Blog, Chirosecure Live Event August 8, 2022

Thinking about Getting off the Insurance Hamster Wheel?

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Hi everyone. This is Michael Miscoe with Miscoe Health Law and welcoming you to another edition of ChiroSecure’s growth without risk Facebook live programs. Joining me today, I was special guest Dr.

Vincent Leone from specialized practice consulting and our topic today. We’re going to discuss and try to address some of the concerns and to be Frank some myths. Switching over to a cash practice. So welcome Dr. Leone Hey Mike. Great to be here. Thanks so much for having me really appreciate.

Oh, it’s my pleasure. So usually, and we’ve had this discussion offline. We we both to a certain degree, are very much in favor of cash. Practices me more from the standpoint of risk mitigation, Efficiency, not having to run on the hamster wheel, so to speak and do all the things other than treat patients, that insurance companies demand that you do for the declining dollars that they pay you only then to find out 18 months later that you didn’t do all the things that they want you to do well enough.

And then they want to take all the money that they paid you back. And that has caused many providers. To question, The sanity of that process. And so I have focused on moving them over to a cash model within the confines of the rules, whether it’s Medicare, Medicaid, or commercial payers with whether they stay in network or not.

And you work with docs, to make sure that they do that transition efficiently, train their staff and teach them how to be profitable. In that context we have two different I help set them up and you bring it home, so to speak, but in your experience and you converted your own practice to cash at one time, did you not.

Oh, yeah, absolutely. When we, when I went on my own I just quickly found out that what I call the high volume, low fee heavy insurance grind was just not for me. My father, practice for over 50 years and he practiced that model for many years. And I, to me, it just seemed broken to me because it’s like you put the.

Dr on a hamster wheel, they’re completely trading time for money. There’s no leverage. And so what I found was, Hey, I want to, first of all, get off insurance cause we were 95% cash. And the insurance dictated what I could charge not so much what I could do, but certainly the value I could play some my services, which I didn’t like, I didn’t think that was fair.

I didn’t think it it gave me. The freedom to actually have the practice I wanted. When we went to cash, we chose what I call high ticket niches, which are high value cash services that address a specific problem. And that gave me the leverage to charge what I want to create a robust protocol that’s all cash.

And it just, our practice exploded and that’s what I teach doctors to do. Okay. As you went through the transition yourself. And obviously I’m, you didn’t have you to help yourself at the time. I, is I discussed the idea of cash to providers let’s say, the most common description is part of a wa what I call walkaway strategy in an audit where a payer is just sinking their feet in the ground, and they want a gazillion dollars and the doc doesn’t have the money.

And in which case, the doc walks away converts has to convert the practice non-covered services for cash. One of the biggest concerns. There are two big concerns. One is all my practice. All my patients are going to quit. They’re all going to go. If I don’t, if I don’t take their insurance, the second one is I’m not going to make any money, how do you deal with those questions? I can tell you how I deal with them, but I’ll let you go first because your answer is probably going to be more professionally oriented and helpful than mine. I don’t know about that, but I think it all comes down to value, but. It’s if you are providing a service that the patients are, that is high on their value scale that is going to keep them with you.

Because it now versus if you are a commodity, if you’re going to just be one of many, then yeah. They’re going to shop for. The lowest price auction. And that’s not what we are. That’s not what we choose to be in the marketplace. Our goal is to really be an expert, a specialist in the marketplace because that allows us to really charge what we want and deal with conditions that patients are really not desperate, but they really want to get fixed and they want to avoid drug, drugs and surgery.

That’s our whole thing. Avoid drugs and surgery. You don’t want to call yourself an expert though, because we’ve got some licensure board issues that might come into play there, but yeah, hundred percent. But we do get your point. You want to create a concentrated area of practice, where you have advanced Pat capabilities.

Let’s put it that way in advanced training and in dealing with certain conditions to set yourself above the crowd. And I knew you would say all that and people like you because you fixed that stuff and you keep us from basically stepping on our own toes. But but so that’s the first thing is we need to provide a service that is of high value to the patient.

We need to move out of commodities. We need to move into a high value service. And then two, in terms of not making as much money. This is the furthest from the truth. We made. Enormously much more money going this route because we were able to charge what we felt was a fair market value for that service.

And and so that was never an issue. We, and by the way, all our clients they’re adding. I don’t know if we can talk numbers, but 10, 20, $50,000 a month in cash with these services. So you’re not going to, in my opinion and experience, you’re not going to be losing money.

