The business of chiropractic is undergoing a tumultuous change right now.  I graduated from chiropractic school in 1995, a time where one could still find “old school” chiropractors from the 70′s and 80′s in practice.   The 80′s were considered the “golden years” of chiropractic.    That was when group health insurance first started to cover chiropractic, following the lead of Medicare, which started covering chiropractic in the mid-70s.  Major carriers like Blue Cross did not really know what to expect in terms of chiropractic utilization, and offered very liberal chiropractic coverage at the start.

So, the stage was set for abuse.  Many chiropractors advertised “NOOPE”– No Out of Pocket Expense in their ads.  They would waive deductibles and copays, bill office visits with multiple modalities (stim, traction, exercise, diathermy, ultrasound, etc.) and the insurance would typically pay around 80% of the bill, no questions asked.  Since chiropractic coverage was new, it would be several years before cost benefit analysis could be done.  In the meantime, chiropractors back then were “raking it in, getting over $100/visit.  Some retired early.

Well, insurance companies figured out what was happening.    There were no oversight/utilization review systems;  no best practices guidelines to determine appropriate covered services, and so on.  This environment was breeding abuse of the system (overtreatment) and restrictions started to make their way into chiropractic coverage.  Managed Care organizations like ASHP and ACN started to come on the scene, which severely reduced coverage for chiropractic services.

Now, as 2010 approaches, amidst the biggest recession since 1930, employers are still offering plans with chiropractic coverage, but with very high deductibles and limited visits.  Many major plans go through a chiropractic managed care company like ACN/Optum Health, offering a paltry reimbursement that hasn’t increased with inflation over the last 10 years (figure that one out).

And, cash practices are not as easy to run these days either.   Back in the 80′s, it was also much easier to sell prepaid plans and “maintenance” packages– often running $4,000- $6,000 per year.  The novelty of “bone on nerve” faded some time ago, and people just aren’t into it as they were back then.  Plus, chiropractors were warned that they could get into trouble for offering prepaid maintenance care packages, because it resembles acting like a health insurance company, and of course chiropractors don’t have the license to conduct that kind of business.   Lastly, the recession is definitely affecting cash practices as consumers don’t find chiropractic maintenance as a necessity, compared to things like mortgages, food, and utilities.

I wrote a book that addresses the changing nature of the chiropractic business model, and teaches you how to make your practice resistant to these adverse changes going on.  Go check it out, it can save you thousands of dollars and a lot of heartache.  The key for chiropractors is to manage costs, have laser sharp marketing, and hedge your business.