector for everyone. We all want to be healthy, to celebrate, love and live life to the fullest. This outlook is no different running a successful cash-only doctor practice than it was with the stress encountered during the Great Depression, World War II, the ups and downs of the stock market, or COVID-19 today. Mankind can only tolerate so much pain or discomfort until it cries out for help.
When we were hurt as children, we called out for our parents to aid us, to stop the pain and give comfort. We soon came to appreciate and expect that kind of care from them. As adults, sometimes I think we cry out for help louder than we did when we were children. Now, as in the past, we will not settle for any health care that doesn’t deliver a consistent positive response to our immediate health needs, and we are willing to pay and sacrifice for that kind of care.
$1 for a chiropractic adjustment
We’ve all heard statistics about how troubling life can be in these times. In 2019, Eric Rosenbaum of CNBC stated that millions of Americans were only $400 away from financial hardship, and now multiple years into the pandemic, long-term financial impact still weighs heavily on many Americans.
Another report by CNBC states that many people we know (and those of us under 30) have lost jobs or are taking pay cuts since the pandemic outbreak began in February 2020. Another 2021 survey by CNBC maintains that Americans are spending $765 more a month dining out and traveling than they did in 2020. Many have come to that tipping point that requires us to change our financial priorities, especially when we realize we are nothing without our physical or mental health.
I was fortunate to have worked for 53 years in a cash-only doctor family chiropractic practice which served our community for 87 years. My father charged $1 for a chiropractic adjustment in 1934 during the Great Depression. People still found a way to come up with a dollar. Chiropractic adjustments were the only trusted affordable care that gave those patients the relief they needed so they could continue to provide for their families’ welfare. They might not have understood what chiropractic was back then, but they knew it worked, and they were willing to sacrifice financially to feel better.
Cash chiropractic as a lifestyle choice
For 52 years, C. Rustici, DC, of Independence, Mo., made a lifestyle choice and chose to run a cash chiropractic practice. He witnessed his fellow doctors, who were insurance-based, constantly having to argue with insurance companies. He told me clinics were always being shortchanged by insurance companies. The charges for treatment were often compromised; additional fees were added for work not performed. Services were jumbled and costs inflated, leaving patients with a bitter and negative attitude toward their whole health care experience.
The doctor runs a mostly referral-based practice. His existing patients share with their friends what to expect from Rustici, how much it will cost, and how long it will take to see results. There are no surprises for them.
“When patients pay with cash, they willingly become invested in their care and are more likely to follow my advice and health care suggestions,” he says.
When deciding on going to a cash-only practice, you are not only making a business decision; you are making a “lifestyle choice” for you and for the way your patients participate in their care.
With an insurance-based practice you shoulder the burden of declining payer reimbursement rates and increased administrative burdens. With documentation and regulatory requirements, perhaps you have realized that higher patient volumes are counterproductive. Perhaps you have been forced to spend less time with each patient to keep abreast of outside demands on your practice by ever-changing regulations. Let us not be consumed by the tasks that are forced upon us from outside our office, lest we forget that life is about people and the relationships that surround us.
If the above sounds familiar, you might want to make a change. The Peloton company notes in its television advertisement, “If your workout is a joy, it’s a joy to work out.” The same can be said for your practice. Do you find joy each day in your practice? This quote from C. Groeschel may ring true for you as it did for me: “The worst enemy to the life you want to live may be the life you’re living now!” You have probably heard this adage as well: “If you are not happy with your life, only you can change it.”
Cash-only doctor: patient and practice responsibilities
With the change to a full-fee cash-only doctor practice your fee is paid by your patient, and your staff is available (and well-trained) to fill out their insurance forms for them. It then becomes the responsibility of the patient to resolve payment from the insurance companies, helping to keep your overhead and fees down.
This type of practice requires a positive response to care with each treatment. Now you have the time to give your patients a detailed understanding of their condition. They become more motivated to follow their treatment plan. They soon see and appreciate your passion for others and direct their loved ones, friends and acquaintances to you so colleagues can share the same feeling of health and wellness. Your focus shifts from trying to see more new patients to taking better care of the ones you have.
Studies in insurance reliance
D.G. Hof, MD, a pulmonary surgeon and internal specialist of Kansas City, Mo., practiced from the ‘70s thru the ‘90s when insurance companies were the gatekeepers of the almighty dollar. Hof had no voice in choosing his lifestyle, for he was bound to the contract with the insurance companies. He shared with me how depressing it was having to rely on the insurance companies and Medicare for payment. He told me:
“The insurance companies come to you and tell you they will send you all these patients, but they expect a discount of your fees. As time goes by, they want a higher percentage of reduction of fees. Your rent on your office space continues to escalate and your staff salaries also escalate. The longer you practice in this type of ‘pressure cooker,’ the less chance you have of maintaining your freedom of clinical practice. The stress becomes too great, your health suffers and you must retire to save yourself.”
Hof fought the system working with Attorney General Ashcroft of Missouri to put pressure on Medicare to make payments within a more reasonable time frame.
M. Strehlow, MD, of Kansas, comes from a medical family practice of 70 years. His father started practicing medicine in 1953. He joined his father in 1988. At that time, insurance companies were the only means of receiving payment for care.
By 2002, one of the largest insurance companies in his area was responsible for paying 60% of all the income of their practice. His clinic of six doctors was responsible for 8,000 patients. It was nearly impossible. They were booked six months out. Each doctor had to see at least 28-35 patients a day. Strehlow did not take a vacation for 11 years. He didn’t have dinner with his family for over 20 years. Sometimes he would spend all day and night at the clinic.
“The insurance company became the acting doctor in my clinic, and I was nothing more than an administrator,” he said.
The insurance company ruled with a firm hand and stated that the doctors must stay in line and hit their numbers, or they would be financially penalized. He felt as though all he provided for his patients was “stomping out fires” and, due to the scant time allowed, not treating causes of illness.
He woke up one morning in 2002 with a blood pressure of 190/100. He and his wife decided something had to change. There is a good ending to his story. For a long time, his patients had been asking more and more questions about “wellness care” and about more “personal care” in his clinic. He dropped all insurance coverage and strictly went to cash. He and his patients finally found the contentment and peace they both wanted. It’s now this personal care that fuels his passion. He goes on family vacations with his children and has dinner every night at home. Unlike some, he had the courage to change his life.
Live your desired lifestyle of care
Doctors must be true to their own natural abilities, desires, motivations, and capabilities about how to practice and live life. There are pros and cons to both cash-only doctor and insurance practices. Just be true to yourself so you can practice in a manner that fuels your life’s passion.
GARY BORING, DC, BCAO (Board Certified Atlas Orthogonal), LCP (HON.), FICA, graduated from Cleveland Chiropractic K.C. in 1968. His father graduated in 1934 from CCC K.C., and his brother in 1966. Boring Chiropractic has served patients for 86 years.