[note: this is a long thread...with some heated and controversial discussion. Some excellent points are made, some not resolved. Editor.] ******************* Date: Sat, 02 May 1998 19:46:19 -0500 To: chiro-list@silcom.com From: Neil and Deanne Tarvin Subject: Cash vs Ins/PI Practices - Pros and Cons???? My wife and I are having a .... discussion .... about the pros and cons of cash vs insurance/pi type practices. Who's doing what?? What are the pros and cons of both??? If you were just starting (knowing what you know now!) - what would you do??? How would you appraoch it?? Give us some feedback! Neil and Deanne ------------------- From: Ivan Delman Subject: Re: Cash vs Ins/PI Practices - Pros and Cons???? Neil & Deanne... When I retired after a bunch of years doing the ins vs cash coin toss, I firmly believe that the less that I would have been in the insurance loop, the more emphasis I would have placed on improving my performance in taking care of my patients. Too much energy was spent trying to hurdle the insurance paperwork barriers. After spending 10 years as an insurance adjuster then having a career in chiropractic, I know absolutely that PI cases will never again be handled on a lien basis. Even alternate recovery can cause difficulties due to offsets and all the other rigamarole. I get heartburn just thinking about the majority of the attorneys with whom we dealt that had absolutely no regard for the value of our services or the health of their own clients. All they seemed to want was ammunition, in the form of a big bill to enable them to work their "formula" for settlement. The whole PI scene made us feel dirty. It is also very hard to get out of the PI loop once you are in due to the ongoing legal aspects of your case such as depositions and court testimony (which was the only time I really enjoyed working in that portion of the legal system). It was the rare PI attorney that handled their case with their client foremost in mind. If I were to start up again, I would attempt to go all-cash. Be prepared to emphasize your patient education process. In cash, the patient , whether you like it or not, will be evaluating the cost/benefit ratio of your services every time they fork over your fee. Some considerations are how much is your "nut" both personal and re your business, how much volume are you comfortable with in your practice, how stong are you in feeling your services are worth your fee, are you willing to confront the cash collection system right off the bat, and what are your long range goals. I'm certain that the following posts will reveal many more sides to this interesting issue. Regards, Ivan ---------------------- From: Drdubin Date: Sun, 3 May 1998 12:49:48 EDT Subject: Re: Cash vs Ins/PI Practices - Pros and Cons-Liens Find and work with attorneys you know won't do this to you, and don't overtreat. The above strategy has always worked for me, and when I am asked to cut a lien, (yes, it happens) the attorney ALWAYS matches my cuts, or it doesn't get done. You know, we get alot closer to our patients than the attorneys do. It has always amazed me that some of us don't exercise the kind of caring we need to display in order keep the patients well protected and happy. Bob Dubin, DC ------------------------ From: Ivan Delman Subject: Re: Cash vs Ins/PI Practices - Pros and Cons-Liens Drdubin wrote: > Find and work with attorneys you know won't do this to you, and don't > overtreat. >>>snip<<< Bob...I agree with what you are saying, however, the point, in that instance, is that the ATTORNEY determined what was overtreating, not the doc or even the patient. Many times the attorney would not be happy if you got a second opinion from any specialist whether DC or MD unless it was one of their "buddies". I also agree that it is best to work with an attorney who you know and can be comfortable with and together both work for the best interests of the patient/client. I felt that it was necessary to make those statements about attornys because if a doc hasn't been in practice very long, sometimes learning what is best for you is a painful process. Don't you agree? Regards, Ivan ------------------ From: DC DOC Subject: Re: Cash vs Ins/PI Practices - Pros and Cons???? I have done both and I like PI. I don't mind giving depos and I like dealing with most lawyers. The patients are motivated. It is I believe a more secure practice. I know there are a lot of great cash practices out there and thats ok. My 2 cents. Richard Rogovin, D.C., F.I.A.C.A. -------------------- From: micheal@ruraltel.net (Family Health Care Center) Subject: Re: Cash vs Ins/PI Practices - Pros and Cons???? Have a good mix of both and hone your collection skills. One type or the other limits your practice to that type of market. (IMO) Many people cannot handle the cash flow problem to pay cash and wait for the