ChiroHealthUSA is a Network of Over 718,787 Chiropractic Patients, and Counting!
INTERVIEW
Interview with Dr. Ray Foxworth
TAC
Dr. Foxworth’s mother and stepfather are both DCs. They are 86 and 87 now. His mom was first, having gone to chiropractic college after working for a DC for five years. She was 26 and a single mom at the time. She worked days as a vet tech, and he would often have to go to chiropractic school with her in the evenings. So, technically, he was in chiropractic college in 1966 at the age of 10. Ray didn’t graduate until 1985, though, from Cleveland Chiropractic College.
Here is a look back at the original interview with ChiroHealthUSA’s Dr. Ray Foxworth from the October 2014 issue of The American Chiropractor (TAC). Some of the stats have been updated. Dr. Foxworth has tripled the size of the ChiroHealthUSA network and doubled his practice in just 5 years. He shares his thoughts on the past, present, and future, of chiropractic.
TAC: How long have you been in private practice?
RF: Thirty-four years. I started out as a solo doctor in 1985 and practiced alone until 1990. Then, my dad joined me in practice for about 10 years. After that, I had two associates for a couple of years, then back to solo practice. Ten years ago, Dr. Andrew Cefalu joined me in practice, and five years ago, Dr. Neely Berry and Dr. Victoria Shearer joined the team. Last year, we opened our second clinic location with two massage therapists and a nurse practitioner.
TAC: What type of practice do you have?
RF: My practice has always been neuromusculoskeletal-focused, but like most others, we’ve seen many other types of cases along the way. My goal in 1985 was to see my profession become more accepted, having witnessed what my folks went through. I wrote goals in 1985, among them that I wanted to be part of a multidisciplinary practice, or practice in a hospital setting, and break down some of the barriers between the different healthcare professions. I have been blessed that, in just one generation, I have experienced all of that. I spent 12 years on the Mississippi State Board of Health, appointed by two governors, and served as chairman for two years. I was the first DC in the history of the state to serve on the board. I had the opportunity to start the chiropractic department at the G. V. Sonny Montgomery VA Medical Center and ran that part-time for four years before bringing on a full-time VA doc. Our practice is currently on the campus of a multidisciplinary spine center with 12 physicians, including six neurosurgeons, one orthopedic surgeon, three physical medicine and rehab docs, two pain management doctors, and a full PT department.
TAC: What are your goals for the chiropractic profession?
RF: I would love to see chiropractic fully integrated into the healthcare system and to no longer be considered an “alternative” approach. While we have certainly made some progress, there is still much to be done. I think that for too long, the public, and perhaps some in the profession, have thought of chiropractic as an “eitheror” option. Many believe that you can choose medical care, or you can choose an alternative such as chiropractic care. It makes more sense to me to choose whatever is most appropriate for the problem being treated and to always provide the most conservative, least invasive, least expensive, treatments first. Only when these options fail, should other forms of treatment be considered.
There is so much to be gained by your working alongside a colleague.
The truth is that chiropractic should most often be the first place to start, rather than the last place for a patient to end up. For that to happen, all healthcare professionals on the team must have a better understanding of what we do, why it works, and when it’s appropriate. That will only happen if we do a better job of educating other professions about chiropractic. Beyond that, we need to make sure that during their training, chiropractic is seen as an integral part of the healthcare team. That can only happen by continuing to pursue opportunities like those within the VA Medical Centers and other training institutions.
After starting the chiropractic program for our local VA Medical Center, I saw first-hand what happens when residents who are making rounds with their instructors in neurosurgery, or other specialists, actually consulted with the chiropractic service. After a while, it became “normal and routine” to request a chiropractic consult and it had a huge impact on the residents. We still see many referrals from MDs that I don’t personally know, but they were residents at the VA and are now in practice. For them, it is “normal” to refer to a DC because that is what they did DURING their training. It’s no secret that we only do what we learn, or are trained to do, and if we didn’t learn it in school, it is less likely to become part of our routine after we are in practice. That is why it is so critical to have other professions exposed to chiropractic during their training.
