A predominating assumption today is that besting Managed Care is like ?Fighting City Hall.? The dwindling spiral of insurance reimbursement in this country is threatening both the future of healthcare on a national basis and your ability to survive and prosper. It even hits at the basic integrity of your relationship with patients. When we lose that, we lose everything.

Managed Care is the key area in which practice owners tell me they have lost the Power of Choice. Some have decided they are simply forced into adjusting themselves by lowering their expectations.

That, my friends, would be the single worst decision you could make for your patients and your prosperity.

In 2006 practice owners reported to several focus groups that insurance write-offs reached 40% to 50% with average treatment charges dropping to $45 and $55 in some regions of the North East and California. Shortened treatment programs, due to insurance restrictions, compounded matters and heavily hit at the clinical bottom lines.

Oddly, Worker's Compensation and Medicare, which at one time may have been considered a bother, paid some practitioners $100 or more per treatment and were now eagerly sought out by some practices. Of those interviewed, some had personal qualms about promoting for patients in the ?personal injury? category as they felt it could attract people who magnify symptoms, were unmotivated to improve or might have a lawyer urging them toward avoiding resolution of their problem in order to increase damages.

This is very likely not new news to you. But it can seem so insurmountable a problem that it can breed hostility or downright apathy to anyone confronted with the results.

This ?nothing I can do about it? attitude perpetuates itself. Case in point is that practice owners continue to sign on with insurance companies who offer lousy reimbursement. They rationalize, ?If I don't do it, somebody else will.? While that line reminds me of one of my favorite Leon Russell songs, it is not an excuse we should accept from anyone, let alone ourselves.

As insurance reimbursement drops, you can be drawn into the dwindling spiral. How can you consistently handle a patient's pain issues and get to the underlying causes and remedy them, when you're only permitted, or capitated at: 6 visits / $45 per visit?

What CAN you do?

You kick the insurance habit!

Kick the habit? YES!

We are hereby starting an intervention. If you honestly are not feeling the effect of insurance, skip this article and refer it to some poor colleague who is.

I see hundreds of practice owners annually. Most are, to varying extent, addicted to insurance. Particularly the non-cash-based professions such as Physical Therapy, Occupational Therapy and Certified Hand Therapists. For many years they mainlined insurance and government programs to the degree that they became entangled in a co-dependency with their patients. I hate that word, but it works here.

I'm reminded of the Chinese proverb about the monkey who had his hand caught in a jar because he wouldn't let go of the banana.

Over the last 30 years, my clients in Canada experienced progressively more socialized medicine, which is somewhat akin to Managed Care on steroids. As reimbursements shriveled, so did the practices. By the time I convinced a few of them to go straight cash-pay and pull their hand out of the entitlement jar, the banana had withered to a bit of green mold in their palm.

After hitting bottom on this addiction, the lucky few that survived had this epiphany:

THE ONLY REAL CONTRACT THAT MATTERS IS BETWEEN THE HEALTHCARE PRACTITIONER AND THE PATIENT!

Your part of the contract is to deliver the product we just identified.

Examples of the patient's exchange for your product are to show up for his sessions, follow your instructions, and pay his bills, either directly out of pocket or indirectly through his insurance, or some combination thereof.

I'm going to speak plainly, but in the hope that you won't think I'm being harsh. Oh, to heck with that?this is an intervention after all!

If the patient was negligent enough to get cut-rate insurance, and you were careless enough to sign on with the insurance plan, it still, ethically, shouldn't let either of you off the hook in terms of getting your product and having him pay for it.

In another article I talked about Power of Choice and the effects of what one does against his will. It is a living hell, so don't go there!

In part two of this article series, I will cover more about how you can take back your patients and your prosperity, and get the exchange you and they both deserve.