This DC practices overseas and is frustrated with his practice. He sees over 200 patient 
visits a week all via a managed care referral

Q:

Dr. M

I have a number of questions

1:My HMO has no cap on the number of visits for chiropractic care.
2. I lowered my fee's less than half because, the hmo i work for told me "do it or leave" 
3. i am scared to leave because of the large referral base. 
4. I have no overhead, but if i leave my overhead might cause a great discomfort and 
stress. in my practice i have ups and downs. more downs than up. about 9 down months to 
3 good months.

I am thinking of leaving here to work in U.S. in L.A.
what is the percentage of managed plans in L.A.?
Is there any PI left? Is there any WC left? Is there any car insurance
coverage left? I also know the ratio of DC to patient is much higher in the US.

I feel I need help in the form of someone with experience (like a
consultant) telling me what to do, and my following every step.
the question is, could i justify the cost of a consultant, with the lack of
a large income. without x-rays and therapies, and tests, and other charges,
could i make enough money on high volume chiropractic adjustment only.
If the answer is yes, than I might try to stick it out here and break off
from the hmo and go private.

Thanks

A:

Thanks for the e-mail. First of all .. everyone wants the grass greener on their side of the 
street. Many DC廣 in this country would love the volume you see and many are hurting 
financially because they are not part of a managed care program and if they are the 
programs can be very limiting filling their office with people but less cash. 

My advice is the same whether you are here or there .. see the patients within the 
framework of their insurance program with the fees you must ask for. Discuss the reality of 
chiropractic and explain the program between relief and corrective care. Those who wish 
corrective care can be offered additional visits for additional fees and placed on a payment 
program .. similar to the form I sent you. The other option is see less  insurance people and 
charge more .. obviously a combination is ideal .. see those that attend with their insurance 
.. place them on  a limited schedule .. tell them any future care will be without insurance 
coverage (many of the HMO廣 in the states only pay for acute conditions not chronic which 
gives us the ability to terminate the insurance portion and convert the patient to cash). If .. 
as you say there are no number limits of visits add other services .. extra exams or nutrition 
if possible to gain more income. There are only three ways to add income .. more patients 
.. more fees .. more services. Marketing beyond the confines of your insurance patient 
base will bring in those who possibly can pay cash .. you probably should tap into this on 
the days you are not working.

If you come to the states you幢l encounter overhead that can eat you up. Not being within 
an HMO from the beginning and having to create a practice from scratch. If you are 
unhappy living there and want to return here .. then do so. If you wish to return here just to 
make some money be aware the roads aren廠 paved in gold .. this no longer is the land of 
milk and honey. Yes .. it can be .. but so can it be where ever you are .. you just have to 
reorient your way of thinking. If I were consulting you .. I寮 have you plan a marketing 
farm .. begin the process of reaching more people .. prepare programs for all types of 
patients and people .. plan an internal marketing program .. add new services and all this 
within the constraints of the insurance program you are in.

As far as California and LA .. being here in Atlanta places me in the same position as you .. 
I don廠 know. Some states still have good PI and WC laws .. many are drying up such as 
New Jersey and here in Atlanta. If still interested I can get in touch with folks out there for 
more details

As far as a consultant .. it would be difficult doing anything professionally from such a 
distance. I recommend you purchase my Smart Start Book and use the format chapter by 
chapter to both consolidate your internal practice management and external public relations. 
The book is $59.95 US funds and the cost of postage will probably be $8. Once you do 
this .. we can discuss details via e-mail. If you wish a concerted effort for consulting this 
can be arranged via planned weekly projects. .. There are many practice consultants in the 
states .. possibly some DC廣 there use them .. find out.

In conclusion .. see if you can bridge the HMO and cash practice together .. this will result 
after you begin marketing and surveying your office and community

Have a Great Day

Dr. M