The entire healthcare system is built on this model, and for us to continue to operate outside of the model, is part of the reason we remain marginalized. For this to change, as a profession, we must make it a priority to see chiropractic fully integrated in all healthcare institutions, either as part of their training, or as a rotation, for residents. If we were to focus on that one thing, we could literally change the future of the profession and have our greatest impact on the healthcare system.
TAC: What is the most common problem you see among chiropractors today?
RF: It’s failing to get involved professionally, and personally, in things that matter and have an impact on the profession. Whether it is politics, association work, or taking steps to personally grow our centers of influence in our communities, we need to get off the sidelines. The profession has spent too many years talking to itself instead of talking to others. We are more comfortable with each other and tend to spend our energy focusing on what divides us instead of focusing on what binds us and how we can have a greater impact by working together. If the profession spent more collective time getting outside of its comfort zone, and making an effort to integrate with other disciplines, we would be seeing far more than the 10-15% of the population that is reported. The book, “The Tipping Point,” provides a great study in how any product or service can reach the point of wide acceptance by consumers and it would be a great model for chiropractic to follow in order to change the publics’ acceptance and utilization of the profession.
We must also stop doing things that drive patients away from us as a profession. It’s rarely our clinical care that drives them away. It’s more often our business practices and how we recommend care. For example, during a visit to a local physician, the nurse found out I was a chiropractor and she was really interested in getting in to see one of our doctors for her neck problem. The unfortunate part was that she had already seen a chiropractor who, on the “first date,” tried to get her to sign a year-long contract for care. While that may be exactly what she needed, the failure to realize that the rest of the world doesn’t know what we know, so they don’t do what we do, literally ran this lady out of the chiropractor’s office and may have run her out of the profession for good. Fortunately, I had the opportunity to try to explain why this chiropractor may have thought that was the best course of treatment for her based on her history.
Patients don’t understand the need to accept “lifetime care” on the first visits. This, combined with other poor business practices, has done more to harm the profession than help it. This is not to say that lifetime care is not appropriate, or not a laudable goal, but it is a timing issue for the patient. A better approach is the concept of meeting people where they are, and then taking them where you want them to go. Earn the patient’s trust by delivering the best chiropractic care you can, and then when they are a raving fan because of your results, you have earned the right to have the conversation about wellness and lifetime care...which is not typically on the first visit. We know what we think of surgeons who recommend surgery on the “first date,” and we should at least be aware of how our recommendations are perceived by those who don’t understand what we understand.
TAC: What is the biggest challenge you see in the chiropractic profession today?
RF: The biggest challenge I think we face is failure to adapt. Due to changes in the economy, reimbursements, and a host of other issues that affect us, we continue to operate as islands which not only affects our incomes, but our quality of life. Although we are seeing more practices with two or more docs on staff, our current model is still predominately made up of solo practices. While it is commonplace to see 10-20 OBGYNs or GI docs working together in a single center, you rarely find chiropractors working together in a group setting. As a result, we all have relatively high overhead because there is no cost-sharing of common services such as billing or radiology. We all engage in individual marketing against one another, instead of marketing to the public to increase awareness of what we do. With all of the rules, regulations, and compliance challenges, it is difficult to be a solo doc, meet all of those requirements, and still have time to treat patients. Couple this with the challenge of actually having some time off and practice can feel more like a ball and chain than a profession. I have practiced solo for a number of years, and now, with three other doctors on board, I can tell you that not one of us would ever want to go back to the solo model. There is so much to be gained by working alongside a colleague. There is the ability to sharpen your skills by learning from one another, the benefit of having an “in-house” consult for a fresh perspective or second opinion, all the way up to actually having a life and some time off without worrying about having to build the practice back from scratch when you get back. I can’t help but wonder if 5-10 DCs committed to work together in a community, how successful they could all be by pooling resources.
