What if the chiropractic profession had the multigazillion dollar medical industrial complex to promote it? We’d have the media blitz telling the world about our developments in the analysis, detection and correction of the VSC. We’d be in virtually every magazine and newspaper, plastered on billboards and seen on every television channel. Our lobby would be influencing key people in the legislative, insurance and corporate arenas to protect and expand our interests. Companies would give us free samples of complementary products for us to give to our patients at no charge, plus perks to us for making recommendations that boost the sales of those products. Our phones would be ringing off the hook. Patients would be calling our offices, urgently seeking care or backend products. While they were at it they would be saying things like, “Do you also have time in your busy schedule to check my kids, too, pretty please, with sugar on top?”
The chiropractic profession was never graced with the silver spoon born in the mouth of organized medicine. We have always been a grass roots profession. To survive and thrive, we have had to have the backbone to stand up to jealous critics, doubting Thomases, and segments of the Medical Industrial Complex which mistakenly think our services compete with theirs. Without the financial and political backing of the M. I.C., we have had to develop alternative ways of marketing our services to a public that has been fed negative propaganda intended to keep them away from us. Most DCs, being marketing mavericks, decided to meet people where they live–by doing talks, screenings, and offering coupons. Many DC’s offered free or discounted services in an attempt to invite perspective patients to see beyond false stereotypes and come in for care. With little financial risk, it gave skeptical or ignorant people a chance to know we are clinically competent, that our care has value and what we do makes perfect sense if they want to have a better life. This practice of giveaways and discounts has become so commonplace within the chiropractic profession that most DCs take these marketing practices for granted. They think it is acceptable. If you’re one of them, THINK AGAIN!! Enter the Federal Government …
The Federal Government has regulations that dictate what a doctor can and cannot do to legally attract patients. Section 1128(A)(5) of the Social Security Act, enacted as part of the Health Insurance Portability and Accountability Act of 1996 (H.I.P.P.A.), says “A person who offers or transfers any remuneration that the persons knows or should know is likely to influence the beneficiary’s selection of a particular provider, practitioner or supplier of Medicare or Medicaid payable items or services may be liable for civil money penalties (CMPs) of up to $10,000 for each wrongful act.” This applies to all DCs, even those who do not provide care to Medicare patients, because DCs may not “opt out” of Medicare. This law has existed for approximately eight years. In 2002, it was the subject of a special bulletin published by the Office of the Inspector General (O.I.G.) *, which is under the Department of Health and Human Services (H.H.S.). This bulletin was clearly intended to put providers on notice that the O.I.G. intends to focus enforcement efforts on what it considers breaches to this law. What should concern DCs most is that a “violation” is based on the offer, not the actual act, of inducement.
In addition to a violation of the inducement law which may result in civil penalties of up to $10,000 for each wrongful act, the statute also calls for the offending DC to refund all money paid for services by the patient who was “induced” into care. Therefore, offering discounted services beyond the Federal guidelines at the close of a lecture, dinner, or to existing patients for other family members not under care are a clear inducement breach–putting your practice and you at extreme risk. We are being warned: “Given the potential fines for noncompliance with the anti-inducement provisions of the H.I.P.P.A. and the amount of inducement-oriented marketing that occurs because this area has not received a lot of attention in the past, O.I.G.’s auditing efforts may become a huge revenue-generator for both the federal government and commercial carriers.”**
What about free spinal screenings? On 03/27/2006, the O.I.G. determined that the practice of offering a component of a spinal exam as a “free” service to determine if a patient could benefit further from an examination is considered an inducement breach, and no longer allowed.*** The DC must show they charged a fee for the screening and report, and have a record that the patient paid it. To encourage public / corporate support, many DCs link screenings to a charity, charge and collect the screening fee and then donate either all or a portion of the fees collected to the charity. Once this fee is paid, this amount is not deducted from the subsequent examination fee should the patient decide to proceed. Most informed DCs use the code #99401 because it is “preventative medicine counseling and/or risk factor reduction, 15 minutes,” which is an excellent description of the service offered in a screening. Because it is an excluded service from insurance reimbursement, it has no value, and the screening DC can set the value to be whatever they want. To find the regional value according to Medicare, consult https://catalog.ama-assn.org/Catalog/cpt/cpt_search_result.jsp?_requestid=1072027 DCs to offer inexpensive gifts (other than cash equivalents) that have a retail value of no more than $10 individually, and no more than $50 in the aggregate annually, per patient. So, what can you do to practice congruently within the Federal statutory guidelines? First, move your thinking from seduction to attraction. It’s who you are that determines how well what you do works. Join The Masters Circle.
Through world class coaching, Practical Open Discussions, masterminds, incredible seminars and terrific products, The Masters Circle specializes in empowering DCs and their staff to become the best version of themselves. Next, focus your marketing on information-based programs that empower people to make more educated decisions on how chiropractic care can meet their needs and support their lifestyle. Invite people to come in and be checked. Quote and collect your usual and customary fees–to everyone, all of the time. By conforming in this manner, you will be able to practice without attracting the attention of the government investigators, while attracting high quality patients who place high value on you and the services you provide.