Create a Rewarding Cash-Based Practice

For the past decade, a good deal of my efforts, both locally and nationally, have been focused on expanding the availability of appropriate insurance coverage for acupuncture services. I am blessed with a busy private practice; however, I now find that I have less interest in, and less patience for, accepting insurance.

With insurance clients, reimbursement often is well below your customary charges; there is excessive paperwork; pre-authorization is required; you may not learn in a timely manner when benefits are exhausted; payment may take as long as three months; and patients are not empowered to participate actively in the healing process. Although there is increasing coverage for acupuncture, often our scope of practice is limited, or the type of patient or condition that would be most interesting and fulfilling to treat is not eligible. In fact, insurance does not pay for wellness or prevention. Nor does it pay for stress management, "energy" balancing or seasonal support. Cash practices are easier to run and manage and, because of the personal investment they make, cash patients are often more motivated to participate in the healing process and get well.

If you are a new practitioner or are still building your practice, consider participating in managed care plans and signing up for as many preferred provider listings as possible. In this way, you maximize exposure of your professional services to the community. If you help one employee at a company, there is a strong likelihood that the employee's coworkers may consider seeking your services as well. Often, people will only seek acupuncture initially if they incur little or no out-of-pocket expense. However, after helping one patient and educating them about the many benefits and applications of acupuncture and Oriental medicine (AOM), you will find that before long you are helping their spouse, parent, child, friend or relative. In other words, visibility and exposure are critical as you build and expand your practice.

Leyland Kaiser gave an inspirational lecture several years ago. He was addressing a group of medical doctors who were interested in integrative medicine, and said that what people sought was "an experience of healing." They want to be listened to; they want to be heard; and they especially want to feel better when they leave. Patients visiting medical doctors often feel rushed, depersonalized, and no better when they leave. In contrast, at your office they have an opportunity to feel heard, considered, touched and transformed. Because the reimbursement is low and the paperwork demanding, the more insurance you accept, the less time you will find to spend with each patient listening, touching and healing.

The key to building a successful cash-based practice is to educate, educate, educate. Share your personal story of how you have been helped by acupuncture, and what inspired you to study and practice. One of the first questions you might ask your patients is, "How much time and energy do you spend each day, week and month on maintaining and supporting your health and wellness?" You will find that the responses you receive vary greatly. Those who spend a great deal of time on their health are generally easier to educate and are more receptive to the many benefits and applications of AOM. Those who spend little or no time caring for their health will most likely need increased attention and guidance. I often describe myself as a cheerleader (sorry, no pictures) and guide. I "cheer" for my patients to participate in positive life changes, and I do my best to guide them through the process by increasing their understanding of their body, health and health care choices. Each of us can improve our health through awareness and education.

Be sure to recommend the care you feel your patients need, not necessarily what their insurance will pay for or cover. You will find that patients with insurance coverage will return as cash clients for non-covered services if you have educated them on the benefits of AOM.

Do you receive a monthly acupuncture treatment for support/balancing? If not, can you ask your clients to do so? I have a very good dentist who has no lack of cash patients. I was impressed by how much time he spent with me one-on-one during my first visit, inquiring what my goals were and explaining how he could support them. Most Americans visit their dentist regularly, and believe their dentist is helping them to maintain their dental health and prevent future problems. Isn't AOM similar in that it offers significant benefits when received at regular intervals? Most cash patients will be interested in preventative and maintenance care. Take time to explain the similarities and differences between conventional and traditional medicine. Many patients have never learned that AOM can accurately describe their "disease"/condition and its etiology, in traditional terminology, even in those instances when conventional medicine has been unable to do so. Explain how this allows for an individualized treatment approach for every presentation.

It is also important to ask for referrals and promote your practice as referral-based. Let your patients know that if they are happy with the care they've received, it would be a great compliment to you if they would share their positive experience with friends and family so they might benefit as well. Invite patients to bring family members or close friends who are curious or concerned about treatment to observe and have their questions answered, thus helping them to better understand the health issue and your treatment. This will provide you with another opportunity to educate and share your experience and expertise.

When a new patient phones for an appointment, ask which of your patients referred them to you. If they weren't referred to your office, assure them that it's all right, but explain that most of your new patients are referred to you by patients who have already been helped. In this way, you are reinforcing your cash-based practice while educating potential new clients right from the start. Be sure to track who refers patients to you, and send those people letters of thanks. You also might want to place a note in each referring patient's file so that you'll remember to thank them the next time they come in. Many practitioners go so far as to display a bulletin board in the reception area with the names of patients who have referred clients to the office, along with some words of thanks.

Advise your patients of your willingness to support their health through professional collaboration. You will inspire confidence and loyalty in your patients through your ability and receptivity to communicating with their medical doctor, to interact with other health professionals and be a part of their collaborative team of experts/practitioners.

Remember, your health and healing is your responsibility, and your investment will reflect your return. The key is to "relax, breathe, pay attention, and enjoy." Remind your patients of this, and have fun building your cash practice.