TAC: Can you think of one change that a c\ iropractor can do to sign Ficantly impact his/her practice’s growth immediately?
RF: Commit to regular staff meetings, with an agenda, where every key indicator of the practice is monitored. This includes stats such as new patients, office visits, re-acts, services, collections, as well as kept-appointment ratios, drop-outs, referrals in and out of the practice, and reports to other providers. What can be measured can be improved and we know what we inspect is respected. Having weekly meetings, and keeping a watch on these stats, is critical, but it’s also important to monitor the practice on a daily basis, with morning and evening huddles, just to see what went right, what went wrong, how to improve patient flow and satisfaction. The idea is to be preventive or pre-emptive. If you wait to look at your stats at the end of the month, there isn’t a darn thing you can do about a bad month. If you are looking at this daily, or weekly, the worst that can happen is you have a bad day, or week, and then you take small, corrective actions along the way to ensure you don’t end up with a bad month. I would also suggest getting a coach, or mentor, or both. Find someone who is doing better than you, or a coach guiding practices bigger than yours. Don’t rely on learning it all yourself. That is expensive tuition. Be willing to “play dumb” and don’t make the mistake of trying to figure it all out yourself.
TAC: Do you have any recommended marketing strategies that chiropractors can do to attract new patients? And to keep current patients?
RF: The practice we have has been built by focusing on one simple principle. If after reviewing a patient’s case, we feel we can help, we’ll tell them. And if we can’t, we’ll let them know that, too, and refer them to someone who can. While that seems simple, it is the most effective thing we can do to build the practice. It builds trust and credibility. We also make a point to capture the name of the patient’s family doctor, or other specialist, and in almost every case, we provide an initial report to those doctors, as well as 2-week and 1-month follow-up reports, along with outcome measurements, to keep them informed of their patient’s progress. We follow this same pattern with PI and Workers Comp cases with the goal being to communicate consistently. The repetitive reporting promotes “top of mind” awareness of the many doctors we work with. In my mind, there are only three types of MDs; those that work with us, those that don’t work with us yet, and those that will never work with us. My goal is to focus on the first two groups and grow those relationships.
The next most important thing is to make sure we don’t run off the patients we DO see by making care affordable and offering reasonable treatment recommendations. To keep patients in the practice, we make it easy for them to rotate in and out of the practice without feeling judged or guilty. Some patients are perfectly satisfied seeing us on a crisis, or as-needed, basis. That is their right and their choice. Certainly, it is our responsibility to educate them and offer a better approach based on our training, but some people just have to learn the lesson themselves. And, after a couple of times of them seeing how the approach of just treating when they are in pain works, then they are a lot more open to hearing about a better way, which may include long-term, more corrective care, as well as prevention or wellness. Following this model for years, it’s not uncommon for us to see 5060 reacts per month, and this has been the case for years.
TAC: Can you tell us about what ChiroHealthUSA represents for the profession?
RF: ChiroHealthUSA represents some sanity for the profession and the ability for doctors to start practicing with more peace of mind. For too long, we have had to worry, and deal with, often confusing and conflicting regulations that affect our fees, our billing, coding, documentation, discounting, and financial policies. If doctors are trying to help patients with the cost of care by offering some form of discount, they must be careful about the way the discount is offered to avoid the risk of having a dual-fee system, or offering an improper timeof-service discount, or worse yet, creating an inducement violation. The rules and regulations vary from our Boards of Examiners, all the way up to the Office of Inspector General, and we are responsible for knowing, and following, all of them, or facing potential fines and penalties. Couple this with the rules we have to follow in our provider agreements, State and Federal Anti-Kickback, and Inducement regulations, and it feels like we need to have an attorney on staff just to get through the day.
ChiroHealthUSA makes all that craziness go away by simplifying the clinic’s financial and discount policy. ChiroHealthUSA providers are able to offer a legal, network-based discounts. Using the network model allows the doctor to get paid well when insurance is available, and still keep care affordable for patients with non-covered services and underinsured patients, such as those with Medicare. As a member of ChiroHealthUSA, a doctor has ONE fee that applies to all patients for every service provided. Using this approach, a doctor can have a simple 1-page summary of their financial policy that is not only compliant, but easy to explain to anyone.
