Personal Injury Collections by State: 2011 vs. 2013 vs. 2015 vs. 2017 Comparison of Collections vs. Cost of Living Analysis
FEATURE
Mark Studin
DC, FASBE(C), DAAPM, DAAMLP
In 2011, 2013, and 2015 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 is no reason other than the insurance companies and state politicians that you have elected into office allow it to be. We are a country of laws and regulations and it is these laws that 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 and they are driven by politics at their ugliest.
The collections listed in the following table depict what chiropractors are collecting as of December 2017, on a per visit basis for a typical treatment versus what they collected in 2011, 2013, and 2015 and 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 and is limited to only services performed by the chiropractor in a private clinical setting.
These numbers of reporting doctors do not reflect a large enough sample size to reflect statistically accurate averages; however, based on the sampling and conversations with doctors in all 50 states, the numbers are close. These dollar amounts accurately reflect the amounts that are currently being collected on a visit basis in all 50 states, as I personally gathered the information.
As I established in my articles in 2011, 2013, and 2015, 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 to rent an office and ran a business, the more a doctor should be entitled to charge and collect. Unfortunately, politics determine your fees on a state-by-state basis, and the stronger the insurance lobby, the lower the reimbursable fees. As was reported, and as is consistent today, New York and Hawaii are two of the most expensive states to live in, yet they have the lowest rates of reimbursement nationally. New York’s ranking of 48th in regard to cost of living, undoubtedly a result of its vast rural areas, 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, yet the maximum reimbursement a chiropractor can receive is approximately $42.00 per visit no matter what services the doctor provides. In addition, the carriers, as a matter of business in New York, orders a DME (defense medical examination, as I have issues calling this independent in today’s marketplace) after a few visits to limit the amount of care that further prevents the doctor's ability to receive fair and equitable reimbursements.
In states like New York and Hawaii, the carriers and politicians are pushing the people of their respective states to opiates and unnecessary surgeries because there are less alternatives in the restrictive environments as many doctors of chiropractic are emigrating out of New York and our new graduates are avoiding those states out of fiscal concern. When consulting with new graduates, or in our chiropractic colleges, I advise students that New York is the worst state to consider practicing in because of the restrictive reimbursement fees as verified in the table.
A 50-state reimbursement comparison between 2015 and 2017 revealed an 11% increase in collections; between 2011 and 2017, a 30% increase was reported for a personal injury visit. This statistic revealed a trend in the chiropractic profession that verifies the personal injury population of patients is a financially stable sect within the industry. In addition, when managed care and other
financial classes in the profession are shrinking in reimbursement, personal injury is the one sector consistently growing. Please note that this author is not suggesting that a doctor maximize his/her charges inappropriately and that only clinically indicated services should be performed based on clinical necessity.
Many doctors will read this report and feel the need to increase those portions of their practices with personal injury patients. From a reimbursement perspective and business plan that would appear to make sense. However, do these doctors have the necessary qualifications? Treating trauma cases requires a very specific skill set and training no different than in any other specialty in healthcare. You wouldn’t want a psychiatrist performing open heart surgery without the requisite training or an OB/GYN doing brain surgery. At the very least, a doctor of chiropractic should have basic training in MRI interpretation, triaging the injured, and spinal biomechanical engineering. Understanding the difference between a herniated, bulged, migrated, or sequestered disc 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 and/or surgery might be indicated. The etiology of pain in a trauma case is often dramatically different than in a geriatric or pediatric patient.
In addition, the 2017-2018 “get rich quick scheme” in personal injury in our profession has been deemed a “false bill of goods” that a “magic report” meeting the algorithmic requirements of the carriers to bolster settlements for lawyers is all lawyers need to refer to en masse. As verified by over 10,000 lawyers and hundreds of doctors nationally in the past year who have tried that have confirmed that it is a wonderful marketing fad that hasn’t delivered to many and the primary beneficiaries are those who have created those schemes. CAVEAT EMPTOR! There is no substitute for credentials, knowledge, and a plan to get your referral sources to run after you as a result. That is the solution for chiropractic practices in 2018 and beyond, and which has been confirmed in extensive market research.
Too many doctors of chiropractic bypass the diagnosis and prognosis stage and delve directly into treatment. The warning here is that sometimes this step is taken to the detriment of 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 that must be answered is, “What is causing that problem?” AND ... if you do not know, do not guess. 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, NON-NEGOTIABLE
“Studin Rule” rule is: IF YOU DO NOW 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 on research that has been published in many forums, chiropractic outcomes have outpaced 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 (post-doctoral 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, and wise legislators should take into account doctors’ reimbursements, or will soon realize there is a doctor shortage in their respective states. Many state legislators are not “penny wise and dollar foolish,” unlike those elected officials in New York and Hawaii. Therefore, for those states that are below the national average, the chiropractic political organizations should strengthen their lobbying efforts with a unified (one) chiropractic voice (organization) and that should happen not only at the state but the national level.
