AJCC October 2000
Financial Repriortization
by
Mark Radermacher, D.C.
Financial
reprioritization is the act of exchanging one or more items or service
of variable expense for another more desired or needed item or service.
For example, if a person has $1,000.00 of income each month, he could
make a list of where that $1,000.00 will be spent. The list will be made
up of fixed expenses and variable expenses. Fixed expenses might be a
house payment, a car payment, etc. Variable expenses might include
paying for vacations, going out to eat, etc.
If a person financially reprioritizes; one would be most likely
to modify the list of variable expenses. If a person wants to buy
something or pay for a service, then he/she has to exchange something
he/she has for whatever it is he/she wants, since most people have fixed
income.
Most people spend all the available income they have, they rarely
have discretionary income. Playing the financial reprioritization
exchange game is the closest most people ever get to having
discretionary income.
When
someone is financially reprioritizing, one is deciding that something
that one would like is more important than something one already has.
What one does then is to make a trade. In this way, most people could
produce down payment for something and have an amount of money available
to pay monthly on the new object by selling another toy. The object
could actually be material or it could be a service. This approach is
only providing the perception of discretionary income.
One usually bases the decision to financially reprioritize on
desire and/or need. If someone desires a new car that doesn’t
necessarily mean he/she needs one. The old car may not need replacing
but the desire to buy a new car out weighs the desire to keep the old
car. Through financial reprioritization, the new car can be purchased.
If, on the other hand, a person needs a new car, the decision making
process is different but the outcome is the same. Without having a car
at all, the need for a new car out weighs the desire and a person will
financially reprioritize to acquire the vehicle.
Financial reprioritization plays a role in chiropractic. The
mechanics of financially reprioritizing are the same - so are the
mechanics of desire and/or need, but knowledge and common sense are
sometimes missing. If a patient desires chiropractic care, the desire
would have to be great enough to cause financial reprioritization to
take place. If knowledge and common sense are not apparent, then the
desire and/or need for chiropractic may not be great enough to start
care or might be great enough to start care but not great enough to
continue care.
Desire and need can change, but the problem is that a patient’s
desire for chiropractic care may be based on symptoms and the need for
chiropractic care might be based on structure. If the desire for care is
based on symptoms, once the symptoms are gone, the patient quits care.
In this case, knowledge and common sense are not being used. The need
for chiropractic care can also change. A patient might initially need
more chiropractic care than less. As time goes on, the patient might
respond to care to the extent that the need for care changes from fix or
as near normal as possible care to maintenance care. Knowledge and
common sense would be a part of this decision.
Most patients financially reprioritize, but usually not the way
they need to. If a patient financially reprioritizes and starts
chiropractic care based on symptoms, once the symptoms are gone, the
desire and/or need for care changes, and that’s the end of financial
reprioritization resulting in the patient quitting care.
The chiropractor needs to propose to the patient a reasonable way
to financially reprioritize. The problem is that the chiropractor
usually doesn’t. When faced with a patient who may have the need for
chiropractic care but doesn’t have the knowledge or common sense to
understand the need, the chiropractor is likely to become emotionally
involved. He/she will usually go one of two ways: 1) Feel financially
sorry for the patient, or 2)
Become upset about the patient’s reaction to care recommendations. If
the chiropractor feels financially sorry for the patient, he/she’s
likely to decrease the price of the care or maybe even decrease the care
recommendations. Decreasing the price of the care backfires, because as
the chiropractor offers some type of financial deal, the patient begins
to think less and less of the need for care. Care isn’t actually
cheapened because the care quality is the same, but as the chiropractor
lowers the price of the care, he/she lessens or cheapens the patient’s
understanding for the need of care. If the chiropractor feels
financially sorry for the patient because one seems unable to afford
care, he/she might also decrease the care recommendations. This also
backfires. If the recommendations are decreased and the patient receives
this less than adequate care, he/she may end up disappointed in the
results. In this instance, the patient may have saved some money but
receive less than adequate care which produced less than adequate
results. In the end, this sort of feeling financially sorry for the
patient usually produces a disgruntled patient who quits care thinking
he wasted not only money (that he wasn’t knowledgeable enough to
reprioritize for) but also wasted time.
Some chiropractors become upset about a patient’s reaction to
care recommendations. Many chiropractors think patients are insulting
them if they complain about the cost of care. The chiropractor then
becomes upset thinking the patient is too cheap to pay for something as
important as health. That’s a dangerous and unfair position for the
chiropractor to take because people don’t understand health or
chiropractic. This element of ignorance turns into a brick wall which
separates the chiropractor on one side who understands health and
chiropractic and who has the potential solution the patient needs, while
on the other side is the patient who doesn’t understand health or
chiropractic and who has the problem that needs to be dealt with. In
this scenario, the end result is usually a patient getting little or no
care and a chiropractor thinking no one has money or cares enough about
health to part with the necessary amount of money to get the care one
needs.
Many chiropractors mistakingly think the majority of people
wouldn’t need to reprioritize because they have insurance coverage.
