Are Cash-Only Practices On The Rise?

In the last post (Chiropractic Marketing Is A Changing) I began revealing the answers to a recent blog survey I conducted. I left the answer to the final question to be discussed in full today.

The question I asked my readers was:

5. What is the biggest challenge you see facing you as a chiropractor over the next year?

The answers I received were very surprising. Let me explain…

First, a bit of history. I asked a very similar question in a survey about a year and half ago. The most common answer at the time had to deal with getting new patients. This was no surprise, as that has always been the biggest struggle in running a chiropractic practice.

Chiropractors struggle with the problem of getting new patients for a couple of reasons.

Reason #1: The common misconception of chiropractic by the public.

Reason #2: Most chiropractors complete disregard for using effective marketing and measuring ROI.

Number 1 above we can do little about individually, other than keep making our practices successful so we can reach more people. But the second reason above is totally within your control.

Why do most chiropractors have a complete disregard for using effective marketing? There are various reasons I’ve heard from doctors over the years, ranging from the “marketing is not professional” to the “it just doesn’t work in my area”.

So it wasn’t a big surprise to me that this was the most common answer with my survey last week. 36% of people mentioned new patients or marketing as their biggest problem. It’s definitely still a problem chiropractors face, and will be until we all become better educated on real chiropractic marketing.

What was a surprise was the second place answer, coming in at 35% of respondents mentioning it in their write-in answers. This new category of answers had to deal with health care reform (Obamacare) and the issue of cash practice or cash patients!

Now you may think this has been around for awhile, so it’s not big deal to see that answer. But think about it for a minute. Almost as many people are concerned about how the insurance industry changes will affect their practice as are concerned about actually getting new patients. This is a big change in our profession.

Especially when you consider only 4-5% of people mentioned anything about insurance or cash patients 1.5 yrs ago in my survey.

Also, what I’m noticing is that chiropractors are looking at the cash practice as a better, less stressful business model because of these new health care laws. This is much different from 5-10 years ago, when most chiropractors were switching to cash practices for more philosophical reasons.

I’m curious as to what you think about all this?

Leave a comment below telling us what type of practice you have now (cash or insurance), and if you plan to change it in the future (and if so, why.) If you didn’t participate in the survey last week and you leave a comment below discussing this, I’ll send you the link to the bonus marketing audios I gave away. (I can see your email address when you leave a comment, so you don’t need to put it in the comment itself.)

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  1. Tong Lee at

    I gave up insurance patients long time ago because insurance companies would not pay me for what I do. They simply denied my claim for thier own reason ignoring what their customers are needed. Also, I had been denied many times after I submitted bills which I believed was necessary for the patients because they do not understand my scope of treatments. I am tired of insurance companies’ BS and simply do not want to short cut my services to my patients. To me, insurance companies do not approve quality services which their customers are entitied to. Although I do not have thriving practice, I am content with cash practice because I can proudly tell my patients that I am giving them first class services rather than what insurance companies want. I sleep well knowing I do my best for my patients rather than do my best for insurance companies for the money. I have no intention of changing the way I practice.

  2. Dan at

    Interesting thought, Michael. Here in Ontario, Canada, Chiropractic was delisted from our government insurance coverage in late 2004. There was a lot of discussion, worry and stress leading up to the decision, but every chiropractor I know is still in business many years later. I’m not sure they’re doing better than they were, but they’ve definitely adapted to the cash practice model in some ways.

    Is it less stressful? I’m not sure, but I do feel there’s something to be said for having hundreds or thousands of patients as customers as opposed to just a few insurance companies. If nothing else, you get a sense of control over the future of your practice that you might not feel when you’re at the mercy of regulatory shifts.

    Great post!

  3. Jose at

    My practice is definitely moving to cash. Toooo many HMO’s and benefits are being stripped away from the patients. Want to make more money, we need to help more people for a reasonable fee. The only thing that is really paying right now is PI.

  4. Tim at

    I have gone out of network on all insurance plans except Blue Cross/Blue Shield. With so many plans going to high deductible/high co pay anyway. Reimbursement has been better this way with far less restrictions. More patients are now paying cash for a visit than in past years due to the high deductibles.

  5. Kim at

    We have had a cash practice going on 11 years now. We are not in network/contracted with anyone, and we live in hmo/medicare capital. It actually is much less stressful. Everyone pays up front regardless of ins., medicare gets billed, with reimbursement going straight to the pt.

