Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 90

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"National Pressure for Healthcare Reform"

In today’s newspaper, the Associated Press reported a coalition between insurance companies, drug makers, hospitals and doctors to contain and control healthcare costs by lowering the premiums so that the 50 million uninsured Americans can get insurance. Healthcare industry leaders pledged a 2 trillion dollar voluntary reduction in spending over 10 years to pay for the program and will report today to the government. Although this doesn’t resolve the healthcare problem, it gives enough room to insure many of those that are currently uninsured and will allow those special interest groups to maintain their influence over Congress in writing the legislative bill.

Last week, it was reported that insurance companies complained that if the government took over insuring many of the uninsured woman and children, they would go out of business. The carriers would not comment on why.

The reasons are quite transparent; when you control the marketplace, you control the profit. If the government steps in, then the insurance industry loses control and loses their profit margins.

Some facts: “Big health insurance company profits mean big pay for health insurance company executives—some$14.2 milliona year for the top seven CEOs,” reported by Mike Hall of the AFL-CIO on March 10, 2009. He goes on to report that, “Ethan Rome, deputy campaign manager for Health Care for America Now found that during the past five years, health insurance company profits have soared by 1,000 percent while health care premiums for working families have risen five times faster than wages. They raise our premiums, they raise our deductibles, they raise our co-pays each and every year and now they’re conducting a fake campaign for reform.”

If you would like the full text of his article and the links to the organization, go to their blog:

If I was writing an exposé on insurance companies, it would be easy to find 100’s of resources within 2 minutes of researching the Internet, but this is about you. If you think that the insurance companies are doing this out of social conscience, then I want you to get ready for Santa Claus and the Easter Bunny. You stand a better chance of those coming!

This is about profit, power, greed and damage control. The insurance companies are in business and their business is not safeguarding Americans against cancer, heart disease and subluxation. They are in business to take your money and pay out as little as possible based not upon what your contract says they should pay, but by paying for as few services as they can and KEEPING the rest. Henceforth, windfall profits at our expense.

An example would be Hurricane Katrina, in 2006, and numerous other hurricanes which supposedly cost the carriers billions; they posted a conglomerate profit of $44.8 billion according to the “Los Angeles Times,” with their top executives reporting an 18.7% profit in the worst of times. During that year, their surplus was $427 billion.

The question now begs itself, “Where are the insurers going to get the difference if they agree to lower premiums?” Part of the answer is so clear; I have been shouting it at you for over a year. They are going to get it from you! Blue Cross/Blue Shield just took the physician status away from chiropractors. Why? Not because they are prejudicial, but because they pay certain claims exclusively to physicians and now do not have to pay you. This is only part of the puzzle.

Retrospective reviews are a billion dollar a year industry and now the big picture is unfolding to the general population for those smart enough to see it. If you are not, I am about to rub your nose in it…to protect you, your practice and your family. Due to your having such inconsistent documentation and poor notes, many of you are easy targets. First, if you still use travel cards…I want you to take out red, yellow and blue paint and paint a bull’s eye on your forehead. This way when, not if, they come, you will make it easier for all involved….and you will deserve it because you have been forewarned over and over.

For those of you who have full charts, good for you. That is the first major step towards bullet proofing your practice regarding retrospective reviews. The next step is what’s in those charts. Everything needs to be clinically correlated as to ICD, CPT, evaluation, orders, treatment plans, re-evaluations, your care, etc.

The last step is to get a VOLUNTARY AUDIT. If you haven’t listened to the interview on the audio section of the Web site with Mr. Peter Birzon, you must. It will open your eyes as to what needs to be done. Not now, but months ago and certainly not months from now. If you haven’t had a voluntary audit from Dr. Michael Schonfeld, 516-695-7732, to ensure your records are in order, the time is, once again, right now. His $500 fee is the best money you could ever spend. Ask those who have; there has not been 1 complaint. The reason I am haranguing you on this issue is that I get too many phone calls, weekly, on the new retrospective audits and reading this in the newspaper underscores my resolve to protect those smart enough to listen. The insurance companies are not willing to give up their unprecedented profits; they are just looking for new sources and you are them.

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