Living Living pervisit pervisit pervisit pervisit Ranked Lowest pervisit pervisit pervisit pervisit Ranked Survey in 2011 Survey in 2013 Survey in 2015 Survey in 2017 to Highest Survey in 2011 Survey in 2013 Survey in 2015 Survey in 2017 to Highest Alabama $80.00 $80.00 $90.00 $200.00 8 New Hampshire $118.00 $129.00 $120.00 $160.00 38 Alaska $175.00 $225.00 $225.00 $349.00 47 New Jersey $136.00 $105.00 $105.00 $105.00 41 Arizona $110.00 $100.00 $135.00 $200.00 23 New Mexico $171.00 $250.00 $160.00 $170.00 14 Arkansas $115.00 $109.00 $120.00 $110.00 2 New York $40.00 $43.00 $42.00 $42.00 48 California $113.00 $140.00 $155.00 $225.00 49 North Carolina $125.00 $120.00 $160.00 $115.00 18 Colorado $75.00 $150.00 $185.00 $250.00 35 North Dakota $145.00 $145.00 $145.00 $145.00 30 Connecticut $100.00 $100.00 $180.00 $200.00 50 Ohio $140.00 $120.00 $100.00 $300.00 12 Delaware $200.00 $200.00 $200.00 $200.00 34 Oklahoma $167.00 $125.00 $253.00 $120.00 5 Florida $250.00 $250.00 $325.00 $300.00 28 Oregon $175.00 $120.00 $150.00 $190.00 44 Georgia $225.00 $140.00 $202.00 $220.00 10 Pennsylvania $155.97 $115.00 $140.00 $150.00 32 Hawaii $75.00 $75.00 $75.00 $75.00 51 Rhode Island $140.00 $130.00 $130.00 $130.00 42 Idaho $160.00 $135.00 $120.00 $100.00 16 South Carolinav $145.00 $165.00 $200.00 $120.00 15 Illinois $230.00 $150.00 $220.00 $250.00 24 South Dakota $100.00 $198.00 $125.00 $200.00 27 Indiana $65.00 $90.00 $125.00 $225.00 15 Tennessee $245.00 $220.00 $155.00 $125.00 7 Iowa $100.00 $100.00 $140.00 $140.00 6 Texas $125.00 $150.00 $225.00 $150.00 11 Kansas $80.00 $150.00 $170.00 $120.00 9 Utah $130.00 $155.00 $170.00 $178.00 25 Kentucky $180.00 $230.00 $185.00 $250.00 17 Vermont $100.00 $140.00 $160.00 $160.00 39 Louisiana $113.00 $90.00 $125.00 $120.00 19 Virginia $120.00 $110.00 $200.00 $250.00 33 Maine $70.00 $160.00 $130.00 $135.00 38 Washington $120.00 $140.00 $225.00 $250.00 37 Maryland $173.00 $150.00 $200.00 $225.00 46 West Virginia $110.00 $135.00 $185.00 $150.00 26 Massachusetts $130.00 $170.00 $250.00 $250.00 45 Wisconsin $117.00 $130.00 $129.00 $185.00 21 Michigan $100.00 $135.00 $250.00 $300.00 3 Wyoming $90.00 $90.00 $115.00 $120.00 20 Minnesota $160.00 $206.00 $200.00 $307.00 29 District of Columbia 50 Mississippi $209.00 $200.00 $210.00 $150.00 1 Missouri $100.00 $190.00 $200.00 $375.00 4 50 State Total $6,532.97 $7,186.00 $8,286.00 $9,320.00 Montana $75.00 $108.00 $195.00 $199.00 31 Nebraska $75.00 $138.00 $150.00 $180.00 13 Average per state $130.66 $143.72 $165.72 $182.75 Nevada $80.00 $180.00 $130.00 $150.00 36
References:
1. Studin, M. (2011, February) Personal Injury Collections by State: 2011 Comparison of Collections vs. Cost of Living Analysis, The American Chiropractor, 33(2) 52-53
2. Studin, M. (2013, July) Personal Injury Collections by State: 2011 vs. 2013 Comparison of Collections vs. Cost of Living Analysis, The American Chiropractor, 35 (7) 32-35
3. Studin M. (2015) Personal Injury Collections by State: 2011 vs. 2013 vs. 2015 Comparison of Collections versus Cost of Living Analysis,
The American Chiropractor, 37(6) 40, 42—43
4. Cost of Living Data Series 2017 Third Quarter 2017 (2017), Retrievedfrom: https://www.missourieconomy.org/indicators/cost_of_living/
jf Dr. Mark Studin is an adjunct associate professor of chiropractic at the University of Bridgeport College of Chiropractic; an adjunct professor of clinical sciences at Texas Chiropractic College; 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, spinal biomechanical engineering, and triaging trauma cases. He also coordinates a clinical rotation in neuroradiology for chiropractic students at the State University of New York at Stony Brook, School of Medicine, Department of Radiology. Dr. Studin is also the president of the Academy of Chiropractic, teaching doctors of chiropractic how to interface with the medical and legal communities (www.DoctorsPIProgram.com). He 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 DrMai'kaA cade my ofChiropractic.com or at 631-786-4253.
