This may not come as a surprise to those of you who are not fans of the Affordable Care Act (Obamacare) plans, but the data regarding your bottom line is in. I’ve no political agenda to report here as I believe that our health care system has been crumbling long before Obama stepped in, but at the same time, as small fish in this big pond we can’t afford to ignore its impact on our chiropractic practices. Here’s what the numbers say so far…
The “official” 5 month totals of the start of Obamacare have resulted in a NO INCREASE in new patients in ALL healthcare categories (with one possible exception) across the board. Yes, you read that correctly. And yes, that’s exactly the opposite of what many experts predicted. So far, the Affordable Care Act, increased access and increased number of insured has not affected our practices for the better.
The Ugly Details
In a research project entitled ACAView which examined a whopping 25 million practice visits, all specialties saw either a decline or no increase in New Patient numbers – including Primary Care, Surgery, OB/GYN and the “Miscellaneous” Category which contained a wide variety of additional specialties. The one category that saw a miniscule increase (0.6%) in New Patients was Pediatrics, although some experts point out that this figure may have been within the margin for statistical error.
Perhaps even worse news for chiropractors is the fact that the Affordable Care Act has also resulted in an increase in Medicaid patient visits. As you are well aware, Medicare only covers the chiropractic adjustment. So, in effect, this increases the number of people who can potentially access your care (but because they are Medicaid) probably can’t pay for most of what you do. And there’s no coverage for any “ancillary services” (yes, I am being sarcastic) such as exams, x-rays or rehabilitation either.
Worst of all, this means that the trend of declining patient visits which has been slowly dropping since 2011 has continued and has not been reversed by Obamacare.
What Chiropractors Need To Do Next
- Strategic Participation: In my previous articles on How to Leave Insurance Without Killing Your Practice (Part 1 and Part 2), I stated that I do NOT advocate a full scale abandonment of insurance. Most practices aren’t ready. And, in many cases, it’s not necessary. But those articles did provide some tangible steps for those who wish to move in the direction of more cash and kick some payers to the curb. Strategic Participation is what makes sense for most chiropractors – wisely choose whom you will play with, get rid of the losers
- Re-Think Your New Patient Acquisition Strategies – some of you may have been admittedly coasting on insurance or patient referrals to fill your new patient pipeline. If your new patient numbers are great, then congrats! If not, you need to consider how you are attracting new patients. I use the word “attract” intentionally because it’s obvious from the above what types of patients are being attracted by Obamacare. So, if you leave your practice on cruise control, you will get those patients…and fewer of the ones you really want. Now is time for you develop a solid framework for attracting new patients – or revamp your existing one.
- Consider Your Reimbursements — one of the most disturbing facts about the decline in New Patient numbers is the “double whammy” it produces on your income. Surely, with fewer patients coming in that equates to fewer visits and a lower bottom line. But for many chiropractors, the salt in the wound is that we don’t even know how to properly bill, code and document a New Patient (or Established Patient) Exam to even get paid correctly for the few patients that do come in.
Chiropractors are Losing a TON of Money
Think I’m exaggerating? Answer this question — what system to do you use to determine how to properly code a New Patient (or Established) patient exam? If you’re like most (and if you’re honest), you have a murky mess of feelings that you go through that ultimately determines how you get paid for that visit. If it’s a PI case, you reason that you spend more time, do a few more tests and therefore, get to bill higher. How high? Well, you do what your buddy does or what’s presumably worked before. If it’s regular insurance, maybe a little lower code. Cash – maybe the lowest.
Unfortunately, this one coding practice is causing you to lose a TON of money in the way of either upcoding (and therefore risking an audit and having to repay the money back) or in downcoding (and therefore, not getting paid what you deserve).
Do the math. Let’s say the average difference between a New Patient exam level (ex: 99202 vs 99203) is $50. Let’s say you have 20 New Patients per month. So, you think $50 x 20 = $1000. Sound costly? It gets worse, really that mistake = $12,000 worth of mistakes per year. Even worse, over a 30 year career, that = $360,000.
Flip it around and the mistake is equally odious. An audit of $12,000 isn’t fun, especially when you spend your money. But the payers are banking on the fact that if you don’t know how to code something so simple as an Exam, you are probably making lots of other mistakes…for lots of other patients. And they are too often right.
The horror really comes in when you begin to realize that this really means your $360,000 mistake over the career is really much larger than that because of all the other codes you are missing as well. Could it be that you will leave $500k, $1Million or more on the table? Get the Maalox now.
Don’t Ignore These Facts!
If you initially blew past recommendations number 1-3 with the thought that “I’ve heard this before”, I urge you to reconsider using the above math. And do something about it.
For those of you interested in learning more AND doing something about growing your cash business, making insurance more profitable, you may want to consider my upcoming ESCAPE CHIROPRACTIC INSURANCE TYRANNY workshops.