The policy reads:
In an effort to maintain compliance with various state and federal regulations, managed care, and preferred provider agreements, as well as billing and coding guidelines, we have adopted the following financial policies. Our clinic has established a single fee schedule that applies to all patients for each service provided. You may be entitled to a network or contractual discount under the following circumstances;
• If we are a participating provider in your health plan.
• If you are covered by a State or Federal program with a mandated fee schedule. (Like Medicare or Medicaid)
• If you are a member of ChiroHealthUSA, or any other Discount Medical Plan Organization we may join. Patients who are uninsured, or underinsured (limited benefits for chiropractic care), may join ChiroHealthUSA in our office and will be entitled to network discounts similar to our insured patients. Membership is $49.00 a year and covers you and your dependents. Ask our staff for more information.
• If you are eligible and choose a payment plan that allows for “prompt-payment” discounts.
• If you are a patient who meets state and/or federal poverty guidelines, or other special circumstances outlined in our “Hardship Policy,” and may be offered a discount for a defined period of time as determined by the clinic. Verification will be required.
So, while our initial focus was one of helping doctors avoid fines and penalties as a result of non-compliant financial policies, as it turns out, ChiroHealthUSA is much like a Swiss Army Knife; one tool, many functions. For example, we are seeing more patients transition from insurance to private pay because providers are able to keep their fees at, or close to, what patients’ copays or coinsurance might have been. We see doctors being able to keep care affordable for patients and their families using a legal and compliant family plan that allows for lower fees for a 2nd, 3rd or subsequent family members. We see the practices converting more “shopper calls” into new patients, because with ChiroHealthUSA, a doctor can have a set fee for a new patient or routine office visit, and they can actually tell callers the cost without dancing around the subject as they often do now. We’ve seen more Medicare patients, and those with limited benefits, accept full treatment recommendations, including therapy and rehab, because the doctor is able to set a capped fee for their non-covered services. We see doctors being able to compete with out-of-network plans because they can offer a competitive fee that is in-line with what the patient may be paying out-of-pocket to an in-network provider. We see more patients choosing care, and opting out of filing their insurance, when they have extremely high deductibles or co-payments. We’ve seen doctors become more compliant because they aren’t down-coding, or tweaking their coding, and they’ve minimized the risk of complaints, audits, and fines, because they have cleaned up their office financial policy.
With over 4,700 providers and over 720,000 patients receiving affordable access to care, we are truly having a positive impact on the profession. And I might add, the kudos go to the doctors and staffs who have decided to start practicing with more peace of mind by offering this program to patients. It is as a result of their efforts that ChiroHealthUSA has been able to donate over $1.7 million dollars back to state associations, the Foundation for Chiropractic Progress, Chiro Congress, Clinical Compass, World Federation of Chiropractic, and offer our annual Foxworth Family Scholarship. The scholarship has provided three chiropractic students with over $40,000 in tuition and cash, while also providing each of their schools a $10,000 donation. We will be awarding our 4th scholarship to a recipient at the FC A National Convention on August 23, 2019. Students may apply for the 2020 scholarship at www.chusascholar.com.
TAC: How do you see the practice of Chiropractic in 10, 20, 30 years?
RF: There is, and never will be, a better time to be in chiropractic. It was true long ago, it’s true now, and it will be true long from now. And there is one other truth. You will get OUT of it exactly what you put into it. If it’s all about you, you’re not going to get much out of it. If it’s all about the patients and the profession, then it will reward you greatly. I think the state of chiropractic in 10 to 30 years will be the collective result of what each of us put back into the profession, and we will only be held back by the limitations we place on ourselves, or those we allow others to place on us because we fail to engage.
Dr. Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA. info@chirohealthusa. com 1-888-719-9990 | chirohealthusa.com
