Insurances vs. Cash in Obamacare

My last post on the new health care reform (entitled “Congress Has Done It, Now What?“), caused quite a few comments. Mostly the feedback was good. One lady called me a right wing nut and we gladly accommodated her request to be removed from the email list. I guess in today’s politically correct world, stating the obvious (that our taxes will go up and it will be more work on our practices) makes you a right wing nut.

A few concerned doctors emailed me trying to persuade me to see the “bright side of things”.  They argued things were not so bad, after all the ACA or ICA (depending on which one you ask) was responsible for getting anti-discriminatory language in the bill. While I commend both organizations for fighting hard for chiropractic, I’m not so sure the gain of anti-discrimination language will justify the huge stack of problems the bill will cause.

Of course if your patients are mostly Muslim, Amish, American Indian or a Christian Scientist you will likely continue on as if nothing has changed.

As for everyone else, this type of government action brings up the age old chiropractic question, “cash or insurance?”

First off, I must state I do not agree with the mentality that has been perpetuated for years by many chiropractic coaches: “we must do cash because all insurance is evil” . There are good reasons not to take insurance, some of which are philosophical, but this type of rhetoric mentioned above is usually just a cop-out for those are are scared and don’t know how to bill insurance. Trust me, I know because this was me for the first 2 years in practice!

So with that said, let’s look at a the biggest reasons some doctors abandon insurance for an all-cash practice.

What the Proponents of an All-Cash Practice Say:

1. Insurance is too restrictive of the services you provide.

Many chiros do away with insurance hassles because of the burden it puts on their practice. They do not like to be told what they can and can not do with their patients. If most of their insurance patients are carrying these types of restrictive plans, they will choose to convert to an all-cash practice. Do you think Obamacare will make insurance more restrictive or less for chiropractic? (Leave your comments below.)

One medical doctor sent a letter to her patients stating she will not comply to the new laws Obama has enacted.

Of course the doctor who takes insurance will rebut this argument when applied broadly to the whole United States. His reply would be that “just because there are some bad insurance pockets, or even whole states, does not justify saying all insurance is bad and only pays for 12 visits anyway, so we might as well go all-cash.”

2. Insurance is too much work.

Other doctors choose not to bill insurance because they say it is too much work. They have to submit reams and reams of paperwork just to make $30 on a visit. Exams and x-rays require even more notes and paperwork. They’ll have to hire another staff person just to figure out all the billing codes and how to do chiropractic insurance appeals.

What does the non-cash chiropractor say to this? He would likely reply that “while some insurance plans and contracts require an insane amount of work, this does not mean that all insurance plans do. I simply do not participate in the ones that are bad.” He would also argue that whether cash or insurance, we all must have documentation. He would likely also add that many cash practices give the patient a superbill, which is essentially doing everything an insurance practice would do, except fight denials.

3. They do not pay special services.

A few doctors choose not to bill insurance because their practice is very specialized and insurance in their area does not pay chiropractors for these services. These include spinal decompression, weight loss, nutrition, cold laser, deep tissue laser, etc.

On the other side, many chiropractors will still implement these uncovered services, but also continue to offer chiropractic adjustments and therapy. So they will bill insurance for those services that are covered and do cash for those services not covered like decompression treatments, etc.

So which side of the fence do I stand on?

Neither. At the current time (and this may change in the future), I do not paint with a broad brush when it comes to this subject. Some states and areas are great with insurance, with plans giving 80-100 visits per year. I’ve even seen a few that allow unlimited visits to chiropractors per year. Other areas are so bad you’d have to be crazy to bill insurance there.

In my Decompression Marketing Elite program, there is one client grossing a million per year as an all cash practice. Another client has a mostly insurance practice and is doing nearly the same amount. Other clients have more of a 50/50 mixture, doing cash for decompression plans and insurance for other services.

You see, whether you choose cash or insurance, you should choose wisely. And once you make that choice, it all comes down to one thing — marketing. Insurance companies won’t bring you many new patients, if they bring any at all. Simply switching your practice to all cash won’t make people flock to you either.

I think too many people sit around thinking the grass is greener on the other side, when in reality they are not reaching their potential because of poor marketing choices.

What do you think about all this? Leave your comments below.

Congress Has Done It, Now What?