insurance to pay. Bottom line,..... lots of people can, some do some don't, you could and you might not want to. And you can do and be successfull at whatever you decide to do. Boy! Did that help, or what? ;-) Micheal J. Miller D.C. Hill City, KS ---------------------- From: Moses Jacob Subject: Re: Cash vs Ins/PI Practices - Pros and Cons-Liens Like everythng else in life you have to pick your spots. Not all lawyers are sleaze. Not all cases need 30+ visits. If you get the job done right and the case is a "lousy" case eg total recovery is low so build a little good will with an honest lawyer. If $15k is the policy limits the 3rd party had the lowest coverage, how can the treater justify $10K in treatment? I've seen it all and recommend just paying attention to the patient and the case. Do not stick your neck out and the outcome will not be unfavorable, at least most of the time. MJ --------------------- From: RdeanH Subject: Re: Cash vs Ins/PI Practices - Pros and Cons???? Suggest that you have a balanced practice. These days, at the wipe of a pen, your governor or legislature can wipe out a whole area of practice. Folks who had big PI practices got wiped out in states that went no fault. The "super doc" concept is still hanging around and could be implemented by the states for WC cases. There would be a panel of drs who would be the only ones who could treat injured workers. Dean ---------------------------- From: "Timothy A. Langley" Subject: Re: Cash vs Ins/PI Practices - Pros and Cons-Liens Ivan makes an excellent point that I'm sure a great number of relatively new DCs would probably confirm. New docs coming out of school with huge debts hear about the money that can be made on PI cases and go to town buildiong a great PI practice only to be hornswoggled by a bunch of sleazy ambulance chasers. Granted not all PI attorneys take advantage of chiropractors, but not all MDs dislike chiros either. The point is that a good many PI cases get written down. And, when you consider the time gone without being paid and your reduced fee, you might have been better off pursuing other types of patients. Tim ----------------------------- From: DR JBJ Subject: Re: Cash vs Ins/PI Practices - Pros and Cons???? Whats wrong with both? In this time of uncertainty in health care reimbursement, I work very hard to keep a healthy balance of PI/work comp/group health/and cash. Each has their own dynamic, each is subject to rules changes and legislation, and each requires different patient management skills. And as you so wisely asessed, each has its pros and cons. Good luck. -John ----------------------------- From: Backman95 Subject: Re: Cash vs Ins/PI Practices - Pros and Cons???? Several years ago I dealt with this very same issue. I discovered several things which may prove helpful to you. First of all, I could find only rhetoric, emotional manipulation, and out right lying, amongst the so called cash provider community. I set out to find a long standing, profitable, viable, survivable, and growing cash only practice. By cash only, I mean no PI liens, no work comp, no medicare, no nothing except cash only. I wanted to find such a practice that had been in operation for at least five years, was growing, operated in a nice facility, was properly staffed, paid its staff well, and was able to keep the doctors work week to less than 40 hours, as well as provide for 4 - 6 weeks of vacation per year, (not all at the same time), and allowed for one three day weekend per month. And provided an income of no less than 180,000.00 dollars per year before taxes, and after all other expenses. Never in my wildest imagination did I ever think that I would NOT be able to find such a practice, but that was exactly the case. So the question I had to ask myself, was why would I change to cash and give up the things I already had! But I did not stop there. I surveyed practices all over the country, and I discovered that many so called cash practices were not really cash. Almost all would do a PI case and take a lien. Many did work comp. Some did Medicare. A few did Medicaid. Most were less than five years old. With few exceptions were any of them making more money than they did in the past, and most were making less, but ALL of them were working at least 33% more hours a week than they did in the past, just to try and stay even with where they were in the past. Very few had associates, and therefore vacations were very costly, or just did not happen. Over half, had given consideration to going back to an "insurance practice", and 20% were in fact already doing just that. Many wished they had never done it because they had given up good office space, cut expenses by dropping equipment and staff, and now could not see how they could it all back, to try and make a go of it in the real world once again. But I did not stop there! I felt