April 2002

The Secrets of a Cash Practice - Practice in the Zone.

by Thomas O. Morgan, D.C., B.S., FICA, FPAC

Dr. Tom Morgan and his wife, Mary Ann, are founders of Volume Practice Seminars. Their goal is to help doctors and staff achieve volume practices, become debt free, and live spiritually disciplined lives that glorify God. Dr. Tom Morgan graduated from the Palmer College of Chiropractic, Davenport, Iowa. He holds a B.S. degree from Upper Iowa University in practice management. Also, he holds two honorary Fellow degrees. Dr. Morgan was in active chiropractic practice for over 30 years.  He retired in 1996 at the age of 54. Since that time he has been teaching the Volume Practice Seminar and doing chiropractic consulting full time. During his time in practice, he had one of the largest high volume, cash practices in the world.  He has written a book about these years entitled “VOLUME PRACTICE” and three more books about chiropractic.  He is famous for his “Touch and Tell” system. Dr. Morgan is a member of the continuing education faculty at Palmer, he was also an instructor in Activator technique for over ten years. He also was president of a state Association and served on the state board of examiners for twelve years.

The constant trap, that I see chiropractors finding themselves in, is one where the patients dictate the course of care. They present as new patients with their symptoms and they want relief or resolution. The chiropractor then becomes trapped in acute care situations and finds that the patient often cannot move from this position. Part of this problem is caused by de-emphasizing cash payments, but more on that later.

            The patient driven practice conflicts with the doctor’s practice mission. I call this ADD, or Arrested Development Disorder, because the new patient cannot move out of the crisis care mindset. This is the main cause of a “patient driven practice.” The doctor loses identity as a true bearer of the “secret of health,” and where it originates, no longer knows how to break the bond of this symptom treating servitude patient to the point of understanding their GREAT mission in practice. These doctors are robbed from practicing in the “zone.” The “zone” is that grand position where the patient and doctor are focusing on TRUE healing; on health and where it originates; on the patient’s personal subluxations, on the T&T exam (detection), correction, and stabilization. When and how does this new patient move from concern for symptom relief to a commitment to long term care?

            There must be a new beginning for new patients when practicing in the Volume Practice “Zone.” This occurs when the doctor lives in the Big Idea Zone of chiropractic, when personal power and desire creates a literal vacuum that draws in more and more patients. It becomes a “true” family practice. The doctor actually creates a family of patients who desire to understand TIC, and be as subluxation free as possible. In my opinion this happened in my Volume Practice, because I was relentless in performing the Touch & Tell System on all patients, all the time. The Touch and Tell System is that table-talk system whereby I vocalize all parts of my subluxation examination and adjustment on every visit, thereby, drawing each patient into a “chiropractic conversation,” which is the goal of this system.

            My first goal for all new patients was to welcome them into a NEW health system. I tried to help them understand that they were there to help me fulfill my practice mission. They felt this. It was never any problem to get the patient to commit to the first series of adjustments. After this, we moved them away from A.D.D. and into lifetime maintenance care. Then came sufficient time to attend our New Patient Class, and to refer family and friends for care. After that was accomplished, they were indoctrinated into the chiropractic “order” of our “Best Kept Secret.” This is when we moved the patient along in “Development.” I sat in waiting until the patient was in the TIC position, then I gave the patient the booklet written below:

            “Here Is My Best Kept Secret”

            For over 104 years, doctors of chiropractic have past on the best kept secret in health care. The best kept secret in my practice and I will share it with you right now is:

            “CHIROPRACTIC ADJUSTMENTS ADD YEARS TO LIFE AND LIFE TO YEARS.”

            Read the above sentence two or three times, because it deals with the BIG IDEA in chiropractic. Is the Big Idea about taking adjustments forever? Does this mean I have to keep coming forever? Is this your goal, to make me come forever to get adjusted? NO! NO! NO!

            The BIG IDEA is about making your body change for the better, from the INSIDE. Eating right, proper exercise, rest, and stress control, all play a part in making us change for the better. BUT THERE IS ONE OTHER PART OF WELLNESS THAT MUST BE FACTORED IN EACH DAY YOU LIVE. That step is to see that we are free of vertebral subluxations.

            I want you to know that I have my spine checked every week. I will continue to do this for the rest of my life. Today, I am making sure my patients and family are clear of subluxations every week just like I was taught. WHY ALL THE CARE? The reason is adjustments are not for “sickness and pain.” They are for subluxations, and it is subluxation, which causes sickness and pain. I have found that the big key to wellness is to stay SUBLUXATION FREE!

            “Since my body is always changing inside, chiropractic adjustments make it change for the better. Even as I am aging, I am doing better and better.”  (©: T. O. Morgan, D.C.)

