Q:

Good Day Dr. M,

After 15 years of practice, I have found a small # of my patients elect any kind of 
maintenance or wellness care for a long term. Supportive care and chronic 
pain producing condition patients are the bulk of my "maintenance" care 
patients. That and episodic or re-injury patients.

Is maintenance care more an idealistic concept then a reality? In your 
experience and research, what percentage of patients commit to and pay 
regular fees (not special UCAFF or discount rates) for non-symptomatic care? 
In general that is.

A:

You are correct .. it is more difficult to convince patients to regard 
their health above other pressing family and financial matters. 
Considering the economic climate .. people are more apt to use their 
insurance or just get over the crisis and return as needed.

The best approach to add to the maintenance care odds is to place a 
value on the adjustment early on in their care. A number of DC's 
offer two types of care .. patch up or relief which is crisis care and 
wellness or corrective care .. this takes further non symptomatic 
time. If during the first few visits you approach them with what you 
consider their need for both short and long term care .. they may 
make the proper decision if the financial arrangements are possible 
for them. 

In my office .. which is heavy managed care .. it is more difficult to 
wean them off the insurance and have them pay but an effort is 
made. Funny though .. when I place great emphasis into wellness care 
and truly express my opinion that they need to consider it and offer 
a 6-8 month payment plan many people sign on. Being lazy .. for no 
better reason .. I often get involved with the busy-ness of the office 
and forget the purpose I am there. I confess and repent my failure!!!!

But to answer your question .. maintenance care is another aspect of 
care beyond relief and correction. I am more successful getting 
patients to follow maintenance care since I make it affordable. I 
have a simple policy. The first visit of each month they pay $35 and 
each additional visit is $20. THis makes it easy and keeps many 
folks returning for necessary care on an as needed basis.

Don't stop trying