Personal Injury Collections by State: 2011 versus 2013 versus 2015
FEATURE
Comparison of Collections versus Cost of Living Analysis
Mark Studin
In February of 2011 and July of 2013, I wrote in The American Chiropractor Magazine, “Why is a life in Tennessee, South Dakota, and Texas worth more than a life in Hawaii and New York?” There really is no reason other than the insurance companies and state politicians elected into office allow it to be so. We are a country of laws and regulations, which dictate the marketplace and how doctors are reimbursed for their services. In most states, it is based upon the usual and customary fees of the doctors and the carriers paying a percentage of those fees. However, in New York, the state sets the doctors’ fees, which are driven by politics at their ugliest.
The collections listed in the following table depict what chiropractors are collecting as of May 2015, on a per-visit basis for a typical treatment versus what they collected in February 2011 and May 2013. They are rated against the cost of living for each state in comparison to other states. The dollar amounts exclude examinations, X-rays, supports, and any other ancillary services or testing.
These numbers of reporting doctors do not reflect a large enough sample size to reflect statistically accurate averages. However, based upon the sampling and conversations with doctors in all 50 states, the numbers are close. These dollar amounts do reflect accurate amounts that are currently being be collected on a per-visit basis in all 50 states nationally.
As I established in 2011 and 2013 in my previous articles, cost of living is not an indicator for reimbursement in personal injury, as one would logically conclude. In a fair and equitable system, the more it costs someone to rent an office and run a business, the more someone should be entitled to charge and collect. Unfortunately, politics determine your fees on a state-
■ " Unfortunately, politics determine your fees on a state-by-state basis, and the stronger the insurance lobby, then the lower the reimbursable fees. As was reported in 2011 and 2013, and as is consistent today. J Ï
by-state basis, and the stronger the insurance lobby, then the lower the reimbursable fees. As was reported in 2011 and 2013, and as is consistent today, New York and Hawaii are two of the most expensive states in which to reside, yet have the lowest levels of reimbursement nationally. New York is ranked 48 in regards to cost of living, undoubtedly a result of its vast rural areas, which pushes it out of the worst ranking. However, a 400-square-foot office in downtown New York City can cost $7,000 per month to rent while the maximum reimbursement a chiropractor can receive is approximately $40 per visit, no matter what services the doctor provides. In addition, if the carrier sends for an IME after a few visits in order to limit the amount of care, a further reduction in the doctor’s ability to receive fair and equitable reimbursement may occur.
The reimbursement comparison between 2011 and 2013 revealed a 9% increase in collections, and between 2013 and 2015 revealed a 13% on average when you combine all of the states for a personal injury visit. This statistic revealed a trend
in the chiropractic profession, which verifies that the personal injury population of patients is a financially stable sect within the industry. (Please note that this author is not suggesting that a doctor maximize his or her charges inappropriately, and that only clinically indicated services should be performed based upon clinical necessity.)
Many doctors will read this report and feel that they must increase those portions of their practices with personal injury patients. From a reimbursement perspective and business plan, that would appeal' to make sense. However, is that doctor qualified? Treating trauma cases requires a very specific skill set and training, just like any medical specialty. You wouldn’t want a psychiatrist performing open-heart surgery without the requisite training. At the very least, a doctor of chiropractic should have basic training in MRI interpretation, triaging the injured, and possibly biomechanical engineering. Understanding the difference between a herniated, bulged, migrated, or sequestered disk is critical in creating an accurate diagnosis, prognosis, and treatment plan in triaging and guiding the patient through care. Although the delivery of chiropractic may not change, when you can and cannot treat your patient might change because collaborative care with a medical specialist or surgeon might be indicated. The etiology of pain in the trauma case is often dramatically different from the chronic pain of a geriatric or pediatric patient.
Too many doctors of chiropractic bypass the diagnosis and prognosis stage and delve directly into treatment. The caveat is that sometimes this step is taken at the detriment to the patient. If the patient has pain radiating down his or her arms or legs with or without associated motor weakness before you touch that patient, the first question to consider is: What is causing that problem? If you do not know the answer, do not guess, and beyond your clinical examination, consider advanced imaging if clinically warranted without shying away from the carriers’ often “fictitious” rules of approving the advanced images. Once again, the hard, nonnegotiable “Studin rule” is: If you do not know, do not guess.
The only way to spiral upward in success is through clinical excellence through the acquisition of knowledge and skill sets. Based upon research that has been published in many forums, chiropractic outcomes have outpaced most other forms of treatment for conditions within our scope to treat. As a profession, the most direct avenue for these published studies to help increase utilization is for each doctor to be expert and credentialed in the area of desired practice. Treating personal injury patients is included in this formula and mandates graduate-level training (postdoctoral education), so choose your courses wisely as a stepping-stone to what you want your practice to be tomorrow.
In personal injury or any financial category, fair and equitable reimbursements will determine if a doctor can afford to live in any community nationally. Wise legislators will take into account the reimbursement statistics so they won’t be “penny wise and dollar foolish,” unlike those elected officials in New York and Hawaii. The solutions are a strong political lobby with a unified (one) chiropractic voice, both nationally and statewide.