that with my management skills, and my communication skills, and my passion for chiropractic that I could succeed where others before me had not quite made it! So I did one more survey. I surveyed the public to find out what the market for a cash practice would be. I discovered that 7 out of 10 people in my region (Northern California Bay Area) expect someone other than themselves to pay for all or most of their health care. Of those 7 out of 10, only 1 in 7 would even consider spending cash on health care if they could not get the results they wanted from whatever health care plan or HMO etc. they were insured by. That left us with 3 out of 10 people. Of those three out of ten, none of them were insured for health care. 1.5 of them had the resources to pay for health care, but would not spend more than 500 dollars out of their own pocket unless it was life threatening, and the other 1.5 had no money, but would be happy to go to a doctor who would let them make payments! All this told me that in my marketplace, 15% of the market would spend a limited amount of money on a cash basis, and another 15% would be attracted to you if you gave them a deal. So I had to ask myself a question, why would I change my practice from access to 70% of the people, to access to 15%, when the 15% placed personal limits on their spending far more draconian than that of most insurace companies? Once I put the emotional issues, and the rhetoric aside, I could make but one choice, and that was to play a game in which I could continue to win the way I had for the previous 20+ years in practice. It can be done, you need not fall victim to those in the profession who make far more than you will ever make, (by selling you the idea of a cash practice), and you need not become an emotional wreck, putting your family and your health in jeapordy. Backman95 ------------------------------- From: "Avery L. Jenkins, D.C." Subject: Re: Cash vs Ins/PI Practices - Pros and Cons???? Just love those "discussions." Why either/or? Do both. Avery ------------------------- From: DAVE Subject: THE TRUTH about Cash vs Ins/PI Practices Having had the luxery of being born into a family of "cash" practices I feel like I have a clearer view than most about what does and does not work, or even occur, when it comes to CASH. My great uncle charged nothing but donations (late 40's, early 50's). That's right, donations. When he noticed that the poor pushed in more than the rich he went to $2 o/c. He passed this $2 o/c onto my uncle (50's). That $2 fee made it's way up to $6 by the mid 70's when my father graduated and was $17 when I started. Today it is at $18. Low PRICE, high VOLUME, and low OVERHEAD is what makes a cash practice work. The things that have changed since that donation o/c have been PI leins, WC and we file some of the ins. for pts but none on assignment. Things that work against the CASH practice follow; 1. Those outrageous damn tuitions make an instant large income necessary. 2. They don't tell you in school that an x-ray machine will pay for itself but a Hi-Lo will not. (In the 50 years of chiro's in my family, a Hi-Lo has yet to be purchased). 3. Insurance is completely out of control. Imagine paying double the amount for your car insurance but not having to pay for air filters and oil changes. You'd think that once you realized you were paying more in than you will ever use, even if your car explodes, that you would go to a "catastrophic" policy. BUT what if your employer was paying it ;-) You'd think that you were getting a real deal. 4. Another thing that works against the CASH practice is the overwhelming number of liars we have who claim million dollar practices and the outrageos o/c prices. When you are just about to graduate and you are figuring out what you'll need to live, pay student loans and buy/lease office equipment you tend to see your o/c raise to whatever you think you can get. That is a PI practice in the making. Some will never have the personality, time, and opportunity to build a high volume practice that could make it as "cash" and the thing to realize is that it's OK to not have a cash practice. If you do want one that is versatile and a combination(a damn smart way to go) KEEP YOUR PRICES AT A LEVEL THAT CASH PATIENTS CAN PAY, THAT LAWYERS AND INSURANCE COMPANIES CAN ACCEPT, AND THAT YOU CAN FEEL GOOD ABOUT. The rest will come if you try to remove subluxations. Lay off all that disproven PT (just ask me for the research) and do what works. Pick wisely, an area to practice. Present yourself as a professional. Be honest (that means tell the TRUTH). Know that chiropractic works and the more difficult the case, the more Dr's they've been to, the more you think that you can't help, the better your results will be if you use your skills to find the subluxation and remove them. David Ferguson, D.C. ---------------------------- From: