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Thursday, 20 February 2020 14:44

Personal Injury Collections by State: 2011 vs. 2013 vs. 2015 vs. 2017 vs. 2019 Comparison of Collections vs. Cost of Living Analysis

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Personal Injury Collections by State:

 

2011 vs. 2013 vs. 2015 vs. 2017 vs. 2019

 

Comparison of Collections vs. Cost of Living Analysis

 

National PI Collections Increase by 24%

 

 

Reference: Studin M., (2020) Personal Injury Collections by State: 2011 vs. 2013 vs. 2015 vs. 2017 vs. 2019 Comparison of Collections vs. Cost of Living Analysis, American Chiropractor, 42 (2), pgs. 34, 36, 38-40

 

by Mark Studin

 

In 2011, 2013, 2015 and 2017 I wrote in the American Chiropractor Magazine, "Why is a life in Tennessee, South Dakota and Texas worth more than a life in Hawaii and New York?" There is no reason other than the insurance companies and state politicians that you have elected into office allow it to be. We are a country of laws and regulations per-visit and it is these laws that dictate the marketplace and how doctors are reimbursed for their services. In most states, it is based upon the usual and customary fees of the doctors and the carriers paying a percentage of those fees. However, in Hawaii, the state sets the doctors’ fees and they are driven by politics.

 

 

The collections listed in the following table depict what chiropractors are collecting as of December 2019, on a per-visit basis for a typical treatment vs. what they collected in 2011, 2013, 2015 and 2017 and are rated against the cost of living for each state in comparison to other states. The dollar amounts exclude examinations, x-rays, supports and any other ancillary services or testing and are limited to only services performed by the chiropractor in a private clinical setting for treatment inclusive of the adjustment, modalities and rehabilitation.

 

 

The number of reporting doctors in all states does not reflect a large enough cohort (sample size) to reflect statistically accurate averages. However, based on survey sampling and conversations in all 50 states, the numbers are what was reported and can be trusted as a guide. The dollar amounts accurately reflect what is currently being collected for personal injury cases on a “visit basis” in all 50 states nationally and I personally gathered the information.

 

 

As I established in 2011, 2013, 2015 and 2017 in my previous articles, the cost of living is not an indicator for reimbursement in personal injury as one would logically conclude. In a fair and equitable system, the more it costs to rent an office and run a business, the more a doctor should be entitled to charge and collect. Unfortunately, politics too often determine your fees on a state-by-state basis and the stronger the insurance lobby, the lower the reimbursable fees. As was reported previously, Hawaii, which is one of the most expensive states to live in, has the lowest levels of reimbursement nationally. New York, previously was the lowest reimbursable state nationally, just got its first substantial fee increase and in October 2020, downstate New York chiropractors can realize approximately $114 per visit and will be reflected as such in this survey, although currently it is roughly $42. The New York State legislature controls New York personal injury fees.

 

 

A 50-state reimbursement comparison between 2017 and 2019 revealed a 25% increase in collections and between 2011 and 2019, a 48% increase was reported for a personal injury visit in a chiropractic office. This statistic showed a trend in the chiropractic profession which verifies that the personal injury population of patients is a financially stable sect within the industry. Also, when managed care and other financial classes in the profession are shrinking in reimbursement, personal injury is the one sector consistently growing. Please note that this author is not suggesting that a doctor maximize his/her charges inappropriately and that only clinically indicated services should be performed based upon clinical necessity.

 

 

Many doctors will read this report and feel that they must increase those portions of their practices with personal injury patients. From a reimbursement perspective and business plan, that would appear to make sense. However, is that doctor qualified? Treating trauma cases requires a particular skill set and training no different than in any specialty in healthcare. You wouldn't want a psychiatrist performing open-heart surgery without the requisite training or an OB/GYN doing brain surgery. In the past, all a doctor of chiropractic would need beyond their doctoral training was advanced education in MRI interpretation. This is a result of improper MRI interpretations by general radiologists. Herzog et. Al (2017) reported a 43.6% error rate of general radiologists misreporting the MRI findings, something a doctor of chiropractic relies on to deliver our care. Today, to compete and be considered an expert, formal education in spinal biomechanics, connective tissue pathology and accident engineering are also required.

