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.

Similar Posts:


  1. Jared at

    Well put. Lets not sit around.

  2. Micah Carter, D.C. at

    37 states have legislation pending that allows the people of their state to opt out of Obamacare. If what the ACA says is right, the anti-discrimination could be helpful for us. But I have to agree with your post.

  3. Dr. Beck,

    Great post, and you were right on with your comments. I actually think the chiropractic profession would be better off going to a system were it was cash based instead of relying on the insurance industry and government. Those that know how to run a business and bring in new patients will survive and those that dont will continue to just get by.

    Todd P. Sullivan, DC

  4. drbeck at

    Micah, that will be nice. But I wonder if I can opt out of paying the taxes for someone else to have it? I doubt it.

  5. Joe at

    This is an excellent post.

    Things will be changing, so we have to change.

    Key thing is to market, but also to differentiate yourself. How you different that the DC down the street? What do you do differently? What conditions do you treat that other DCs don’t? Get out there and let people know what you do. Do talks, do advertising, do whatever it takes. Now is the time to get to work.

    I’ve been working on my practice for about the 6 months, so this Obamacare thing will have little impact on my practice.

    IMO, Obamacare is a good thing – only the strong will survive.

  6. drbeck at
  7. Chiropractor Pittsfield at

    Great article… Thanks for the insight

  8. I wanted to add that I did practice as a Chiropractor in Australia and cash practice chiropractic is alive, well, and thriving. Dr. Beck, you are correct that in order to make that work, you will need to market and get new patients in the door.

  9. […] 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 […]

  10. Micah Carter, D.C. at

    I wish we could opt out of paying taxes for “services” we don’t use or agree with but they would never be able to fund them so that’s not going to happen. We can dream though.


  11. drbeck at

    I agree Micah. But you know what my Grandma used to say? “You can wish in one hand and ____ in the other and see which one fills up first.”

  12. Dr. Dave Peavy at

    Yep big changes..being an eternal optomist, we must also be a realist…who knows what’s going to happen? The key is BE PREPARED for anything. My late Father-in-law practiced from ’48 to ’82 in a total PP market and saw 200+ visits a week cash and was very successful. Personally I had my first 4 years of ONLY PP and did very well. Having seen 408 visits per week for the last 27 of 32 years with 2 Docs , I have always felt high volume is a focus on rightness of purpose, and also provides much more security for all staff & Dr. After 32 years my heartfelt experience and counsel is gear up to see more patients as high volume has never failed to prove Chiropractic still has the same value to patients. Insurance coverage has no impact on the value giving patients their quality of life back in say a C1 subluxation induced migraine case. Chiropractic is the only answer for that subluxated patient who has suffered a very poor quality of life 5, 10, to 20, years and they will gladly pay for the only true effective treatment..assuming of course the Dr can simply communicate the facts.” Chiropractic will never fail you as long as you don’t fail Chiropractic”..Dr. W. Jack Cleere…God bless, Dr. Dave Peavy

  13. Micah Carter, D.C. at

    Spit in the other, right? 😉 I hear you. I think it’s best to do what we do best and just roll with the punches that come our way. Most of us worry too much about things that never happen…


  14. John Dmochowski at

    Obama- Care does not pass the distant early warning smell tests. From what I know we are inslaved to Medicare and they control prices, proceedures, notations, and privacy with first rights of refusal. There $22.00 reimbursement is the sound of the whip cracking and they can lower prices at their discretion. Keeping only Medicare is an alledged cash practice opens discrimination suits for the insurers. With a full scheduling, the total income of a given practice is locked, with only a downside to “controlling the costs curve.” Malpractice follows to increase with patient load. Insurance companies even with their evils did legimatize chiropractic.
    An entire system that contains more regulations with more regulations and controls to follow does no one a positive service. Weaker practices may thrive with the 30 million new card carrying practices, strong or innovative practices go against the earnings wall. Is this ‘redistribution of talent’ as well as wealth?
    What happens to patient rights with the data banks of electronic notes. Already the SI wants entire medical histories per claim. The director assured me that only a few people have access to those doctor-patient confidential records. Do you believe in hack-proof?
    Obama-Care was never about health care, it is about government control of insurance companies and the healing industry. The future of chiropractic looks as inspiring as the post office without the benefits. No good can come of it. Canada and California dropped chiropractic from claims to save costs.

  15. […] Congress Has Done It, Now What? […]

  16. Jeremy Owens at

    With complete respect for the information in this article, I have to disagree that a cash based practice needs more patient flow to generate the same collections as an insurance based practice. I work for a Doctor that has been successfully doing cash for almost 15 years. To maintain a healthy income that covers all marketing, staff and equipment overhead we start between 30-50 new patients per month. Many of our clients on the consulting sides have goals of “start 30 new patients, collect $40,000” when the join us. While the new patient goal may stay the same, the income goal triples once they implement what we do here. This is not a plug for our company. Simply some insight that cash is the way to go ESPECIALLY once Obamacare is in place….if it’s done in the correct manner. Stay positive and keep helping as many patients as possible!!

  17. drbeck at

    Hi Jeremy. While it is not the case 100% of the time, no average an all cash practice in the United States will need more new patients. For some, more patients means 1-2, for others 10-20. I do not mean to imply this cannot be overcome, or that it’s not worth doing a cash practice. I only wish to admit the fact because many in the profession are not willing to do so, as I have experienced in some coaching groups.

Leave A Comment

This Is A Custom Widget

This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.

This Is A Custom Widget

This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.