Balancing Affordable Care and Practice Profitability

by Ray Foxworth, D.C., FICC • 

President & Founder, ChiroHealthUSA • 

In 2021, roughly 92% of the US population had health insurance. The largest uninsured population is between the ages of 19-25 years old at 14.9%. (Statista Research Department, 2023) 55.7% of American workers are enrolled in a high deductible health plan. The rising cost of health insurance has driven the popularity of high deductible plans. (DeMarco, 2023) With half of US adults stating they have difficulty affording healthcare costs, how do we offer affordable care to patients while balancing our own rising costs due to inflation? (Montero, Kearney, Hamel, & Brodie, 2022)

The crux of the issue is finding a balance between market value of your products and services, affordable pricing for patients, rising business costs, diminishing reimbursements, and limitations from the rules and regulations that come from operating in the second most regulated industry in our country. I have heard from countless chiropractic business owners that they are going to get out of insurance and charge a flat fee to their patients per visit. It sounds great in theory but is rarely profitable to a practice. Additionally, as we fight for parity with third party payers, all too often, it diminishes the value of the services we provide.

Before making any big changes in your practice start with determining your cost of doing business. This overhead calculator will tell you how much you need to make per visit to break even. According to a national survey a few years back, overhead in a typical chiropractic practice averages 50%. I would be surprised if that average hasn’t increased in light of increased costs and lower reimbursement models.

Review your provider contracts. Are you signing contracts for LESS than what it costs to deliver care? You must read your provider’s agreement and understand every stipulation that you are agreeing to with your signature. Far too often, doctors find out well after the fact that a procedure regularly performed in the practice isn’t covered or bundled under the terms of the contract. Additionally, providers may choose to add a new service or product—such as spinal pelvic stabilizers—and find that their provider agreement allows for reimbursement in the fee schedule at a level lower than the cost of the product or service.

As a business owner, you should be evaluating your fees on an annual basis. While the 2022 Cost of Living Adjustment (COLA) was 5.9%, government inflation data showed costs grew at a faster pace for much of last year. Now, the 8.7% COLA for 2023 is outpacing current inflation, with a 5.8% increase over the past 12 months for the consumer price index for urban wage earners and clerical workers. (Konish, 2023) There are several websites (such as chirocode.com and fairhealth.org) that provide fee calculators to give you an idea of what is considered “usual, reasonable and customary” (UCR) per code and zip code. Pulling published fee schedules (such as workers’ comp) also lets you know if you are billing above or below the allowables. Your fees should not be so far below your market averages that you are undervaluing the services you provide and leaving revenue on the table.

If you determine that your fees need to be adjusted, then take the time now to make those changes. If it has been several years and your fees need a major overhaul, consider using a consultant to help you bring your fees in line. Whatever route you take, make sure that you make the commitment to see these changes through. One of the primary reasons providers say that they have not made changes to their fees in years is their desire to keep care affordable for patients with no insurance, limited benefits, and high deductibles. Maintaining your fees based on the last century is not an option. Using a DMPO, such as ChiroHealthUSA, is a great way to maximize reimbursement when it is available and keep care affordable for your patients for their non-covered services.

Our team is here to help you make chiropractic care more affordable for your patients, while helping you to remain profitable. Just contact us or schedule a free, no-obligation 1-to-1 consultation and learn how much more we can do for your practice!