This isn’t accurate. Many people have insurance coverage, but not many
insurance policies cover chiropractic care. And, when a policy does
cover chiropractic care, it is usually very poor coverage. This means
that if a person wanted chiropractic care, one would have to pay for it
and paying for it usually requires financial reprioritization.
This raises the question of whether or not a policy with poor
chiropractic coverage would be better than no coverage at all. Actually,
an insurance policy that has less than adequate chiropractic coverage is
usually worse than no coverage at all. When a patient goes to a
chiropractic office and finds out they have poor coverage, the patient
often decides that the care he/she’ll get will match what the
insurance will cover. In other words, if the insurance policy covers 10
visits then the patient decides he/she’ll start care but stay for only
those 10 visits. The patient has little or no financial reprioritization
to consider and has little or no reason to listen to what the
chiropractor is saying. In this instance, about the best a patient could
receive is patch care to relieve some symptoms.
Expecting that some care, which is covered by a poor insurance
policy, is better than no care is false. If a person understands
chiropractic, one understands that more care is better than less care
and less care is worse than no care at all. In other words, if a patient
needs a regiment program of chiropractic care in order to fix a problem
or get it to as near normal as possible, then more care is required and
would be the best. Less care is worse than no care at all because with
an inadequate amount of chiropractic care, a patient usually becomes
very confused. For example, if a few weeks of care helps reduce or even
eliminate a symptom, the patient might think he/she’s healthy and will
often quit care. After he/she quits, it will only be a matter of time
before the condition will re-establish itself and the pain will return.
When this happens the patient is often upset and confused. Upset because
he/she’s hurting again and confused because he/she falsely thought
that the problem was fixed and obviously it wasn’t. In this state of
mind, the patient will often seek an alternative health care thinking
that he/she tried chiropractic but found out that it didn’t work. When
all he/she really did was to dabble in chiropractic which never gave the
body the opportunity to see if it would work. No care at all is better
than less care. With no chiropractic care, at least the patient can’t
think that chiropractic failed because one never even tried.
It is inappropriate to blame poor insurance coverage for a
patient not getting enough chiropractic care. Chiropractic is so poorly
understood and chiropractors are either addicted to third party pay
and/or unable to successfully ask the patient for money. The “poor
insurance coverage syndrome” has a serious detrimental effect. In this
fast paced society, people want everything and they want it now! When
patients take this attitude to a chiropractic office and then learn that
the insurance only covers a few visits, it’s exactly what they want to
hear... fast care for a short period of time and just enough insurance
coverage so as to eliminate the need for financial reprioritization. But
the insurance companies aren’t the only culprit. The chiropractor is
also at fault.
Many chiropractors are either addicted to the third party pay
system and/or are unable to successfully ask the patient for money. The
third party pay addiction is due to laziness and lack of vision. Many
chiropractors have watched third party pay dramatically decrease the
amount of visits they’ll pay for chiropractic care, they’ve
witnessed ridiculous restrictions placed on care and have been buried
with copious quantities of paperwork required for every third party pay
case. Yet these same chiropractors have actually added fuel to the fire,
by scrambling to join HMO and other restricted third party pay insurance
organizations. In other words, chiropractors have added to the overall
problem by participating in the system.
You see, it seemed easy, even enticing, to join the insurance
programs. If, as a chiropractor, you were on a list that potential
patients were given to choose from, then you’d have an endless supply
of new patients who all had chiropractic coverage. Utopia you say? Not
at all. As mentioned earlier, these patients enter the office with a
pre-conceived agenda that is they want fast care for a short time and
believe the few visits that the insurance covers are all that are
necessary. These patients usually represent more work, less retention,
less money collected and much much less chiropractic understanding and
fulfillment. It’s easy to see how a chiropractor could become addicted
to this game because it still resembles the old game when a lot of
insurance coverage had existed and there was a false sense of security
in that many chiropractors believed they’d go out of business if they
left the third party pay system. The perspective has proven to be a
strategic mistake. It’s easy for everyone to look back now and see how
unsuccessful third party pay addiction has become but the only
chiropractors looking back and smiling are those that had enough vision
to see the entrapment that was occurring.
Many chiropractors might be heavily involved in third party pay
because they are unable to ask a patient for money. The inability is due
to the dependency on third party pay and due to confusion in fees.
It’s easy to ask an insurance company for money. The insurance company
isn’t a poor patient with bills and taxes and a family to raise, the
insurance company is often seen as an insensitive faceless entity with
deep pockets. The deep pockets are envisioned as the pot of gold, but
the gold is at the end of a rat-mazed rainbow. Insurance companies do
have deep pockets but they set up a game of paperwork and restrictions
that make it very difficult to get through. To be dependent on third
party pay is similar to being addicted to alcohol or drugs, it is an
unhealthy journey laced with moments of perceived enjoyment and
enlightenment.
Insurance companies, like any business, have a right to exist.
The insurance covering chiropractic isn’t the only problem, it
doesn’t work. The solution to the insurance problem isn’t learning
how to beat them at their game, it’s no longer playing their game.