Whether the American people wanted it or not, the U.S. Congress has passed President Obama’s long awaited healthcare bill. But what does it mean for us chiropractors? How will it affect our lives?

Many of these questions will take time to answer, since the bill is massive and it’s doubtful the word “chiropractor” is mentioned too often. But for those who take insurance, your office will have to spend more time and money to figure out the changes you’ll need to make.

Let’s look at 2 certainties that will come of this…

#1. If you are successful in your business, you’re taxes will go up.
To pay for this new plan, the payroll taxes of “the rich” will be raised. Guess who the rich are? Any bum who wants to make more than $200k per year.

Does your dream of a successful practice entail you making more than $200k per year? It should. Most of us did not go to chiropractic school and go into mountains of debt to make $50k or $60k per year.

#2. You’re going to spend a lot more time and money trying to figure out these new laws.

Do you think it’s going to be easier or more difficult to bill insurance after this plan takes affect? Is Medicare currently more or less trouble than other insurance billings?

Your staff is going to have to go through training seminars to get updated. You may even need to hire more staff to keep everything compliant. SOAP notes will have to be top notch (after all we got big brother watching over everything now.) And guess who is going to pay for all these “upgrades” your practice will have to make? The government? Congress? No, you are!

So let’s summarize what we are going to get out of this “historic” bill. Higher taxes and more work. Oh joy, everyone loves those two things, right?

Lest you think I’m all doom and gloom, let me say there is hope. In other countries chiropractic has survived fine without health insurance coverage. Our Australian brothers have been doing it for years. So chiropractic will not end as we know it.

But many chiropractors will suffer. Mainly because they waited too long to counteract the negative effects of this legislation.

“So going to an “all cash” practice is the way to go, right?”

No, an all cash practice is not going to work for everyone. If you’ve been around awhile and have some established marketing strategies that are working, you could make the switch. But there’s a little secret to running a cash practice none of the gurus ever mention. A cash practice requires a lot more new patient flow than an insurance practice.  And since most chiropractors are terrible at marketing…well, they are just not in a place to risk it all. (Of course being terrible at marketing is not an excuse to stay that way. Learn how to do it right, or pay others to do it right for you.)

Plus insurance is still good in some states and not much of a hassle to work with. So if you’re practice heavily relies on insurance, wait and see what’s going to happen. But it’s likely things will get worse in the future as the government gets their hands on more and more private industries.

So how do you overcome the government takeover of health insurance?

First you’ve got to make more than you did previously (and get a really good CPA). To make more money in your practice, you’ll need to grow it by getting more new patients. And doing so now, not in 2014 when this plan fully kicks in. If you wait until then, you’ll be completely behind the curve ball. And the “chiropractic recession of 2014″ will be much worse than the one you’ve been through these past 3 years.

Second, you’ll need to trim the fat. That means getting rid of old marketing tactics, like blindly spending money on “brand” marketing. You don’t need to “get your name out there”. You need to get more new patients. Now. Next month. The month after that, and so on.

Also, you’ve got to get rid of equipment that’s taking up space and isn’t making you money. Get more patients on your spinal decompression table now (see Decompression Marketing Elite) and stop letting it collect dust. If you aren’t going to market it properly, sell it and use the space for something else. Throw out the passive therapies and get some active rehab going.

Plus you should add other non-healthcare based services. Get a cash-only weight loss program going. Add massage therapy. Build up your PI practice. (Look for our new PI marketing course in the next few weeks.) Sell supplements and do nutritional consulting.

“Is there anything good about Obamacare?”

What, you don’t think the added expenses, higher taxes, more stress, more paperwork, more government control, and having to hire more employees is a good thing?

Well, I guess you could look on the bright side. At least more people will have health insurance since we are all now forced by law to carry it. But that may be like getting excited that Medicare covers x-rays, except not for chiropractors. Or getting excited about more high deductible insurance patients, except most of them don’t have the money saved to cover the high deductible.

But I digress. Let’s focus on what you need to do now.

Your 2010 Game Plan

In summary, here’s what you need to do:

Get more new patients now. Through newspaper ads, the internet, referrals, TV, radio, MD referrals, attorney referrals. Get one stream up and running now. Then start another. Then another.

Cut the fat. Run your practice lean and mean. Use the equipment or loose it. Have your staff do the work or cut them. Add more cash services to your practice.