  6. George at

    I think we are being moved into the cash practice model by the insurance companies! With $25, $35, and $50 copays. Insurance companies that use guidelines that think that chiropractic x-rays are unnecessary. Using sEMG and Thermography that is useful, but not covered. I think most DC’s have been transitioned toward cash without even thinking about it.

  7. As the Founder & CEO of Cash Practice Inc, I feel I have a firm understanding of this trend. We are definitely seeing an increase in the number of doctors moving towards 100% cash only practices. Early on we saw mostly doctors who were doing insurance, but wanted to add more cash to their practices. Now we are seeing more wanting to leave insurance completely and go all cash.

  8. J at

    Most of us have in fact made the move to cash without even knowing it. George above put it perfectly, the high deductibles and large co-pays have put us in to a cash position. The interesting thing however, is the public perception is that we are still in the insurance game. Patients think that they are “using their insurance” even when they are paying totally out of pocket to fulfill deductibles and co-pays. Our real success is going to come when the public perception and reality match.

  9. Back in 2001 I transitioned my practice into a 100% cash practice. The main stumbling block that I had to overcome was my mindset.

    You see, the majority of chiropractors in my community at that time were on every health insurance plan offered. So you can see my hesitancy in jumping on board with a cash practice.

    Some questions that I struggled with were as follows:

    What would new patients think? Would they accept my care plan and pay cash knowing that my services wouldn’t be covered by their health insurance plan? And, if they did accept my care, how long would they stay onboard before funds dwindled?

    But, what it ultimately came down to was overcoming FEAR. I realize many of us have heard that word used as an acronym but once you grab hold of it and live it, it will truly revolutionize your life let alone your practice.

    For those that don’t know what FEAR stands for, it is as follows:

    F(alse) E(vidence) A(ppearing) R(eal)

    False evidence appearing real was exactly what was holding me back from having a practice of my dreams. Once I overcame FEAR and implemented the right system, I grew my practice to new heights within a 6 to 8 month time frame.

    And yes, it was done within a cash environment.

  10. Joseph Doughty, DC at

    Cash vs. Insurance the “big smack down” continues. I’ve had a mixed insurance cash practice, all cash and all insurance practices. Philosophy aside regarding insurance companies profiting from peoples sickness and perpetuating a sickness and disease care model. I’d say the better way to go is cash and take PI until that too becomes unprofitable. Had an 80% PI practice at one point. It paid fine, once you worked out the kinks in the system. The challenge was patient education and transition to cash once State Farm stopped paying.
    Keep in mind these practice styles have different ways of operating profitably and different ways of educating the patient.
    Chiropractic took insurance back in “wild 80’s”. Lot’s of doc’s got rich on unlimited, union based, high volume insurance practices. I believe the motto was “bill the hell out of the insurance companies, take what they pay and waive the rest the patient should pay.” This generation of chiropractors is now paying for that gluttony.
    I could keep going, as we are all seeing this same greed played out on Wall Street and now national health care. Cash practice offers some freedoms away from many regulations, but not all.

  11. I feel if more chiropractors truly valued the service they provided and had more of a unique selling proposition / specialty, doctors that accepted insurance would be a rarity.

    Think about it, who in there right rational mind would provide a 20-30 minute service and wait 2 months in the mail for a meager $20 from BCBS. Yet, this is what many have been settling for time and time again. You’re a professional and should be paid as one!

    I’m not speaking about seeing 200-1000 patients / week at $30 a pop, either. That only stereotypes you as “cheap” while you bust your ass. I’m talking about charging MD comparable fees. Good post, Beck 😉

  12. Doctor Wil at

    I’m a new DC in my 2nd month of practice. I took the advice of some of my mentors and went cash-only. After speaking with my colleagues in the area it seems like they never have enough time in their day. When I’m taking my girlfriend kayaking these guys are worrying about when the money is coming in. My overhead is nothing compared to others in my region and my patient base is growing daily. I have a flat fee of $50/visit. My patients know thats all it will cost them when they come to me. For my area $50 is in the middle of the road for cash paying patients. There’s a walk-in clinic down the road that charges $35 and a primarily insurance practice thats charging $65 in an adjacent city. I know where I’m taking this practice, afterall, “its not about the bike… its the rider”.

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