References:
1. Studin, M. (2013, July). Personal Injury Collections by State: 2011 vs. 2013 Com parison of Collections vs Cost of Living Analysis. The American Chiropractor, 35(7), 32-35. 2. Studin, M. (2011, February). Personal Inju ry Collections by State: 2011 Comparison of Collections vs Cost of Living Analysis. The American Chiropractor, 33(2), 52-53. 3. Missouri Economic Research and Informa tion Center. (2014). Cost of Living Data Series: 2014 Annual Average. Retrieved from http://www.missourieconomy.org/ indicators/cost_of_living!
Collection per Collection per Collection per 2015 Cost State of Living: Survey in Survey in 2011 2013 Survey in Ranked 2015 Lowest to Highest Alabama $ 80.00 $ 80.00 $ 90.00 10 Alaska $ 175.00 $ 225.00 $ 225.00 47 Arizona $ 110.00 $ 100.00 $ 135.00 28 Arkansas $ 115.00 $ 109.00 $ 120.00 12 California $ 113.00 $ 140.00 $ 155.00 46 Colorado $ 75.00 $ 150.00 $ 185.00 31 Connecticut $ 100.00 $ 100.00 $ 180.00 50 Delaware $ 200.00 $ 200.00 $ 200.00 37 Florida $ 250.00 $ 250.00 $ 325.00 27 Georgia $ 225.00 $ 140.00 $ 202.00 16 Hawaii $ 75.00 $ 75.00 $ 75.00 51 $ 160.00 $ 135.00 $ 120.00 Illinois $ 230.00 $ 150.00 $ 220.00 22 Indiana $ 65.00 $ 90.00 $ 125.00 $ 100.00 $ 100.00 $ 140.00 14 Kansas $ 80.00 $ 150.00 $ 170.00 Kentucky $ 180.00 $ 230.00 $ 185.00 Louisiana $ 113.00 $ 90.00 $ 125.00 20 Maine $ 70.00 $ 160.00 $ 130.00 38 Maryland $ 173.00 $ 150.00 $ 200.00 40 Massachusetts $ 130.00 $ 170.00 $ 250.00 43 Michigan $ 100.00 $ 135.00 $ 250.00 Minnesota $ 160.00 $ 206.00 $ 200.00 32 Mississippi $ 209.00 $ 200.00 $ 210.00 Missouri $ 100.00 $ 190.00 $ 200.00 17 Montana $ 75.00 $ 108.00 $ 195.00 30 Nebraska $ 75.00 $ 138.00 $ 150.00 Nevada $ 80.00 $ 180.00 $ 130.00 33 New Hampshire $ 118.00 $ 129.00 $ 120.00 39 New Jersey $ 136.00 $ 105.00 $ 105.00 45 New Mexico $ 171.00 $ 250.00 $ 160.00 13 New York $ 40.00 $ 43.00 $ 42.00 48 North Carolina $ 125.00 $ 120.00 $ 160.00 23 North Dakota $ 145.00 $ 145.00 $ 145.00 29 Ohio $ 140.00 $ 120.00 $ 100.00 19 Oklahoma $ 167.00 $ 125.00 $ 253.00 Oregon $ 175.00 $ 120.00 $ 150.00 44 Pennsylvania $ 155.97 $ 115.00 $ 140.00 34 Rhode Island $ 140.00 $ 130.00 $ 130.00 42 South Carolina $ 145.00 $ 165.00 $ 200.00 15 South Dakota $ 100.00 $ 198.00 $ 125.00 35 Tennessee $ 245.00 $ 220.00 $ 155.00 $ 125.00 $ 150.00 $ 225.00 15 Utah $ 130.00 $ 155.00 $ 170.00 Vermont $ 100.00 $ 140.00 $ 160.00 41 Virginia $ 120.00 $ 110.00 $ 200.00 25 Washington $ 120.00 $ 140.00 $ 225.00 36 West Virginia $ 110.00 $ 135.00 $ 185.00 24 Wisconsin $ 117.00 $ 130.00 $ 129.00 26 Wyoming $ 90.00 $ 90.00 $ 115.00 District of Columbia 49 50 State Total : 6,532.97 7,186.00 8,286.00 Average per state 130.66 143.72 165.72
Dr. Mark Studin is an adjunct associate professor of chiropractic at the University Of Bridgeport College Of Chiropractic and a clinical presenter for the State of New York at Buffalo, School of Medicine and Biomedical Sciences for postdoctoral education, teaching MRI spine interpretation and triaging trauma cases. He is also the president of the Academy of Chiropractic teaching doctors of chiropractic how to interface with the legal community (www.DoctorsPIProgram.com), teaches MRI interpretation and triaging trauma cases to doctors of all disciplines nationally, and studies trends in health care on a national scale (www.TeachDoctors.com). He can be reached at [email protected] or at 631-786-4253.