 

 

Understanding the differences between herniated, bulged, protruded, extruded, migrated or sequestered disk is critical in creating an accurate diagnosis prognosis and treatment plan in triaging and guiding the patient through care. Although the delivery of chiropractic may not change, when you can and cannot treat your patient might change because collaborative care with a medical specialist and or surgery might be indicated. The etiology of pain in the trauma case is often dramatically different than in a geriatric or pediatric patient. Training and credentials matter.

 

 

After consulting and educating chiropractors for 20 years nationally, 100% of the doctors who have made the effort to be trained and compete in the “personal injury space” have succeeded. Although the reported levels of success have varied, all now consider themselves better doctors and experts, allowing themselves to be successful and make their competition irrelevant in personal injury. That is our goal for the doctors we train.

 

 

Also, there are many “get rich quick schemes” in personal injury that our profession has been exposed to. These are typically a “false bill of goods” with offers of “magic reports and research articles” to garner referrals. There are programs designed to overcome the algorithmic requirements of the carriers to bolster settlements for lawyers with claims that is all the lawyers need to refer to en masse`. As verified by over 10,000’s of lawyers and hundreds of doctors nationally in the past 5 years who have tried that, confirmed it is a “plausible marketing fad” that hasn’t delivered. The primary beneficiaries of those programs are those who have created those schemes. CAVEAT EMPTOR! There is no substitute for credentials, knowledge and a strategic business plan to get your referral sources to run after you. That is the solution for chiropractic practices in 2020 and beyond; a fact that has been confirmed by extensive market research.

 

Too many doctors of chiropractic bypass the diagnosis and prognosis stage and delve directly into treatment. Too often, this step is taken to the detriment of the patient. If the patient has pain radiating down their arms or legs with or without associated motor weakness before you touch that patient, the first question that must be answered is “what is causing that problem?” AND… if you do not know, do not guess. Beyond your clinical examination, consider advanced imaging if clinically warranted without shying away from the carriers often “fictitious” rules of approving the advanced images. Once again, the hard, NON-NEGOTIABLE “Studin Rule” rule is: IF YOU DO NOW KNOW…DO NOT GUESS.  

 

 

The only way to spiral upwards is through clinical excellence through the acquisition of knowledge and credentials. Based on the literature, chiropractic outcomes have outpaced other forms of treatment for spinal conditions within our scope. For mechanical spine pain, both physical therapy and medicine have realized far poorer outcomes with an increased incidence of secondary disabilities, increase opiate use and significantly higher costs compared to chiropractic care.

 

 

As a profession, the most direct avenue for these published studies to help increase utilization is for each doctor to be expert and credentialed in the area of desired practice. Treating personal injury patients is included in this formula and mandates graduate-level training (post-doctoral education), so choose your courses wisely as a stepping-stone to what you want your practice to be tomorrow.

 

With personal injury or any financial category, fair and equitable reimbursements will determine if a doctor can afford to live in any community nationally and wise legislators should take into account doctor’s reimbursements, or will soon realize there is a doctor shortage in their respective state. Many state legislators are not "penny wise and dollar foolish," unlike those elected officials in Hawaii and this has fueled the opioid crisis with only pharmacologic or surgical solutions. Therefore, for those states who are below the national average, the chiropractic political organizations should strengthen their lobbying efforts with a unified (one) chiropractic voice (organization) and that should happen not only at the state level but nationally.

 

 

NEVER LOSE SIGHT THAT THERE CAN NEVER BE A PHARMACOLOGICAL SOLUTION TO A MECHANICAL PROBLEM. Therin lies the genesis of part of the opioid crisis.

