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I knew this day was coming in 2009, and its here

Exit forum ID Forum Discussion I knew this day was coming in 2009, and its here

This topic contains 5 replies, has 2 voices, and was last updated by   Christopher Stepien November 15, 2018 at 7:17 am.

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    Matthew Ellerbrock

      “The human ego prefers anything, just about anything, to falling or changing or dying.  The ego is that part of you that loves the status quo, even when its not working.  It attaches to the past and present, and fears the future.”

      In 2009 I had a great year, reaching a few milestones that I had set out and was feeling pretty good about myself and my practice.  There was that sinking realization that I was really hitting the same group of people with really good insurance pretty hard with big rehab plans and many many visits.  Practice wasn’t a lot of fun, but it was profitable.

      I knew that a new contract at one of our major employers could ‘nuke’ my office if a high deductible plan would come in.  Luckily I came across an ID youtube video (the load capacity one) and it solved a few problems.

      1.  I was on my path to providing value, not just services that patients enjoyed as long as they were free.

      2.  I was engaged (finally) in something that made sense and I could sell without feeling like a jerk.  Every other technique would have me scratching my head (I mean seriously Clarence Gonstead, in all due respect, our line of drive is through the disc plane?, how about those facet joints, where do they go?)

      3.  Practice has now become so much fun.  Its really cool to work through a case and see how it plays out, the skill set of 5 years of coaching calls and a bunch of seminars has given me a skill set to set up shop and kick butt with swagger.  (and humility of course, as the road is long and bumpy)

      That day has finally come.  Ohio has basically two insurance companies that control 80% of the market in the state.  MMO and Anthem.  I was currently in a PHO that collectively bargained decent reimbursements for the doctors.  I was paid 94% of my cash fee from Anthem, and 112% from MMO.  Anthem was 47% of my patient base, MMO another 23%.   I didnt advertise or market externally and kept my practice full.

      It has been on my radar, and Bill has always said that when I look back on it I will have wished I had done it sooner.

      Anyhow, Mercy health in its infinite corporate evil, bought our major hospital chain and abolished our little group of doctors who banded together to fight for a living wage.  So this morning they had all payers come to town and let us know what happens after this current contract expires.  Spoiler alert!  Its not a happy ending for the little guys, or the people who fork over $2000 per month for coverage.

      I spent about 2.5-3 minutes with the Anthem rep who was super cool.  She said with no hesitation that services by PT and chiros will be cut minimum 20% across the board.  Most likely 30% and will continue to drop every year for the next three years.  I liked how matter of fact she was and that the cut was HUGE!   I went in hoping that the decision would be made for me.

      MMO didnt bother to show up, but I rent space to an OT and when she credentialed with MMO I laughed at the $18 for ther ex, and $21 for CMT, $18 for man therapy on the fee schedule.  I cannot imagine they will have a better offer for me.

      So as of 3/31/19 I will be a cash practice (when the PHO expires).  I have already dropped all the little ones.  Good quality patients stayed and write checks.  Flaky ones hit the road. I am about 30% cash right now, and over 60% of my income comes directly from patients due to high deductible plans anyhow.

      Any words of wisdom on this flip would be great.  I do not fear this day and actually welcome the whole process.  But I do want to make the transition as smooth as it can be on everyone.

      A bunch of chiros in Ohio are currently shitting their pants, well sorta.  Some just figured they would accept the new contract and just figure on doing more things per visit and seeing them more often since its cheaper they would want to come more… or some other attempt to not come to terms with the fact if you do not provide real value no one will actually pay you real money.

      I look forward to the head space that will be freed up in me and my staff by not coding/documenting or calling for benefits.


      William Brady, DC

        This is great news. Thanks for posting. Everyone that takes insurance already has this ‘problem’ too… and it will only worsen.

        I say it’s great news because the mediocre practice will perish. The world needs great doctors that can diagnose, treat and communicate. The declining reimbursement forces docs on the fence to make the move toward quality. Yes, it can be scary. But weren’t you scared when the training wheels came off your bike? Then you cruised around the neighborhood like a champ.

        As for advice on the transition. Be transparent, explain the pay cut and ask would you go to work tomorrow for 20-30% less? Explain that you care about their health and the insurance company cares about minimizing expenses.

        For more detail re-watch many of the webinars and implement the advice.

        Above all don’t worry. People pay for things they need. Yesterday, I had a wood stove installer quote me $2800 to install a chimney liner and stove. On labor alone he is making $500 per hour. Tell me how your care isn’t worth $3000 per case?

        Finally, I am glad healthcare insurance is crumbling because it helps make the patient think someone else is responsible for their health. I much prefer the patient thinking “My health, my choices, my money.”


        Seth Schultz, DC

          I still remember my 1st seminar back in 2015 when Bill said health insurance was crumbling. As a recent grad who had never really experienced the shittiness of insurance companies, I thought to myself “no way, how could it? How would people be able to go to the doctor if that happens?” I guess I couldn’t fathom a massive failure like that.

          Fast forward 3.5 years and it’s been crumbling every year I’ve been in practice. And I look back thinking “why the hell did I ever question that statement Bill made?”. He saw it coming from a mile away when no one else was even looking. Then he gave us the tools to be completely independent of insurance companies. How cool is that?! I’m thankful every day that I found ID and couldn’t be happier with what our future looks like.

          So I guess to sum it up, congratulations Matt! Welcome to the next step of practice.


          Christopher Stepien

            This is great Matt.

            There’s a famous quote by someone:

            “Necessity makes us do shit we knew we had to do years ago.” Or something like that.

            Last winter, my practice was seeing 30 patients/week at $65/visit due to a winter depression, my gym closing, and two office moves in 3 months.

            I had $30k in gym debt and a baby born in May – I thought, “Shit. I guess now, I have to do those things I’ve been avoiding the past few years.”

            In 9 months, I raised our rates twice, to $75/visit, then $85/visit, and finally to case fee.

            There’s nothing like being forced to do the things we know we have to do based on life circumstances. Now, I try to make artificial constraints around me when things are “comfy” so I reach my goals.

            Hope this is helpful.


            Anthony Moreno

              Thanks to all of you for your posts and responses. I’m continuously inspired by all of your stories and goals.

              Thanks again.


              Christopher Stepien

                Will we see you at a seminar soon Anthony?

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