Go now. What are you waiting for? Choose one of the above and do it now.

Why didn’t I get more new patients

In my last post, we looked at the “5 Biggest Questions About Chiropractic Ads“. But due to length, we only got through 4 questions and answers. So today’s post is the 5th and final question we get asked most from buyers of my ads kit. And it’s probably the most important question to get the answer for.

The question comes in various forms, but it goes something like this, “I ran your ad and want to know why we didn’t get more new patients?”

Now, as you might realize, this is a hard question for me to answer. Mainly because I don’t know how many new patients he did actually get. And how many did he expect to get from the ad?

What’s a good number, 10, 15, 20? I know expectations have been elevated to unrealistic numbers in chiropractic. What else can we expect after years of hyped up marketing strategies that said they would give us 100 new patients every time we ran them, or make us $1 million a month the first month!

Don’t get me wrong, my ads work well to bring in new patients and I don’t think they’re over-hyped. We even give a guarantee for those who aren’t happy. But I can say right now it’s unlikely you’ll get 80 new patients every time you run them. Maybe if you’re in a small town with no other chiros, but as for the rest of us we’ll gladly take 10-30 new patients each run.

But what’s strange is when we get an email of a doctor who’s actually doing very well, ‘making a killin’ actually, but he didn’t get “as many as he expected”.

For example, once I was told by a doctor they had received 5 decompression patients from one of my ads. This doctor knows that other doctors are getting 15-25 decompression patients per ad, so his question would have been a good one if he was asking “how do I get as many as those other guys do”. But alas, we rarely get that question asked of us. Instead, this doc was saying that 5 new patients just wasn’t enough. After all, he had paid $1000 to run the ad.

But hold on a second. We’re looking at this scenario completely backwards! Let me explain…

I asked him if all of the 5 started care. He said yes. I asked how much his care plans were priced at. He said $3000. Quick math lead me to determine he got $15,000 back on his investment. What was his investment? Cost of $1000 to run the ad.

That’s a 15-to-1 return on investment! Who wouldn’t like a 15:1 ROI?

There are very few businesses anywhere that get that kind of return. But this doctor was bummed that he only got 5 new patients in for $1000 spent. Do you see where the premises are wrong with this kind of thinking?

You cannot measure an ads success solely by the number of new patients it brought in. And you certainly can’t measure it’s success by how much money you spent. It’s your return on investment that matters. The money spent (ad cost) is only used to figure out the ROI.

Think about it this way…

What if a new patient come into your office with an 11 out of 10 (!) on the pain scale. They got their first treatment, looked at you angrily and said “I’m not happy doctor. I paid you all that money and only got a 60% reduction in my pain today!” After picking your jaw up off the floor, you’d kindly remind the patient of how they are were doing when that crawled into your office on their hands and knees. Therefore, you’re telling them to compare the “before” to the “after”, which is essentially their return on investment. How much they spent doesn’t directly have anything to do with how much better they got.

Are you measuring your ROI?

It’s simple to do really. Take all the new patients who come in from the ad and record their name in a spreadsheet. Then keep track of how much money each one spends in your office. Your patient accounting software should make this number easily accessible.

So your spreadsheet might look something like the one to the left here.

If I hadn’t kept this spreadsheet and tracked every patient, I might try and rely on my memory of how the ad performed. And think, “man, that ad really sucked because Antonio never started care, and Maria she didn’t even come back after the exam. Bah, advertising doesn’t work!”

But the truth is I got a 2061% ROI, or a 20-to-1 return! You can bet I’m running this ad again after seeing how well it really did. (And this ad is actually in the Ultimate Chiropractic Ads.)

So start tracking your ads. Not using “memory” tracking, where you just try and remember how well it did. But actually record the numbers and see what the real story is.

5 Biggest Questions About Chiropractic Ads Answered

We get quite a few questions about my Ultimate Chiropractic Ads, both from those interested in buying and from doctors who are using them. Today, I wanted to let you in on the 5 biggest questions (and the answers) we get from doctors using the system.

What’s the best ad to start with?

We recently conducted a survey of all the doctors using the chiropractic ads. One question in the survey asked “Which ad has brought you the most new patients?”