You’re going to basically be making more money with working. I think for the providers that are doing, MIPS and therapies and rehab and whatnot, and they may be still banging out $270 charges per visit. They don’t see the ability to treat. Cash, but I’ve always looked at it from a profit perspective.

There’s an insane amount of overhead expense associated with messing around with insurance. EMR systems and documentation and extra doctor time where your hands are on a keyboard and not on a patient. You have to pay people to bill it. You have to pay clearing houses to process your.

Then you have to pay people to chase after the stuff that didn’t get paid and figure out why and send notes and run through all those traps, which to me when you do, let’s say even a $50 cash service and the patient comes in and they pay their $50, you do your thing and they leave.

You’ve got documentation to keep your malpractice carrier happy, as well as your state licensure board. And that’s pretty much it. And you got to pay the gal, put the $50 in the drawer and take it to the bank. So you know the amount of overhead associated with a cash practice is significantly less.

So then even if your gross numbers. What I’ve heard from my clients is that their gross numbers aren’t the same as what they were when they were doing insurance, but their net is way higher. Is that your experience, are you seeing both an increase in gross in net? It depends on the model that you go after, right?

So there’s the old saying, it’s not how much you make. It’s how much you keep. So in a traditional chiropractic model, that’s going cash. By and large. Yeah. You’re going to see a little less gross. But the simplicity of the model is going to not only in, in equipment and staff, et cetera, you’re going to have a lower overhead given you a higher.

But if you decide to essentially do your traditional chiropractic where you’re just doing manipulations, but you are also adding in a niche, which is what we do and teach then that’s when you get that’s when you have the leverage, right? Because our average case fee is three to $5,000. If you just, had five of these patients a month, in addition to your chiropractice it’s.

It’s incredibly profitable because you’re using the same model that you’re talking about in terms of not billing insurance, not having the staff, not having all that necessary that you’re gonna need the EMR and all that type of stuff, but it’s mainly staffing and some stuff around the office. But the point being with when we add these niches, in addition to a traditional chiropractic office, you can boost your revenue while actually.

Working as much because you are going to do the evaluation, you’re going to do the enrollment and you’re going to do your exams. But in terms of the treatment, by and large, that’s going to be done by staff systems and technology. Where that is permissible, of course. And there’s people listening across the country.

So the rules vary relative to the use of unlicensed assistance. Some states they’re required to be certified and whatnot. Now you mentioned niches and wondering if you would be willing to share which niches get the most riches. Yeah. Yeah, that was good. Interesting where we’re actually having a seminar on this coming up in September in Nashville, but, and it’s called the riches and niches advanced seminar, but we’ve found that Of course herniated disc, with spinal decompression. And this is really here’s. What’s interesting to me doctor say isn’t decompression played out or isn’t it essentially saturated and the answer to that is absolutely not. Because if you look at how many surgeries there are on a yearly basis and how many don’t really need to go to surgery, all of those are potential patients.

But even if you just took your. Average new patient flows say you had 20 new patients a month. We’ve found that 10 to 20% of those are actually dis patients and can be better served with decompression. So that’s the first niche and that’s always what I recommend. The first niche that doctors add. But spinal decompression is the first one.

Peripheral neuropathy is an excellent niche, but it’s a complicated niche. You really need to be super sharp clinically from a neurological stand. Chronic knee pain, fantastic niche, right? Because these are your patients that are very similar to your chiropractic patients, right? They want to stay active, it’s interfering with their life.

They can’t, a lot of times we’re not a lot of times, but sometimes they can’t work, but a lot of times they can’t do the things that they love, golf exercise those types of things. So chronic knee pain. Patients from surgery and the, three to six months of rehab after. And then plantar fasciitis is another really good niche that we have an excellent protocol to treat.

And those are the four niches that we focus on. And we do that because there’s so many of these patients, like so many patients have chronic back pain, tons of patients with knee pain neuropathy. Primarily induced by chemo are by diabetes, which is the number three chronic condition in the U S and then plantar fasciitis, it a lot of times you’ll, if you’re doing rock that you you’ll see some of each, but those are the niches that we have found that produce the most patients, the most revenue and the most satisfaction for the doctor.

And I find it interesting that All of your niches are condition focus, which I think is awesome rather than focusing on the treatment. So I would assume that in your marketing as you try to build out these niches, your marketing that the condition or the problem rather than the treatment, is that a safest.

