I have been trying to get a questioned answered for sometime now. I have contacted the Department of professional regulations, my states attorney general and spoken to a few lawyers but they didn't have background in medical related law. My question is, I am a Chiropractic Physician and come across plenty of patients that have insurance and want chiropractic care to alleviate conditions that they have had for years. Unfortunately a high deductible or no insurance is a big concern for many, and eventually deters them from receiving care, thus in turn living with problems that can be resolved with care. I want to offer a monthly membership type plan that allows patients to come in a certain number of times per month to see either me, the chiropractor, or the massage therapists on staff. Now after speaking with the department of professional regulations in Chicago, IL they said if you tell a patient to come in more often than recommended that it would be deemed bad practice. While we would still be following guidelines as far a patient care and recommended course of treatment, I would like to approach this carefully before implementing it and not sure what all needs to be done. I guess my question is how to approach the situation to get the process going to allow patients without insurance or high deductibles to take advantage of the membership without having to deal with legal actions in the future from either the state or anyone else.
I hope this message finds you well and you are broaching a topic that is actually being looked into by many physicians across the nation in response to the new federal health care bill (that was approved through the US Supreme Court yesterday).
Right now, it seems that there is a movement by many towards a cooperative type system and/or a membership system in which a group of uninsured or high deductible clients pay in to a co-op system of sorts or membership in which they can receive treatment as needed up to a certain amount (say four visits per member, per month).
You are not setting appointments and they come when they can, not to exceed a certain amount. The patient pays a set fee per month for access to the care. Like many co-ops throughout the country, you may even offer a refund at year's end to those that did not use more than a certain percentage of the allowed visits per year (say 48 allowed visits in a year) for those patients that paid into the co-op for the full 12 months if you choose a co-op type set-up. If strictly a membership, then you treat it like a country club restaurant in which dues are paid and services rendered up to a certain amount.
In either scenario, you protect yourself contractually but a strong informed consent contract that the patient signs. They either pay by the treatment, by the month or by the year...that is at your discretion and upon the agreement of the patient.
In essence, you almost treat this like a spa that is membership based. Obviously, any treatments given should be within the standard of care, and complications should be referred to other health care professionals on an as needed basis.
I think you would need to seek some form of approval from the licensing body in your state to do this. I would suggest putting a detailed business model together, be it co-op, membership, etc., and present it to your licensing body. You, in your presentation, request express written permission to proceed.
Lastly, it should go without saying that you separate out the insurance utilizing customers from the cash/credit based customers. There needs to be a clear division there as that will help you get clearance from licensing bodies. You need to illustrate that the same standard of care will be applicable for both types of patients however.
In summary, this can be done and is being done in settings across the nation. Some physicians are actually dropping the acceptance of insurance altogether and are working on a cash only basis in primary care. Relative to your wishes, I think you need to decide on a business model of either membership based or co-op, put together a detailed business model that points out the distinctions between your regular clients that use insurance and your members, and then you need to seek written approval from your board of licensure in your state. I would not proceed without express written acknowledgement and approval.
What kind of details would need to be encompassed in the said proposal? My other friend who is an attorney said the same thing, its almost like I don't know where to start though but I do have the relative price point in mind where it would be say $69 a month and that would allow for the patient to see the chiropractor twice a month, see the massage therapist for an hour once a month, or see the chiropractor once a month and the massage therapist for a half an hour, or in the future allow two appointments for acupuncture or physical therapy. There after any additional visits to the chiro, acupuncturist or physical therapist would be an additional $25-$30 per session or the massage therapy at $50 an hour so long as they have a monthly membership. The possibility of adding a family member for an extra $10 or $15 a month to the plan but not increase the monthly visit allowance. Just not sure how detailed and how professional the proposal would need to be, would like to go in there and just get it figured out in one shot instead of constantly going back and forth revising things.
I think you are legally clear to do exactly what you are proposing. Just as would be the case with your regular clients, you also build in an informed consent into the membership agreement. You also need to build into the membership contract that under no circumstances will the services be billed to their insurance provider and that if the patient (or member in this case) would like the services to be billed to their insurance provider, they must do so outside of the membership for which they are apart of and must do so only upon giving your clinic express written notice of this desire (you should generate a simple form for them to fill out acknowledging their desire to receive insurance covered care outside of the membership that you keep on file).
I would also advise you to keep a separate membership file on each patient than their typical medical file that would included insurance based clients, referral based clients, etc. (in essence any non membership based clients). Therefore, you may have patients with two files in your office (one for insurance purposed and one for membership purposes). I believe this will help alleviate any questions by prying eyes about your business structure and motivations for care.
If any of your attorney friends could get their hands on a membership form that they have worked on for a gym, club, etc., that may be a good basis for some boilerplate language for your own membership agreement.
You then tailor it a bit with informed consent and insurance based exclusionary coverage language. I would also recommend having an attorney draft your membership contract. If the contract ever has to be defended, you want someone defending it with intimate knowledge of what the motivations are within the contract.
So now given that I basically told you the plan that I had in mind is this something I still should bring in front of the department of professional regulation? How long would something like this take to get into motion because I have brought the idea up to a couple of patients or potential patients and they are very interested.
I would definitely move on it. Government can be slow, but I would expect around six to eight month turnaround with that in mind. I'd recommend moving on it as soon as possible.
Given the 6-8 month turn around, can I still implement the program say next month after presenting the proposal or am I going to run into issues with that as well? I wanted this running yesterday.
I think you can go ahead and start. Just make sure the agreement for membership has the proper language, as previously discussed, to protect you and your employees.
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