The winner by a long shot was my neuropathy ad. This is not surprising since neuropathy is such a hot niche right now with one else really marketing to these patients. While not everyone will get these kinds of numbers, some chiropractors have reported 20-30 and up to 50 new patients from one single run of this neuropathy ad.

A three-way tie for second occurred between my fibromyalgia, sciatica, and numbness/tingling ads. If you haven’t tried these ads yet, I would recommend you do so soon. Also, the winning decompression ad was my “Decompression Sciatica” ad, which has been a proven winner for over 2 years now.

What about making an offer when I’m in an insurance contract, my patient have deductibles and copays, etc?

We get this question a lot from doctors who’ve never run special offers before. And as much as I wished I could answer this one directly, it’s just impossible. Every insurance company is different. Every contract with an insurance company is different. What I can say here is that if you’re in the U.S.,  Medicare and Federal BCBS do not allow offers to be made to their insureds.

Many doctors want us to give free billing, coding and legal advice in addition to the great marketing tools we provide in our kit. While I did put together some great chiropractic appeal letters a few years back, billing and coding is just not my expertise. Marketing is, and those who use my ads are happy that it is.

But I’ve seen doctors so scared of 1 insurance company that they won’t even run an ad with an offer period! Even though there are thousands of new patients out there with other insurance plans or no insurance at all. Do what is right and legal, but don’t let insurance companies cripple you’re marketing. If you’re going to let that happen, you’d be better off going all cash.

I don’t have an x-ray machine, what do I do?

This is probably the most common question we get. Since none of my chiropractic ads are built around “x-rays” or even spend much time talking about them, the answer is fairly simple: take that bullet point out.

Now its best if you can offer some type of objective test that gives your offer some value, like surface EMG, thermal scan, computerized ROM, etc. But it’s not necessary, and the ads will be ok without any mention of x-rays. This is especially the case if you are marketing to a specific niche, like neuropathy or decompression. These people just want help and they see any qualified doctor’s exam as a step in the right direction. But the more perceived value you can put in the offer, the better.

What size ad should I run?

The answer to this question will depend on the size of your marketing budget and the newspaper you run in. The Ultimate Chiropractic Ads includes large and small ads, but doctors using the large ads are getting the best results by far. The “large ads” are ready to go as an insert and can easily be printed as such once you change your name and contact information. Half page or full page is also recommended. In a large paper, sometimes a quarter page will work. Any smaller than a quarter page and you’re results are going to be slim.

What I strongly discourage is cutting out sections of my ads to make them fit into a tiny ad that saves you a few bucks. Better to spend a few extra dollars and run the full ad to bring in 15 or 20 new patients, than to chop the ad up and get nothing for your money.

I can not tell you how frustrating it is to see an ad I spent weeks writing — and proven to work by doctors for years — to have someone say “it doesn’t work” when they have completely butchered it. I’ve seen newspapers change up the ad, replace my photos, and even had doctors put their contact info in huge letters that are bigger than the ad headline itself. For example, someone just sent me a copy of my ad where they paid thousands of dollars for a full page numbness ad, then put something like this at the bottom:

Dr. Messup DisAd DC CCSMP, PSST, BS, BA
201 Anywhere St., Anytown, PA, 12345

Actually this is about to 50% scale, but you get the point. Now he still got some new patients, since the rest of my ad was still intact above this monstrosity. But he was not pleased with his response. Hmm, can anyone determine why his response was low?

Hmm, I wonder where the reader is going to look first? The headline, the copy, nope…the reader is going to look right down at the bottom of the ad, say “this looks like another stinking advertisement”, and turn the page. Nowhere in my kit, nor on my blog, nor anywhere have I ever recommended, implied or suggested doctors do this. It’s like the doctor thought to himself “well, I know Dr. Beck is the copywriter and his ads brought in over $20 million for chiros last year, but what does he know, I want to get my name out there so everyone doesn’t miss it.” Come on! My ads aren’t designed to get your name out there, these ads are designed to bring in new patients! If you want to get your name out there, take a full page ad with just your name, address and phone number.

Ok, I’ll get down off my soap box now.

There’s one question left, and it’s a big one. But since I spent so many words on the last question, this post has already exceeded it’s intended length. We’ll continue next time with the #5 question that’s most commonly asked.

If you haven’t grabbed the Ultimate Chiropractic Ads yet, click here to do so.