It is, it’s a very astute observation. And when I was practicing, we had our clinic, we have two other sister clinics and we did cooperative marketing and still going on sound pain, here in the Northwest. And we focused on those conditions. And it, it just was when, cause we’ve dumped a lot of money into advertising a lot and we did radio, TV, digital, and print, and.

If you try to market anything other than the condition, your marketing dollars do not go as far, because you have to think from the patient’s perspective, it’s, everyone’s like what’s in it for me. Everyone, the only the person that everyone cares about the most is themselves. So you need to, to your message needs to talk to them.

And what they are experiencing, are you suffering from. Back pain. Are you suffering from chronic knee pain? Do you have pain, numbness and tingling in your hands or feet when you use a headline like that, or a message like that? That’s focused on the condition. That’s what perks people’s ears up and gets them to read further.

And then hopefully it’s like the button and. Plus it’s something that the patient that know the patient can understand, they know whether their knees hurt or they’re, they have plantar fascitis. Maybe they don’t know it in that term, but or if they’ve been told they have a peripheral neuropathy or something like that, those are things that patients understand you.

I have to imagine if you throw something out, I’m no marketing stud by any stretch of the imagination, when you mark. Like a treatment let’s say there’s these new, like a class four laser or the new, what’s the new sound thing that the shock wave.

Yeah. They have no clue what that is, i, and I’ve always favored the condition-based marketing because even if you’re doing experimental. Investigational type treatments, which is why your cash, you’re not marketing the treatment for a condition. You’re just marketing the condition.

And then you’re not going to get in, in, in Dutch with, your licensure board for deceptive advertising. If I were saying, Hey, we have this new treatment shockwave for whatever, and it’s not cleared for that. You can’t say that. And you get, I can get you in trouble. A hundred percent, we’re Closing in on our time.

How have now I’ve in past presentations have addressed, the issue of bringing Medicare patients in for cash. And it’s a very simple construct. Some of the myths that, that I wanted to debunk, are that, with the appropriate documentation, and depending on what you’re doing if it’s a service it’s not covered by Medicare, you absolutely have no obligation to bill it.

As a chiropractor if you do manual manipulation of the spine or manipulation with the manually controlled instrument it’s potentially covered. And even in those circumstances if the purpose of the treatment is not something that’s covered meaning you don’t have all the documentation that they want you to have.

And most people don’t Then they’re going to deem that not medically necessary. And if you do an ABN option two, you don’t have to bill it. So before we leave and wanted to debunk the myth, wanting to make sure that this is consistent with your experience in the practices that you’ve worked with and even in your own practice, If you’re in the same, zip code is a Medicare patient.

You don’t have to submit a claim. That’s just not the law and people that tell you that. And that shy away from accepting Medicare patients into their practice because they want to be cash. You don’t need to do that. The Medicare population is is a fertile market for a cash practice.

And you don’t need to be shy away from it, but you do need to learn how to do it, and I couldn’t agree with you more. And I’m so glad you brought that up because I loved Medicare patients when I was in practice and I had, it’s so weird when doctors are like, oh, I hate Medicare patients.

Why? They show up on time. They have money. They want to get better. They don’t want to spend their golden years. How many times have you heard someone say gosh, I thought these were supposed to be golden years. They don’t want to spend that time in pain. They own their home. They have money and investments.

They probably have more money than you do and they bake your cookies at Christmas time. Exactly. And they bring you all types of treats and flowers and gift cards. It’s ridiculous. So Medicare patients and I always, that’s why I always tell docs, Hey, if my clients, Hey, if you’re concerned about this at all, go talk to Mike because he’ll set you straight and he’ll tell you exactly what you need to do.

But Medicare patients are wonderful patients and it would be a shame to leave them out of your, potential. Yeah. As we finish up I hope that for those that have thought about cash practice in Vince, you can do a conclusion to tell your experience and what your clients are telling you, but I haven’t.

To meet a client. I’ve been converting people to cash for probably the last 10 or 15 years. And it’s really not in my business interest to do that since I make my living off of defending doctors in post-payment cases. But I think it’s the right call for the practice that, you either. Deal with all that compliance stuff and dig into all those rules and spend all that time or you don’t.

And because most of the OCS, I recognize, went to doctor school to become doctors, not compliance geeks like me and coders. It’s just as my dad, you said it’s just not my cup of tea, and so for those docs, that have made that transition. I have never had one. So that was the dumbest thing I ever.

