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Case Fee Questions

Exit forum ID Forum Discussion Case Fee Questions

This topic contains 2 replies, has 1 voice, and was last updated by   Christopher Stepien September 22, 2018 at 1:01 pm.

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    Christopher Stepien

      I set a goal for myself to go Case Fee by Jan 1, 2019.

      I’m working my head around some questions. Any help would be appreciated.

      1. Where’s the cut-off for accepting a case fee patient?

      • If a patient has 25% adhesion and 75% degeneration, do we take that patient?
      • If a patient has 75% adhesion and 25% degeneration, do we take that patient?
      Where are we supposed to accept patients based on our ideal client?
      Or do we diagnose and leave that question up to the patient?
      2. What about those patients who we don’t think we can help, but we do?
      I currently have a patient who needs a knee replacement, I told her she needs one, and told her I probably couldn’t help her.
      She begged me for treatment.
      She is 80% better with her symptoms and is ecstatic about her care.
      I would’ve never taken her on as a case fee.
      Is this, again, leaving it in the patient’s court?
      3. What about patients who MUST work (and load their damaged body) and 3 strikes rule?
      If a patient has low back pain but must sit, or is a typer and must type, how do we manage this given the 3 strike rule and LOAD?
      Is it, “We’ll see if we make progress and if we don’t, just discharge you?”
      I’m sure I’ll have more questions, but that’s all for now.

      Seth Schultz, DC

        Really good questions Chris! To answer the first one, it depends how much you think you can help and what their other treatment options are. The bar is set higher on case fee and the patients that need this treatment will have their own set of difficulties to navigate. With that said your treatment and communication skills will be able to transition perfectly. If they have been to multiple providers you are the last resort. Being on case fee for 5 months now, I’ve seen an uptick in patients that are at their wits end with other treatments. So know you will be seeing more patients with more degeneration than adhesion. It’s a longer road but if you’re communication is up front and honest they’ll respect the hell out of your honesty. We also have a refund clause written in our contract to help combat the rare case that treatment isn’t what they need.

        To answer the 2nd question doing the consult and exam will help you determine how much you will be able to help. And this goes back to the first question a bit. Be honest with them and let them know if things don’t turn around after x number of visits it’s time to refer out. Again, the refund clause will go into effect there as well. At the end of the day we want what’s best for our patient’s. Most of the time its our treatment and load management but other times they need to be referred out.

        The last one is a tough one, especially if they can’t take time off or manage their work load properly. Most patients that need load managed at work require a doctor’s note of what to avoid at work. I’ve found this works best and there’s been no push back from their superiors.

        I hope this helps and will be interested in hearing other thoughts!


        Christopher Stepien

          Very helpful Seth.

          My biggest problem is probably how to fully diagnose someone so I understand what I can/can’t help. I’m pretty comfortable with palpation at this point.

          TY so much.

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