Going Commando

Since I seem to be mentioning this repeatedly in telephone consultations and elsewhere, it may be worth mentioning here—having a cash practice isn’t merely about changing your financial policy and no longer taking assignment.

Many chiropractors imagine the fear and trauma of announcing that they will no longer be accepting assignment. But that’s actually the easy part. Far more difficult is the energy required to attract people who actually value their health and have the financial resources to pay for it.

Few patients who depend upon their insurance carriers are interested in true health. Most simply want to become symptom free and have their policy pay for it. It’s an entirely different mindset than those who want to be healthy.

The headspace necessary to move from a practice of symptom treating, to the promotion of optimum health, is far more complicated than no longer accepting assignment. Especially if you’ve acquired the reputation of being a back doctor or spine fixer over the years.

Whether you’re tired of being the whipping boy for insurance carriers or see the Obamacare storm clouds threatening on the horizon, moving toward a fee-for-service model holds the promise of far greater freedom and security. Relying on hundreds of patients for your paycheck is far more secure than relying on the whims of a half-dozen insurance carriers. Granted, it won’t minimize your obligation to properly document your care, but it will provide a far greater predictable cash flow. Eventually.

Here some basics to keep in mind:

1. You must have financial margin in your own life first. If you’re as financially fragile as your patient base, you’re not ready. When your only debt is your mortgage and you have three or four months of overhead stashed away in savings, you’ll be better prepared to weather the dip. The dip is the two or three months in which your income decreases as you reinvent your practice and attract a new crowd of health-conscious practice members.

2. Disengaging from insurance carriers takes time. Chiropractors, famous for coming home from a weekend seminar and knocking down walls Sunday night, will want to take things more slowly. Once you decide that you’re going commando, it’s tempting to give a month’s notice and bulldoze your way through it. Please don’t. This is a surefire way to needlessly put your practice into shock. Be grown up about this. Spend six to nine months or more making the transition. You’ve practiced for so long attempting to serve two masters (loving the one but hating the other), take it easy and make the transition one carrier at a time.

3. You will have an all-new marketing burden. This is what many chiropractors who contemplate a cash practice overlook. Instead of depending upon being in network, on an approved list or simply servicing neck and back pain (and other complaints people rely on their insurance for), you’ll want to become familiar to those in your community who actually value their health. Those who place a high priority on their health (or anything else) generally come up with a way to pay for it.

For chiropractors who have slipped into a social cocoon over the last decade or so, rarely encountering strangers, this can be a serious choke point. You must be prepared to introduce yourself to other practitioners, businesses, groups, clubs and organizations that currently serve the health-oriented tribe you want to serve.

That means conducting the screenings, the seminars, the community talks, and the health care classes, engaging in social media and small talk, and doing the general schmoozing necessary to get out “there” and become familiar. Since you’re the product, this can’t be effectively delegated or outsourced. Prospective patients are buying you. So you’ll want to pursue ways that reveal your beliefs, values, opinions and likability.

Are you up for it?

Unfortunately, for many chiropractors, getting their hands dirty and doing the things that previously only new chiropractors had to do come precisely at the wrong time in their career. With several decades of experience under their belts, many have assumed they’d paid their dues and wouldn’t have to beat the bushes ever again.

But in many ways, you’re starting over. You’re reinventing your practice with the focus on attracting people who value their health. If you’ve been serving the “I-just-want-to-be-pain-free” crowd, and now want to help the “I-want-to-be-truly-healthy-and-perform-at-my-highest” crowd, then yes, you’re basically starting over.

That means there are some groups and organizations you’ll want to befriend, support and become involved with because they attract the wellness tribe. Your local newspaper or chamber of commerce probably has a far more complete list:

Toastmasters – Start here. Until you conquer your ability to express yourself in front of others, you’ll be working with one arm tied behind your back. Master the social skill of sharing yourself in front of groups.

Learn PowerPoint – Time to learn how to use this simple tool to visualize the key points of your presentation. Yes, you may feel disoriented for a while, but it’s short-lived. Millions of mere mortals have learned how to use this program. You can too.

Yoga and Pilate Studios – My guess is that anyone who is paying someone to teach them these disciplines has an interest in better health. (Unlike gym memberships, which are often about weight loss or recovering from divorce.) Seems like you’d want to befriend every such instructor in your jurisdiction.

Runners – Many areas have running clubs that support individuals who run competitively, but more likely for health reasons. Perhaps you could take up running yourself. Maybe you can become the club’s chiropractor. Join.

Birthing practitioners – Midwives, doulas, breastfeeding experts, natural childbirth teachers and similar resources can be a gold mine. Contribute to this network and you’ll meet pediatric patients.

Health food stores – Befriend the proprietors of every Whole Foods, Sprouts, Vitamin Cottage, GNC and similar business in your area. Many have a regular lecture series. Discover what it takes to contribute.

Vitalistic practitioners – If you haven’t yet, it’s time to meet the nutritionists, acupuncturists, naturopaths and all the rest. Better yet, send a few referrals their way. Your mission is to become trusted and familiar.

Sports instructors – Golf and tennis pros encounter those with financial resources who want a better swing or a more powerful serve. Might even be worth a club membership.

But you know all this. So here’s the kicker—if you show up at these gigs exuding even the slightest odor of trying to get new patients, you will be greeted by the sound of doors closing. Instead, you’re there to share, connect and become familiar. Move too fast and those who might be interested will be turned off or frightened away.

Seem like too much work? Too risky? Unsure there’s a sufficient number of people in your community who value their health enough to support such a practice?

Then the insurance gig may not be so bad after all. No problem. Just get accustomed to putting every insurance check into escrow for a year or two, knowing that some day a commissioned auditor may demand the money back because your life-affirming, health-advancing, vitality-enhancing adjustments weren’t “medically necessary.”

(Originally posted May 23, 2013)