Backman95 Subject: Re: THE TRUTH about Cash vs Ins/PI Practices Dr. Fergueson, If you can make a living and not burn yourself out @ 18 dollars a visit more power to you. I would love to see your practice. In Northern California, according to a study done about 4 years ago, the cost of seeing each patient was 24.60, before the doctor made any profit at all. (this figure was based on simple cost of business for a practice that sees 200 patients a week, and has no special equipment or facility items. The costs did no go down based on volume until the practice exceeded 300 visits per week, and could actually go up if the practice added staff and an associate doctor. That makes an 18 dollar visit a loss from the begining. Too Bad. Also with public attitudes being what they are, no matter the level of service, or the enlightenment of the patient and or doctor, the public will not pay out of pocket for what they deem someone else should pay for. This is the price we pay for living in the most expensive region in America, more expensive than Manhattan, and more expensive than Washington DC, which are number 2 and 3 on the Commerced Departments cost of living reports of last year. Is your practice in a rural, suburban, or metro area, and what state is it in? Backman95 ------------------------ From: Gene Martin To: Backman95 Subject: Re: THE TRUTH about Cash vs Ins/PI Practices I must dispute that.....I've been going more and more cash for the past 2 years...the patients pay out of their pocket when they understand what chiropractic is. BTW I make a very good living. Gene Martin --------------------------- From: DAVE Subject: Re: THE TRUTH about Cash vs Ins/PI Practices I'd have to say that this is undoubtedly the craziest thing I have ever heard, though I don't deny that it may be accurate. Just one more reason that business classes should be in the curriculum at all chiropractic colleges. New DC costs/month: Malpractice ins. $150 Rent $1000 Lght/water etc.. $200 x-ray mach $500 1 employee $800 extra crap $350 OK, thats $3000 a month. Take 100 pts/week at $20 o/c. Plus, $200/week in new patient x-rays etc. That totals $8800 gross income. The difference being $5800 profit. And thats with only 100pts/week, not the 200 you mentioned. That makes an 18 dollar visit a loss from the begining. Too Bad. Also >>with public attitudes being what they are, no matter the level of service, or >>the enlightenment of the patient and or doctor, the public will not pay out of >>pocket for what they deem someone else should pay for. This is the price we >>pay for living in the most expensive region in America, more expensive than >>Manhattan, and more expensive than Washington DC, which are number 2 and 3 on >>the Commerced Departments cost of living reports of last year. Maybe $50,000/yr is chump change but if we make the practice into a 200pts/wk, with 2 new pts/ wk, business that makes $250,000 gross. I think I could live on that. It's that crazy overhead crap like automatic processors, Hi-Lo's, New PT stuff, Top of the line office furniture, computer, etc... that makes it impossible to run a low o/c practice. Everyone wants a "CHIRO COMPOUND" the day after graduation. >>Is your practice in a rural, suburban, or metro area, and what state is it in? My practice(father/son) is in a town of about 9,000. 30 miles from a 250,000 city in Ky. In a 5 year old 2,400 sq ft office with 3 adjusting rooms, new Hi frequency x-ray machine, all that good stuff(still no Hi-Lo). I was fortunate to join my father and had many of the luxuries that most new DC's want. David Ferguson, D.C. ------------------------- From: Drdubin Subject: Re: THE TRUTH about Cash vs Ins/PI Practices In a message dated 5/5/98 , drdave@kih.net writes: << I'd have to say that this is undoubtedly the craziest thing I have ever heard, << though I don't deny that it may be accurate. Just one more reason that business << classes should be in the curriculum at all chiropractic colleges. New DC costs/month; Malpractice ins. $150 Rent $1000 Lght/water etc.. $200 x-ray mach $500 1 employee $800 extra crap $350 >> Obviously, Dr. Dave has apparently never been to California, especially here in Northern CA. Rents START at around 1500 a month, salaries START at 12 to 1300 a month. He doesn't note the costs of a phone or fax or computer, nor does he factor in association dues and expenses. The original writer, I believe it was Dr. Charscan, has been in practice quite a long time, and he is quite aware of the realities of doing business here. At 18 bucks a visit, we would be broke in no time at all. Bob Dubin, DC -------------------------------- From: DAVE Subject: Re: THE TRUTH about Cash vs Ins/PI Practices Look Doc, I don't doubt for a second that the cost of living is much higher where you are. I said in the original post that picking the right