Changing Income Streams in the Middle of a Recession

Changing Income Streams in the Middle of a Recession

by Dr. Mark R. Payne D.C.


Graduated in 1979 and, trust me, I’ve seen better days for chiropractic. For the past decade, I‘ve watched once vibrant practices slowly wither on the vine as third party pay dried up. Many patients forced to pay out-of-pocket for chiropractic care began to scrutinize their health care expenditures more closely. To make matters worse, now we’ve got a full blown recession on our hands. All indications are that doctors and patients alike will be going through some tough times in the foreseeable future.

We all know the days of eighty percent coverage for an unlimited series of adjustments are over. In spite of that, many doctors continue recommending care programs from the eighties. Such programs are of questionable benefit to your patient and, in today’s environment, are probably counterproductive for your practice as well. The good news is you can still deliver a high standard of care to your patients AND make a living doing it. Here are three simple strategies for improving income streams for your practice and helping your cash-strapped patients at the same time.

Step One: Include rehab as part of your treatment plan.

Most insurance companies severely limit coverage for adjustments. Conversely, many will continue to pay IF your treatment plan includes rehab. You can get started for about a hundred bucks, yet nearly half of the profession still hasn’t made the leap. If you aren’t already doing rehab, you’ll be amazed at the benefits simple spinal exercise programs can have for both your patients and your bottom line. You don’t need a diplomate program in rehab to get started, just a few basics.


Step Two: Transition patients away from “intensive care” as soon as possible.

In an age where nearly every practice manager recommends selling long periods of “corrective care,” consider things from your patient’s perspective. The economy is floundering and many folks are struggling just to make ends meet. Even so, most patients will agree to anything…while they are in pain. Once the pain is gone, though, patients inevitably do what they think is in their best interest. Often that means discontinuing what seems to be a never ending series of expensive office visits.

So, why fight that mindset? Instead, explain the chronic nature of their underlying problems, provide care to stabilize their symptoms, and then begin the process of creating independent, healthy patients. Make sure patients understand the goal of care upfront and can see there’s an endpoint to care in your office. In the process, patients begin to see you as a true partner in their health care. Patients intuitively know when doctors have their best interests at heart and will remain loyal to those who are really on their side. In the long run, that means better patient retention and more referrals.


Step Three: Provide necessary equipment and follow up for successful home care.

In addition to whatever charges accrue during the acute phase of care, there are a few necessary things which are needed as your patient is moved over to a home care program. These charges are incurred for services and equipment needed for a successful rehab program. Even though these may be only occasional charges to the patient, they still serve to provide additional revenue streams for your office without unduly burdening your patient. Here are some examples:

A. Evaluation and Management Fees: Once patients are asymptomatic, we reevaluate to determine what, if any, rehab activities are appropriate and to monitor progress. Usually this takes some additional time and a higher level of decision making and we bill accordingly. Such reevaluations are typically only done a time or two, but will generate some additional charges over and above your typical office visit.

B. Follow-Up Visits: Once patients are well versed in their home rehab, I typically schedule a follow-up visit in approximately six months. Follow-up visits are a great opportunity to monitor progress, coach as needed, and reinforce the importance of continuing with home care. Such visits generate very little cost to patients and provide an excellent opportunity to reestablish contact and rekindle the doctor-patient relationship. The payoff here is in better patient retention, increased referrals and, yes, a slight improvement in your $/case average. The point is that you are doing your best to insure their long term well being without beating them up financially.

C. Equipment Sales: Most home care requires some type of basic rehab equipment. In our office, home traction units and tubing type exercisers are frequently employed to help patients correct their own postural problems. You’ll probably never get rich selling home care equipment, but it’s fair to say that sales of home care equipment probably average around $100.00 per patient in our office. Many insurance plans will cover such equipment and even your cash patients will realize the value of good home care in reducing their need for expensive treatment.


During the Great Depression, chiropractors survived by providing personalized care appropriate to the needs and budgets of their patients. Bear in mind, this was long before the days of practice managers and lengthy “corrective care” programs. Today’s economy provides an excellent opportunity to learn from history. Consider better helping your patients through tough times by providing only those services necessary to help them feel and stay better on their own. In the long run, they’ll appreciate your efforts and help build your practice. Some things never change.

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