Managed Care, poor reimbursement
One of the biggest challenges facing us Chiropractors, and to some extent, other health care providers, is the decision to stay in-network with third party payers.
Many in my profession are moving to 'all-cash' practices. For those who have older practices, this is a harder conversion as many of these practices are filled with insurance based patients. One of my old bosses once told me that when I go out on my own, to open a cash only practice and to do it from the very beginning.
Well, my practice started out that way but now is over 65% insurance. Hmmm. It is definitely a trend I would like to reverse and work towards a 100% cash practice. When I mentioned this to an M.D. friend of mine, he mentioned who in their right mind would want to pay cash for services when they have benefits.
Well, many people think they have benefits when in reality it's a farce. Some companies will grant a few visits and make it harder than a triathalon to get the amount required to care for the patient. The time, energy, and money expended on satisfying third party payers is ridiculous. Then you have the network reimbursement rates which hover near the medicare rate, some even going below it.
My service requires multiple visits, after the initial, to be effective. The face time with the patient coupled with the decision making required daily demands a fair reimbursement and the cash model is quickly becoming the only way to have a viable practice, let alone succeed.
There is also the fact that i am worth what i'm worth. My fee is my fee is my fee! Or is it? There come times in practice when we are asked to lower our fee or take special consideration for various cases. This trend will increase as reimbursement sinks and D.C.s are forced to set cash rates at proper levels.
Furthermore, as health care providers, we are strictly limited in the ways we can discount our services. We are not treated as other businesses are and must follow restrictions put in place to 'protect' the consumer. BS. It's to protect the insurance companies because they do not want to pay a penny more than anybody else, save Medicare.
Now, I'm just thinking out loud here, but if providers everywhere were to drop out of their respective networks, managed care or otherwise, the health care scene as we know it, would be forced to change....for the better.
Many in my profession are moving to 'all-cash' practices. For those who have older practices, this is a harder conversion as many of these practices are filled with insurance based patients. One of my old bosses once told me that when I go out on my own, to open a cash only practice and to do it from the very beginning.
Well, my practice started out that way but now is over 65% insurance. Hmmm. It is definitely a trend I would like to reverse and work towards a 100% cash practice. When I mentioned this to an M.D. friend of mine, he mentioned who in their right mind would want to pay cash for services when they have benefits.
Well, many people think they have benefits when in reality it's a farce. Some companies will grant a few visits and make it harder than a triathalon to get the amount required to care for the patient. The time, energy, and money expended on satisfying third party payers is ridiculous. Then you have the network reimbursement rates which hover near the medicare rate, some even going below it.
My service requires multiple visits, after the initial, to be effective. The face time with the patient coupled with the decision making required daily demands a fair reimbursement and the cash model is quickly becoming the only way to have a viable practice, let alone succeed.
There is also the fact that i am worth what i'm worth. My fee is my fee is my fee! Or is it? There come times in practice when we are asked to lower our fee or take special consideration for various cases. This trend will increase as reimbursement sinks and D.C.s are forced to set cash rates at proper levels.
Furthermore, as health care providers, we are strictly limited in the ways we can discount our services. We are not treated as other businesses are and must follow restrictions put in place to 'protect' the consumer. BS. It's to protect the insurance companies because they do not want to pay a penny more than anybody else, save Medicare.
Now, I'm just thinking out loud here, but if providers everywhere were to drop out of their respective networks, managed care or otherwise, the health care scene as we know it, would be forced to change....for the better.
posted by Dr. Scott E. Brunengraber | 12:14 AM
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