area to practice in is vital. The fact remains that students are turned loose on the world thinking that they need things like computers, hi-lo's, multiple adjusting rooms, a harem of front desk workers, automatic processors, etc.. when in reality none of those things are necessary to make it no matter where you are. Sights of a new Chiro Complex with your name in lights is what kills so many that are starting out. After watching my ole' man start out in an 800sq.ft. office at $6 o/c and make $60,000 his first year, and that was on the advice of his brother who told him exactly what to do, I decided I better see how they were all doing it and believe that I could do it too. Would I like to be getting $50 o/c's? You bet, but I don't think it's as necessary as many of you would like to lead yourselves to believe. David Ferguson, D.C. ------------------------------ From: "Timothy A. Langley" Subject: Re: THE TRUTH about Cash vs Ins/PI Practices I think it might be interesting for someone to net out the cost of carrying PI and insurance (staff, equipment, time, etc) and see what the Net is before normal overhead. Many of you folks might be mighty surprised. Oh BTW be sure to include all those write-offs to your friendly PI sources and disputed insurance claims. Tim ------------------------ From: Drdubin Subject: Re: THE TRUTH about Cash vs Ins/PI Practices In a message dated 5/5/98 tlangley@mindspring.com writes: << I think it might be interesting for someone to net out the cost of carrying << PI and insurance (staff, equipment, time, etc) and see what the Net is << before normal overhead. Many of you folks might be mighty surprised. Oh BTW be sure to include all those write-offs to your friendly PI sources and disputed insurance claims. >> Hardly ever have to write off anything, except to conform to the Work comp fee schedule, which is lower than my UCR. Overhead is easy to guage, as I do most all my own paperwork. My wife and I are the sole participants in the practice, no outside employees for almost 10 years now. We work at home, and most of the work is comp and PI. This scenario works for me to the tune of very satisfied patients, month long vacations every year, time to participate in the CCA activities, and good relations with the legal community here, and I could go on. I am not geared for 300 PV a week, nor would I ever consider working that pace. Bob Dubin, DC -------------------------------- From: Neil and Deanne Tarvin Subject: Cash, PI/Ins/ and Office Costs... I've read all the replies to my original post and it's offshoot thread with great interest... and, I have to say that many have made valid points in all areas ... (1) Yes, going "one way or the other" limits the number of patients, and/or income. Well, that's a given - but there are a few arguments that favor making a choice to limit a practice... Primary reason here would be your motivation - neither my wife or I are "money-motivated"... that is NOT our driving force to go into practice. We don't particularly care about having month-long vacations in Tahiti, or driving BMW's, or taking home $180K per year. We just want to treat patients - and, not in a "wham-bam-thank you, ma'am" fashion... We don't feel that it's a "luxury" to take the time to get to know your patients...and how many patients can you really know when you've got an assembly line going in your office? Just doesn't fit our style... or what we feel being a "holistic healer" is all about... (2) Yes, the part of the country you CHOOSE to practice in will influence the way you practice. Those of you moaning about the costs in California and the West Coast - that was your choice to practice there. You have to take the good with the bad. We've chosen a much more "lifestyle-cost friendly" state. The result being that we can practice with minimal costs (example - $3-7 per sq ft office costs, low utilities, etc) with total office monthly costs in the $3000-3500 per month range for a 1500 sq ft office with all the "bells and whistles" we want. No where even remotely close to $24 per patient costs... (3) Yes, the schools are definitely "business-weak", but, keep in mind, the schools are not in the business of teaching the students how to run a practice, or give them business basics. It takes some basic business knowledge of how to keep costs down, negotiate, marketing, etc to get started without incurring huge debt. We've owned businesses before - we've made all the mistakes - we know what to do, and, more importantly, what NOT to do... For example - how many 24 year olds right out of school will know how to present a lease proposal to a landloard that will give the landlord exactly what they want in money while still maintaining the right to get build-outs, free rent time, and other goodies included in the lease??? How many will know that you can get free shipping, and