STRIVE FOR OVER 50% CASH PRACTICE

            A doctor who just finished reading my new book “The Secrets of a Cash Practice” called to tell me that he believed this to be the best book he had ever read in chiropractic. I am humbled by this comment. However, I suspect that he has not read too many chiropractic books!! This book is not a formula for getting the wallet out of the patient’s purse or hip pocket. Rather, it is about the attitude that it takes to practice in the “zone.” To provide service above and beyond what they expect or pay for. To me, all patients are cash patients. Even when they have insurance that is acceptable, they pay the co-pay in cash by the week. When they reach the maintenance level, they are used to paying and will continue for each adjustment. They must always pay some cash. It is my intent, that our coaching brings each doctor’s practice to over 50% pure cash practice. However, when I start telling chiropractors that they need to increase volume and number of cash patients, I get mixed reviews.

            There was a time when doctors only focused on the type of insurance coverage the patient had. In my first book, “Volume Practice,” I wrote about the days when I was adjusting over 1200 patients a week. Today, I am asked wherever I speak if this could be done today. The answer is YES! But, it takes a highly motivated doctor and a cash based practice to do it.

            Today, chiropractors are faced with practices and a marketplace left fragmented by insurance. The low volume, high fee days are changing fast! This is why we are teaching our consulting docs to aim their practices at over fifty percent cash. I practiced my first twenty years with nothing but cash. A dollar’s worth of service for a dollar paid. A new concept today, or so it seems. In my new book about cash practice, I work hard at relating the “mind set” of a high volume, cash-based practice. The respect we need to continue to propagate is the fact that we are great adjustors serving at affordable, cash fees. The happy chiropractor must work to get out of the endless paper work and frustration of insurance, and once again start focusing on the fantastic results that kept our profession in the marketplace for over 100 years. The cycle has come full swing.

            Why all the change in insurance? Why do some doctors believe that because we worked so hard to achieve insurance equality laws that we should not “drop” our efforts to use insurance. The facts are clear. Do not “drop” the fair and seemly honest provider. What about managed care? Managed care is something created by the insurance wizards to get out of the equality laws. Many of you may have seen the lawyer on 60 Minutes, who is fighting managed care because he believes that when doctors are on salary, there is no one to represent the consumer. Another fact is that there is no one to represent the consumer when insurance is involved. It becomes a “system” to work for the doctor, under the guise of a “benefit” for employees.

            What your office team should do today is evaluate the insurance companies they deal with right now and create a personal “black list.” Usually, a patient with a company on this list, already knows that every doctor has had trouble with the company, so we approach this patient with our special cash plans. The doctor often takes in less income per visit, but there is a trade off here that is very important. The doctor has to have an attitude that the cash patient is a very important part of the chiropractic future; and that his or her mission is to find those patients who have found the value in chiropracTIC. What doctors must do is learn how to be positive about

receiving less per visit from these patients. That is the attitude challenge. After practicing for more than twenty years in a totally cash practice, I believe I have the knowledge necessary to explore the positive benefits of people paying strictly cash for their care. Number one on the positive list is that cash patients have no interference with their care plans from insurance companies.

            Let us get deeper into what is actually happening. How do you deal with insurance companies and MCO’s who are conspiring to destroy peoples’ faith in chiropractic? We have to ask ourselves, why would chiropractors deal with insurance companies which de-value the adjustment; pay for most any services before the adjustment; do not understand the subluxation, or the time and force needed for positive clinical outcomes; and then write patients and tell them the doctor’s services are not necessary. Some companies even write the patients telling them to demand their money back? Why do companies write policies which limit care and ultimately stop patients from continuing the adjustments they need? Why?? You answer that one, doctor. By even associating ourselves with these companies, I believe we are sacrificing our spirit, time and principles for money. Is this just a sign of the times? To quote a great philosopher of my era (Bob Dylan) “The times, they are a changing.”

THE DILEMMA

            When the insurance coverage started breaking up, doctors who had total insurance practices, were caught without a loyal cash base. They virtually had to start their practices over again. The chiropractors who had maintained 50% or better cash practices though, were protected from the winds of change. There was respect from those long-term patients who appreciated their honest service at affordable fees. The only barrier was those patients who felt caught with their MCO doctor list in one hand, and the need for an adjustment in the other. Eventually, these would all go back to the doctor who was best fulfilling their needs. Today, cash practices are thriving. That is a healthy sign in our profession.

LOOK ON THE BRIGHT SIDE

            What looks bright to me at this point in history is the fact that chiropractors are once again interested in cash practices where they can go strictly toward the needs of each patient. In some ways, it will be like the old days when people paid cash, and every doctor had to have a cost-effective system of delivery. Chiropractors can once again teach their patients and have the system in place so, like ourselves, the patients can choose lifetime care. But, they must be able to prove their efficiency visit by visit and teach the big idea in health care....CHIROPRACTIC.