A cash practice seems like the only way to survive in the HMO and managed care environment. There are many nuances to it and it all boils down to creating value for the patient. In order for them to open their wallet and spend the money and time in your office .. they must feel the ordeal will be worth their time and money. This begins with the consultation .. examination and report of findings. I recommend you begin the cash practice by creating some financial options over periods of time to pay .. six months to twelve months. As you are probably aware there are many variations on the theme of cash practice. There is the UCAFF .. unlimited care at a fixed fee. This is a one time fee with a discount if paid at once or possibly less a discount if paid in installments .. just break it down on a monthly basis. When explaining any cash program be sure to make it digestible. In other words .. if it is $100 a month .. it sounds better as $25 a week. Be sure to have their credit card on account so you don¼t have to hunt them down if they skip payments and be sure they pay at the beginning of the cycle (week or month) rather than the end. Also .. care may be more in the beginning than at the end so be sure to have them realize it and when asking for money as they progress they are actually paying for care received already. Also .. and most important .. have them sign a statement that you do not guarantee any healthcare results since paying in advance may be perceived as such. Also be sure to let them know that they are paying for a set amount of visits per month or a year (even if they are on a UCAFF plan). The purpose of this is simple .. if they paid $1000 for a set of visits and after they have seen you .. lets say 25 times and your usual customary fee for an adjustment is $30 .. that would be $750. Lets say they are leaving town or wish to quit care and want a rebate .. well .. you multiply 30 x 25 and come up with $750 and rebate them the difference. This should be made clear. If you check my webpage under Practice Tips and scroll down a bit you may find a copy of my Financial Arrangement Form .. this is something you can use. There are a number of practice consultants that promote Cash Practices .. the best one may be Dr. Nikitow .. check my webpage under weblinks and hopefully you¼ll find his webpage there. Also .. Dr. Bob Hoffman the President of the ICA sells a UCAFF program .. you can probably find his e-mail address via the ICA also found on my webpage under weblinks. This is all I can do from here. Hopefully you¼ll get some response. Below I copied from a New Beginnings Bulletin Board. The discussion was about fees. Check my webpage again under weblinks and look under organizations and open the New Beginnings group. I hope the material below will help: The two or three that are writing below can be reached at these e-mail addresses: Dr. Jay Yuhas at: drjay@yuhaschiro.com Dr.Shawn Powers at: in8coach@texas.net Good morning everyone, Our office is similar to those described. We offer cash, annual care plans only. Initial visit is $60 ($35 for consult, exam - we no longer do x-rays on a regular basis, actually haven't taken one in months - and $25 for the first adjustment). This is an opportunity for someone to experience our office and Chiropractic and make a decision if this is what they want. They are responsible for their own health care decisions. From the first visit we tell them that our goal is lifetime wellness Chiropractic care for everyone in our community so their are no surprises. If they are unsure that they want to commit for a year we allow them to come in FFS at $25/adjustment for two weeks (we max their out of pocket at $75 per week even if we see them everyday). At the end of that time (usually way before it) they have to decide if they are going to become a practice member or not. Annual care plans in our office are: Families $1875/year if paid monthly (10% down $187.50 and $153.41 per month) this is for unlimited care for all immediate family members but we require that they come in at least once a week. We give a 15% discount if they pay the year up front. Individual are $1250 per year with same payment arrangements as above. Adults are required to bring in children but if the spouse doesn't want to come in that is up to them. They are big people and can make those decisions, children on the other hand need to be checked. Finally, indigent care is provided on an individual basis. Most can pay but it might be just letting them pay $25 per week for an individual because that year commitment scares them too much on their salary. Most people are very open with us about their finances and when we truly know their situation we work with them. We are still considering a box practice. Again, these numbers work for the area that we live in. They obviously will vary according to your area. > Date: Mon, 20 Nov 2000 12:04:32 -0500 > From: "Jay Yuhas" > Subject: Re: Chiropractors to earth!!! > > I have nipped initial intensive care or maintenance care in the bud and recently simplified my system.... My fee is $30/visit or $30/Wk for family or individual that comes regularly. Regularly, is once a week. This keeps it simple for me...i have one part time C/A only to log payments, bookkeeping, set up flyers, newsletter, etc. We have envelopes they fill out , drop in the slot with payment and they are responsible for doing it and knowing which group they fall in. This is $1440 a year for individual or family .. you make the choice of bringing them...so in my office individuals pay a little more and families a little less.... I did pre-pays ...this is easier for me ....all i do is adjust ..the rest takes care of itself.. > > Jay you touched on value for service. So many times I have been curious as to what other DC's like ourselves cash fees are. It seems that this is a bedroom secret that most of us conceal. Forgive me if I am breaking a rule that I am unaware of but would including yourself Jay, be willing to share some fee schedules for all, patients who can pay, children, families and patients who are indigent? Right now, I am charging $30/visit in NJ for initial intensive care but I still get in lump in my throat when I speak of family care or include a spouse. Personally I have a hard time charging a couple or family $30/visit/person. So, Right now I am adding a flat fee of $20/week for your spouse and/or children to whatever the primary patients weekly bill is. After 3-6 months of care in my office, you are considered a lifetime member and eligible for reduced fees if: You make your appointments on a regular basis and/or if you prepay for monthly or yearly care. Single care is 100 family is 150 for max once a week. Sometimes I have been known to agonize over my fees. I want it to be affordable but I also want it to be profitable and most of all uniform and easy to understand for my own sake as well as the patient. I don't know about you guys but how many of you (like myself) still have patients coming in paying fees from the different plans you created. It gets confusing. I shared my thoughts here in an attempt to open a dialogue on the subject. I realize some may view this as unethical or a private matter. I am not worried about it one way or another. I share this info in hopes some will gain and others will share in order for us all to gain. Over the years we have applied different savings percentages to the plan according to our over head, retention and profitability. Years ago when we started we were doing it based on comfort level and our own misguided feelings about money. It didn't take us long to see we would quickly go broke and be out of business if we kept that up. Yes, there is a care plan for the first year of care and the saving 20% off retail and 25% if paid in a one time investment. The 50 and 25% savings for the second and further family members are also available although we require to utilize the saving the other family members must start within the first 30 days of the first individual.