reduced payments on equipment leases just by asking for it in the right way??? How many know that in some cities the local Goodwill has monthly business equipment auctions where you can get *anything* from shelving to computers for pennies??? (Great resource - example - when I owned my publishing company, I bought 10 IBM Selectric typewriters for $20 - all but 1 worked perfectly.) How many will know how to do co-op marketing where it costs each participant exactly $0 to get their message out??? All this takes experience - cutting costs without losing quality or functionality is an art, and you learn it through experience. (4) Yes, the initial debt out of school is burdensome - but, a little investigation will show you how to get several years forebearance at the start, and how to get payments after that that are far from a strain on the budget. (5) Yes, start-up costs CAN be overwhelming - they can also be livable - *IF* you know how to do it. I've seen people come out of school, and immediately go borrow (usually on Mom or Dad's credit) 75-100K just to get started. They know nothing of equipment leasing (and it's tax advantages), how to negotiate, or any other basic business "stuff" - they just go get the money and start buying equipment and doing their office build-outs (which invariably end up being changed because when they start they have no clue what the *actual* office flow will be.) Interesting side note here - one of the universities built a new campus, but did NO landscaping, or sidewalk construction. 6 months AFTER the school opened, they put in the sidewalks - exactly where the students had made paths walking around the campus.... There are also a number of ways to get started with exactly $0, but I'm not giving those ideas away here! So, the end result is simple - the way you practice will be dependent on (1) your motivations, (2) the cost of living and doing business in the area you choose to practice in, (3) basic business knowledge and experience, (4) what it will take to retire both school and business debt. Once you know those basics, determining what type of practice you will have is easy.... Neil ------------------------------- From: Backman95 Date: Wed, 6 May 1998 12:17:36 EDT To: drdave@kih.net Subject: Re: THE TRUTH about Cash vs Ins/PI Practices I have no idea where you are located but in this geography, and economy, 1000 a month in rent will get you 689 square feet (average rent in this town is 1.45/ft/month which is one of the lowest rent towns in the northern California Bay Area), you forgot to include phone expense which will be a minumum of 225 per month , since there are now 7 or 8 area codes in the bay area and most calls become toll calls, (ie for me to call my inlaws who live 22 miles away, its a long distance call, to call my dentist who is five miles away, but in another town and county, its also a long distance call.). For 800 dollars a month for an employee, you will get an illiterate, gum snapping, valley girl wanna be who will work maybe 10 hours a week, IF you offer her health insurance. Your expense scenario is so un realistic in todays world as to be totally unbelievable. The fact that its a cash practice does not mean that we can retire from the rest of the world, pay less than minumum wages, offer no benefits, and expect to secure sufficient office space in a tolerable neighborhood. Any personal philosophy used to justify such measures is totally ridiculous. 25 years ago I practices out of 890 square feet, had two adjsuting rooms, a reception area with staff work area, an x-ray exam room combo, a dark room in a closet, and a small back office, This office was cramped, busy, and profitable, but certainly not the ideal situation for me or my patients. I also had no lavatory facilities in the office. That office, in 1977 cost 1200.00 dollars a month! If you are going to participate in this thread, please give us some realistic information, unless of course you are in some extreme rural backwoods area, where all the hicks just dont care. Backman95 -------------------------------------- From: Backman95 Subject: Re: THE TRUTH about Cash vs Ins/PI Practices Tim, I have been doing just that for 20 years, on a cost accounting basis. PI is the highest profit margin, followed by Work Comp, followed by Medicare, followed by indemnity, followed by cash. Backman95 ---------------------------------- From: Backman95 To: gaucho@crl.com Subject: Re: THE TRUTH about Cash vs Ins/PI Practices A good living is always relative to several factors, not the least of which is the cost of living where you live. For instance in a region where the average 3 bedroom, 1600 square foot house costs 350,000.00, and the average household earns 85,000.00 before taxes, a good living is one that is over 120,000.00, and in many families that means that both spouses work just to keep their