Many chiropractors have successfully dealt with this problem by choosing
a fee that they’re proud of, charging it and then collecting it from
the patient.
This is a simple enough idea but it has been difficult for many
chiropractors. Many chiropractors have diluted the simplicity of the
concept. They have unsuccessfully tried to develop a segment of cash
practice by charging multiple fees. If chiropractors study an entire
month of charges in their office, they will often see the problem. Many
chiropractors will find 15-20 different amounts charged for the same
service. This practice eliminates the possibility of having and charging
a fee that they’re proud of. When you deliver service to someone, you
must be very proud of the service and of what you charge for it, if
you’re not, you come across as unsure and non-confident. In
chiropractic, you come across as “needing” the patients more than
they need your service.
The end result is that money gets in the way. There are many ways
in which chiropractors cause fee problems: Discount plans, family plans,
kids prices, pre-pay plans, percentage off if paid on day of service,
life long plans, maintenance discounts, etc...
They’re really all creative options of the same idea, that is,
many different charges exist for many different patients who all get
essentially the same service. The confusion that exists is
unconscionable. For example, if a personal injury case is getting
charged $80.00 per visit until the case settles, the chiropractor then
starts charging the patient $20.00 per visit because he/she now pays
cash. Ask yourself, what were the visits actually worth? $20? $80? or
somewhere in between? If the chiropractor doesn’t think the staff and
the patients wonder, then the chiropractor is lying to himself. The
multiple fee embarrassment costs patient retention and referral by
creating confusion, unfairness and the erosion of good will.
A logical approach to the fee problem would be to charge one fee
that you’re proud of, and convert all the insurance patients to that
same cash fee once the insurance stops paying. Many chiropractors have
tried this approach, most have failed. It seems that patients who have
restricted insurance coverage have the pre-planned agenda mentioned
earlier. They want fast care in a short time without the responsibility
of having to financially reprioritize. Many chiropractors saw the
continued involvement in third party pay as a way to build their
practices. They felt the endless source of new patients would guarantee
their success in practice. The reality is that most of their patients
end up coming from third party pay lists, they stay only for the care
that the insurance will cover and then they quit. The patient was never
interested in listening to the chiropractor explain health and
chiropractic. It’s easy to see how a chiropractor quickly becomes
disheartened in this type of practice. He/she ends up feeling as though
what he/she’s trying to say falls on deaf ears. And he/she’s right.
He/she can’t make a patient want to listen. If, however, a new patient
realizes he/she must pay for the care that he/she needs, he/she’ll be
much more likely to want to listen to why he/she needs it, how long it
will take and how much it will cost.
The problem of conversion can be difficult, yet many
chiropractors are still attempting it. This is mostly because of the
addiction and confusion. Many chiropractors are trying to convert but
they don’t have goals and they don’t analyze progress. They seem to
go part-way in conversion and stay there. This is possibly the worst
place to be. With a percentage of third party pay, “deaf eared
patients” in the practice and a percentage of single fee cash paying
patients, the chiropractor is trying to run two fundamentally different
kinds of practices simultaneously. That’s almost like being
conservative and liberal at the same time. He’s adjusting the
insurance patients with 10 or maybe 20 visits covered realizing
they’re going to quit when coverage ends and he’s also adjusting the
cash paying patients and teaching them about health and the potential
life impact benefits of chiropractic care, at the same time. It is very
stressful to keep track of who’s who and to change your philosophy
back and forth from one end of the spectrum to the other, all day long.
The eventual end result for the chiropractor is apathy, hypocrisy and
finally burn-out.
Should the chiropractor just demand that the patient
reprioritize? Not exactly. The chiropractor must explain the need for
care and clearly present the options the patient has for care. Then, the
chiropractor needs to express the fact that if the patient desires care,
it will be necessary for the patient to financially reprioritize. The
chiropractor should briefly explain financial reprioritization in the
final step of the 5 minute report of findings. He should then more
completely develop the point of financial reprioritization in the 15
minute spinal care class that all new patient must attend in their first
week of care. He can begin with explaining to the patient that
“insurance isn’t what it used to be, it doesn’t cover chiropractic
care like it used to, the eye doctor or dentist like it used to.
Insurance doesn’t even cover some medical tests and procedures like it
used to. With this explanation, the patient realizes the chiropractor is
aware of poor insurance coverage and is fully aware and proud to talk of
his own fees. Then the chiropractor must explain what financial
reprioritization is and point out the fact that most patients are using
financial reprioritization in his office in order to receive the care
they so desperately need. Due to the fact that people practice financial
reprioritization throughout their lives, it isn’t uncommon to see them
financially reprioritize for chiropractic care. It’s up to the
chiropractor to confidently and clearly explain the need for care, the
potential life impact benefits from care, and to remind the patients
that they certainly can afford chiropractic care through the simplicity
of financial reprioritization.
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CONTENTS
Biomechanical & Neuro responses to Adjustment
Communicating From the Inside Out
Normal Values in Anatomy, Physiology, Disease and Chiropractic
Ambulatory Translational Traction
Percutaneous Radiofrequency Neurotomy...