SmartInjuryDoctors are Aligned with Insurance Company Needs
SmartInjuryDoctors are aligned with insurance company needs. That may sound a little bit interesting, but I train doctors all over the country, with attorney groups and with groups where insurers were present. The thing that has always baffled me is that the injury market is such an adversarial market. This is because there is so much confusion in the market. As a trainer of doctors and lawyers on ligament injuries, one of the things that I found fascinating is that my role in this market is to help doctors to identify really significant injuries to the ligaments early so that you can get great outcomes with the patient.
In the personal injury market, everyone is looking at the injuries and the resolution process. And it is an interesting process. I have doctors that approach me in seminars and say, “Well, how do I make attorneys more money so they refer to me?” My answer is “Well gosh, your actual job in the market is to reduce insurance benefits. You’re more aligned with the insurance carrier than you may believe.”
I was in the injury market for a time as a young practitioner and I used to think the insurance companies were hard to deal with or constantly trying to cut my bill even though my bill was legitimate. They are always using independent medical examination and utilization reviews. Then I would have to write a rebuttal. It was a bit traumatic for me at the time because I didn’t like the paperwork aspect of it.
What I liked was treating patients, diagnosing their condition accurately, and getting great results with them. One day, I had this big ‘aha’ moment. The thought that came to me was that my purpose and my goals were perfectly aligned with the insurance carriers’ purpose and goals. I’m going to explain that to you really simply.
For example, a patient came into my office and they were in a wheelchair due to a low back injury that they received in a car accident and they couldn’t walk. They went for 4-6 months’ worth of care in my clinic and now they were able to run a 5K, they had no chronic pain, and they had no activity of daily living that was interfered with at all by their trauma. They could do everything they did prior to the trauma and they had no disability of any kind.
My role was complete and my role significantly reduced down the future benefit need of the patient. And that’s my role as a doctor. That’s any doctors that is really good at injury work. Our role is to reduce down future benefit needs. That’s our job. Our job is not to take an injury and make the patient so that they need care for the rest of their life. That’s not our job. In some situations, patients can need care for the rest of their life. I am a licensed Doctor of Chiropractic and I believe very much in wellness care, elective care that patients choose to actually help maintain their spines, but that’s significantly different than what the insurer’s responsible for in an injury scenario.
In an injury scenario, that insurance carrier, for the most part for the types of injuries that we deal with spinal soft tissue injuries, patients that don’t fully recover, may need future care. And that future care can be argued and needs to be paid for by the insurance carrier that’s insuring the person that caused the injury in the first place. But the bottom line is, my role as a really good injury doctor is to reduce the benefit need. It’s to reduce the long-term benefit needs. It’s to minimize it significantly. If I can minimize it completely, that’s my job. That’s my role. That’s what I teach our smart injury doctors is their role.
We may be one of the only groups in the country that teaches that. What draws attention to you is that your job as a doctor is to get great patient results. Your job is to do this as efficiently and as cost effectively as you possibly can. If you can do that, especially in the back and neck injuries and you can minimize the cost significantly, you should be the most sought-after doctor in the market.
Employers will be searching for you. Insurers eventually should be searching for you. Patients should definitely be searching for you and attorneys should be searching for you because your goal as a doctor that actually can accurately diagnose what the patient has and then treat them to a great result, in a relatively short, and when I say relatively short, I consider three to six months to be relatively short, amount of time.
According to research, 50% of the patients with significant ligament injuries are going to be chronic. If you can get them not to be chronic and you can do that in a relatively short amount of time and in a cost-effective manner, you become one of the most sought after doctors in the market today.
What is nice about that is that you learn to sleep extremely well because you realize your purpose and your drive are actually aligned with everybody in the market. It’s aligned with exactly what the patient wants. It’s aligned with exactly what the insurer wants. It’s aligned actually exactly what the attorneys want. It’s aligned with what employers would be looking for. It’s aligned with everyone in the market. When you’re aligned with everybody in the market and you’re producing a valuable service that everybody in the market wants, it makes it a whole lot easier.
Now I’m going to tell you a funny story and this is problematic for all of us in the injury market that do really good work. I was asked to speak with a very large defense medical defense firm in Michigan years back. I went and spoke on ligament injuries. I had only an hour. I gave a very good talk and I thought, okay, why would insurers want somebody who points out objectively a patient’s injuries? Why would they want me to speak on ligament injuries? This is the most costly injuries that there are. And then I realized, okay, remember Jeff, your purpose and your goal is very much aligned with what the insurers need.
There were approximately 100-150 people in the room. And I started off the talk with the fact that half of you in the room right now are probably suffering with some form of chronic pain. And the reason why you suffer with it is because you don’t have a doctor that knows how to accurately diagnose it because it’s a ligament condition. If you’re suffering with any kind of back, back related, neck related problems, you’re suffering with a ligament condition that’s gone undiagnosed. And I gave this talk and I had a lot of case managers and defense firm people and utilization reviewers come up to me afterwards and say, “Well, Dr. Cronk, how do I find this kind of doctor?”
A representative from one of the major insurance carriers came up and said, “Well, Dr. Cronk, how do you explain, I’ve got four months’ worth of chiropractic care and a $42,000 bill.” And I said, “Well, okay, I don’t know. That sounds excessive to me. I don’t know anything about the specifics of it. But you have your internal fraud detection procedures that you can use to reduce that. Let me follow up and ask you a question. Why do you treat the good doctors exactly the way that you treat the bad doctors?” I asked a preliminary question, “Are there good doctors?” And she said, “Yes.” And I said, “Well then why do the insurance carriers treat all doctors the same as if they’re all bad? You have to reward the actual good injury work when it is occurring. You have to reward the behavior that you want.”
When I talk about the new injury market, I am referring to the new injury markets that is about innovation. It should be about getting great results with patients right away and not being so inefficient in the market. The medical/chiropractic/osteopathic/physical therapy market needs to become a much more efficient market. It needs to get a lot better results very quickly with these neck and back injuries.
If you get great results in a short amount of time, you are very much aligned with the insurance carrier, so why are you adversarial with them? Now, I realize they do things that are kind of different and they can do things that are adversarial and they can outright attack good doctors. I understand that. But if you’re doing the right things and you’re attacked, you can withstand the attack. It changed me when I started to realize that the insurance carriers themselves were not the enemy.
And take a look today when you’re sitting there and you’re thinking about what I just mentioned, think about this person, he’s in a wheelchair, six months later, he’s running a 10K run and he has no problems. I’ve seriously minimized his long-term insurance benefit needs. And that’s my job as a doctor. That’s your job as a doctor. And again, that’s what I teach in our SmartInjuryDoctor’s program.
For more information on Spinal Ligament Injuries please check us out at http://www.smartinjurydoctor.comor check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.
For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com