heads above water. I know lots of people who just get by on 120k a year pre tax! Sounds crazy, but its true. On the other hand, there are areas where you can buy this 350K house for 80K. While in many areas of the country, gasoline is selling for as low as 89 cents a gallon for regular, here in the bay area, its still between 1.29, and 1.35. I personally believe that we should not deprive ourselves just because we pay the price for living in an area where there are over 300 days of sunshine a year, the temperature never drops to freezing, and never below 45 in the day time during winter, there are mild summers, with natural nocturnal cooling patterns, and there is a very high quality of life. So the point is, a good living is relative to a multiple of factors. If the 1200 + chiropractors in this COUNTY, were all to move to your town in order to get a lower cost of living, I am positive that your good living would deteriorate as all of the other DCs earned a good living too. Backman95 ----------------------------------- From: "Christophe Dean" Subject: Re: THE TRUTH about Cash vs Ins/PI Practices It should be pretty obvious to most readers of this thread that there can be several ways to do this thing we love. Small towns have small over heads, less competition, less third party financial assistance, easier name recognition. The $18/ov won't fly in SF and the $85/ov boutique practice won't sail for 30 seconds in Dewougiac ND. WE are different. If you guys swapped your ideal practices, you'd each go mental in 30 days and patients from each practice would hate the "new guy." Each of us has different things that we want from our practice and from the geographical/demographical area in which we chose to set up. So it comes down to this: Neither style is "Wrong" There are, in fact, more than 2 ways to do chiropractic. There are as many ways as there are chiropractors. There is a place for patients of every temperament and income level. I think older chiropractors achieve a level of inner peace when they find a practice style that is congruent with their values, their chiropractic philosophy and their level of confront tolerance. Gary Green lives in Maylasia which is REALLY out of the way so you'd think the practice could be a little more basic/no frills but he says you can't practice without a fax or computer but then he quotes Hippocrates who probably had neither. Christophe --------------------------------------- From: Nucleus Subject: Re: THE TRUTH about Cash vs Ins/PI Practices I am surprised by the animosity generated by this discussion... Most of the DCs in the field that I know run cash practices, and hand insurance patients a superbill for them to file themselves. Here is what I have observed: One Doctor I know operates in a town of 50k, and charges $60 an adjustment, but discounts up to 30% for a years worth of care paid in advance, or 15% for the monthly payment plan... He says that that is very popular because many people only make 12 or 15 grand a year. he sees between 200 and 310 a week. Another Doc I know charges $40 an adjustment and the third one is free in any given week, kind of strange, but he sees about 70 people a day, three days a week. His thursdays are busy, but only a portion of his patients come in more than once or twice a week... He is in a real upscale part of Dallas, I believe he pays $3500 for a classy space in a commercial building, his adjusting room has a waterfall. Dr Saylor, in practice for over 50 years, right down the street, $25 an adjustment, major metropolitan area. My chiro back home never charged me more than $15 for an adjustment, I would guess that 80 pt visits would be a busy week for him, small college town. I suppose that I am blessed in a way, I have always paid for my chiropractic care with cash, always as a student, so even $15 2x a week for year was a sacrifice... If the insurance patient is going to get whatever the insurance co. is going to pay anyway, what is wrong with having the patient pay us, and get the $ from the insurance co. themselves? They hired them, not us. Seems like like it is a good way to sort out the serious patients to me. Nuke ----------------------------------- From: DC DOC Subject: Re: Cash, PI/Ins/ and Office Costs... In a message dated 98-05-06 09:16:35 EDT, you write: << ... the end result is simple - the way you practice will be dependent on (1) your << motivations, (2) the cost of living and doing business in the area you choose << to practice in, (3) basic business knowledge and experience, (4) what it will << take to retire both school and business debt. Once you know those basics, << determining what type of practice you will have is easy.... >> Check out the article I wrote in chiro.org new practicioners section on how I started my practice for $5000. Richard Rogovin, DC ----------------------------------------