Chiropractors are finally getting it. The survey showed that among doctors that offer retail products the overwhelming most popular item sold today by nearly 68% of the chiropractors responding, was nutrition, a consumable, reusable cash product. The next most popular cash item listed, at only 38%, was electrotherapy. I'm not surprised to see "elective" electrotherapy that unpopular. Let's face it, most patients will pay cash for a nutritional support product instead of an additional therapy modality because they think their insurances should pay for therapy, but they know they have to pay for nutrition.

So offering a nutritional "cash" product that improves patient outcomes makes great sense. This might come as a surprise to some chiropractors, but certainly not to me. Offering a nutritional product designed to use on the first visit to help with pain and inflammation is the best nutritional product to recommend because it deals with almost 100% of chiropractic first visit patients, those who come to us suffering with these two symptoms.

Offer Nutrition or Let Them Use NSAID's?

I think it's fair to say that the overwhelming majority of new patients that visit chiropractors are self-medicating with some type of over-the-counter NSAID. Why? Patients have learned that NSAID's help reduce pain, so they figure why not give it a try. Unfortunately most patients don't know that NSAID's may also cause stomach bleeding, liver damage and a host of other concerns which might have prompted the American Heart Association to issue a scientific statement suggesting physicians change the way they prescribe over-the-counter pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment. (AHA Statement 2-26-07). NSAID's are typically recommended for pain and inflammation because they inhibit the COX-2 enzyme. As chiropractors know the COX-2 enzyme converts arachidonic acid to PGHS-2 and is typically unexpressed under normal conditions, but becomes elevated during inflammation. NSAID's are made to target directly the COX-2 enzyme but unfortunately most also target the COX-1 enzyme which helps to protect kidney and stomach cells and seems to prevent ulcers. So if chiropractors could help their patients on the first visit move away from dangerous NSAID's to a safe and natural nutritional alternative that may help to support minor pain relief, I feel they are obligated to share this information regardless of the product being covered by insurance or not.

Why Not Have An Insurance and Cash Practice Blend?

Typically most chiropractors agree with this concept but most do it all wrong by trying to combine them together without any game plan which usually backfires. The only way to be successful is to start getting patients use to paying cash for something that's not covered but that they want, like "out of pain quicker" on their first visit. Doctors owe their patients their best advice and should not withhold any recommendations that will improve outcomes, regardless of it not being covered.

Offering patient's specific advice on supportive products to improve conditions is not being a salesperson, it's the duty of a doctor. Tell the patient the best plan and let the patient decide. The key to conversion from Insurance/PI to Cash is to get patients to accept some financial responsibility on their first visit so they get familiar with paying cash for uncovered items. This will make the job easier when it comes time to convert patients from their 12 visits to either wellness or maintenance; they become more accepting and understanding of the "cash model." Of course I teach this concept and call it becoming a "Health Care Advisor", (HCA).

A HCA should tell patients everything that could help them get well sooner, regardless of their ability to pay or the insurance coverage. I get asked constantly from chiropractors who know that insurance coverage is in decline how they can add some type of cash product that really makes a difference in outcomes that patients would be willing to pay for.

First of all in my opinion a high antioxidant fruit and vegetable powdered drink mix is a great example of a non-insurance covered product that can improve outcomes. In addition it's very important to offer an all-natural cox-2 inhibitor type product that can help to reduce minor pain and stabilize the inflammatory response. Some chiropractors wait to offer nutrition after the patient is out of pain and their insurance has run out thinking its best recommended as part of a wellness program. Even though it can be used that way, they've forgotten how important free radical quenching and natural cox-2 inhibiting nutrition is for reducing inflammation and reducing pain.

To infuse your practice with cash without sacrificing accepting the patient's insurance consider becoming a Health Care Advisor and use the position to improve your patient's outcomes. Let's face it in most cases patients are going down the street and purchasing nutritional products to help them get well sooner. You as their trusted health care provider at least owe them the right to know of products you recommend to accomplish the same thing.

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Dr. Donald L. Hayes, DC is a clinician, educator and author of several books, including Lifestyle Wellness and, along with Michael E. Gerber, The E-Myth Nutritionist: Why Most Healthcare Practices Don't Work and What to Do About It. He is founder and president of the Greens First line of nutritional products and the Lifestyle Wellness Total Health Improvement Program. He can be reached at 866-410-1818 or through www.greensfirst.com.