Every to a person, they all say, I wish I would’ve done that 10 years. I should’ve been audited 10 years ago and made that transition because I love practice again. I feel like I’m in control of my practice. Again, I’m financially fine. I’m in better shape than I ever was. My stress curve is like substantially reduced.

And to say a little bit different what you said so eloquently about value. I, for the docs that are concerned about, all their patients going away my response is a little bit more. You have to really be terrible at what you do, in terms of how you use your hands, if that, for that to be true, because if you’re good with your hands, my dad used to say, when I was planning on becoming a chiropractor, he said, look, if you’ve got good hands, you’re going to be fine.

If you don’t have good hands, you’re going to be used in them, the bus tables. So the point being is, if you’re good at what you do, patients will pay for it. They always have, and they always will. And. Putting yourself at the pinnacle of that value curve in the marketplace, because you do something that they can’t get somewhere else or you’re delivering results that they can’t get somewhere else.

You will always be in demand and to a person, every single client that’s converted to cash has not returned. The journey and the transition. And I’d like you to share your experience with your clients. You ever had one that said point that was a big mistake? No, not when they did it correctly.

That, so the only caveat to this is when that I found is doctors try to do it on their own. They tried to figure it out and it’s in other words, they want to try to figure out how to treat neuropathy or chronic knee pain without falling apart. And so what happens is they invest a bunch of money in equipment.

But they don’t want invest in themselves in the training, which is just ludicrous to me. And I’m not trying to, I know this is a self-serving statement, but it, you wouldn’t open a chiropractic practice without being trained as a chiropractor. So why would you start a niche? Whether it’s decompression and rock the knee pain and plantar fasciitis, why would you start a niche without getting the proper training?

Why would you want to try. Run through a forest with a blindfold on that’s how I felt when I started out, although I did also have coaches but the point being is, if you’re going to do this and you should do it you got to get training, you have to follow a proven model and a protocol.

And the equipment that we already know that works, like why would you try and figure this out on your own? That’s the only caveat or that’s the only pitfall or one of the major pitfalls. I’ve seen doctors where they regret it. Because they don’t get the results. So if you can’t deliver clinical results, just like you said, you’re going to be busing tables.

So you need to deliver clinical results. If you’re going to ask cash and you’re going to have them write a check it’s three to five grand or whatever the number is, you better deliver the results. That’s our number one principle at my company is deliver clinical outcomes, right? So that’s the only pitfall is if you’re interested in this, don’t try to figure it out on your own because you will be.

You’ll struggle, that’s th that’s my struggle. The difference, when I’m showing him the, the administrative side of it in terms of how to do it correctly so that you’re not creating new potential risk areas for yourself. And it sounds like what you’re doing with these guys is walking them through the process of how to make that transition staff training patient education, whatever, such that it actually works out that you’re delivering a great clinical result, but making sure that your.

Bringing the patient along so that they understand what’s happening and why they have to pay for it and all of that stuff. I think that is critical. I agree that there’s probably some people that have tried to make the jump to cash without any help. And it turned out badly for a variety of reasons, whether it caused licensure board complaints or marketing issues or something like that.

But by and large I have never had a a practice that switched that. That regretted it. I think if you’re out there, you’re thinking about this model certainly get help in terms of how to do it the right way with your paperwork and all the admin stuff. And then if you need Assistance from somebody like Vince to help build out your niches, that so to speak and to improve the profitability of your cash practice.

I’m pretty sure you’re not going to regret the transition. And it will definitely put you back in control of your practice. Put all of the decisions about the treatment between you and the patient without this third-party insurance company, getting involved saying, Hey, we’re going to cover this.

We’re not going to cover that. And I think that that level of freedom is, has gotta be enticing to many of you. Vince, I certainly want to thank you for coming on. Tell folks how to get in touch with you if you could. Yeah, absolutely. And I just, would love to. Thank you guys, both you Mike and ChiroSecure for having me it’s really an honor to, to jump on the live stream with you guys.

A couple of ways if you want a to go watch a webinar, it’s a, the fourth step to how to add a high value cash service to your practice. That’s where I recommend a lot of doctors start. I’m just going to teach you a ton, or if you said, Hey, I’m ready to chat. I want to set up a consultation.

You can always go to, either one and whatever suits your needs the best. And once again, thanks so much for having me. Oh my pleasure. And I really appreciate you taking the time to be on wanna remind everybody next week. Dr. Sam Collins is going to be with you and I will see you guys next month.

Thanks for.