 

 

 

Survey in 2011

Survey in 2013

Survey in 2015

Survey in 2017

Survey in 2019

Cost of Living Ranked Lowest to Highest

Alabama

$80.00

$80.00

$90.00

$200.00

$         250.00

8

Alaska

$175.00

$225.00

$225.00

$349.00

$         375.00

47

Arizona

$110.00

$100.00

$135.00

$200.00

$         333.00

23

Arkansas

$115.00

$109.00

$120.00

$110.00

$         235.00

2

California

$113.00

$140.00

$155.00

$225.00

$         210.00

49

Colorado

$75.00

$150.00

$185.00

$250.00

$         275.00

35

Connecticut

$100.00

$100.00

$180.00

$200.00

$         200.00

50

Delaware

$200.00

$200.00

$200.00

$200.00

$         460.00

34

Florida

$250.00

$250.00

$325.00

$300.00

$         325.00

28

Georgia

$225.00

$140.00

$202.00

$220.00

$         366.00

10

Hawaii

$75.00

$75.00

$75.00

$75.00

$           75.00

51

Idaho

$160.00

$135.00

$120.00

$100.00

$         195.00

16

Illinois

$230.00

$150.00

$220.00

$250.00

$         357.00

24

Indiana

$65.00

$90.00

$125.00

$225.00

$         250.00

15

Iowa

$100.00

$100.00

$140.00

$140.00

$         225.00

6

Kansas

$80.00

$150.00

$170.00

$120.00

$         240.00

9

Kentucky

$180.00

$230.00

$185.00

$250.00

$         400.00

17

Louisiana

$113.00

$90.00

$125.00

$120.00

$         225.00

19

Maine

$70.00

$160.00

$130.00

$135.00

$         145.00

38

Maryland

$173.00

$150.00

$200.00

$225.00

$         300.00

46

Massachusetts

$130.00

$170.00

$250.00

$250.00

$         300.00

45

Michigan

$100.00

$135.00

$250.00

$300.00

$         350.00

3

Minnesota

$160.00

$206.00

$200.00

$307.00

$         400.00

29

Mississippi

$209.00

$200.00

$210.00

$150.00

$         225.00

1

Missouri

$100.00

$190.00

$200.00

$375.00

$         145.00

4

Montana

$75.00

$108.00

$195.00

$199.00

$         198.00

31

Nebraska

$75.00

$138.00

$150.00

$180.00

$         195.00

13

Nevada

$80.00

$180.00

$130.00

$150.00

$         221.00

36

New Hampshire

$118.00

$129.00

$120.00

$160.00

$         240.00

38

New Jersey

$136.00

$105.00

$105.00

$105.00

$         110.00

41

New Mexico

$171.00

$250.00

$160.00

$170.00

$         210.00

14

New York

$40.00

$43.00

$42.00

$42.00

$         114.00

48

North Carolina

$125.00

$120.00

$160.00

$115.00

$         155.00

18

North Dakota

$145.00

$145.00

$145.00

$145.00

$         250.00

30

Ohio

$140.00

$120.00

$100.00

$300.00

$         345.00

12

Oklahoma

$167.00

$125.00

$253.00

$120.00

$         195.00

5

Oregon

$175.00

$120.00

$150.00

$190.00

$         200.00

44

Pennsylvania

$155.97

$115.00

$140.00

$150.00

$         235.00

32

Rhode Island

$140.00

$130.00

$130.00

$130.00

$         150.00

42

South Carolina

$145.00

$165.00

$200.00

$120.00

$         145.00

15

South Dakota

$100.00

$198.00

$125.00

$200.00

$         225.00

27

Tennessee

$245.00

$220.00

$155.00

$125.00

$         325.00

7

Texas

$125.00

$150.00

$225.00

$150.00

$         525.00

11

Utah

$130.00

$155.00

$170.00

$178.00

$         227.00

25

Vermont

$100.00

$140.00

$160.00

$160.00

$         167.00

39

Virginia

$120.00

$110.00

$200.00

$250.00

$         300.00

33

Washington

$120.00

$140.00

$225.00

$250.00

$         315.00

37

West Virginia

$110.00

$135.00

$185.00

$150.00

$         208.00

26

Wisconsin

$117.00

$130.00

$129.00

$185.00

$         225.00

21

Wyoming

$90.00

$90.00

$115.00

$120.00

$         145.00

20

 

References:

 

  1. Studin, M. (2011, February) Personal Injury Collections by State: 2011 Comparison of Collections vs Cost of Living Analysis, The American Chiropractor, 33(2) 52-53
  2. Studin, M. (2013, July) Personal Injury Collections by State: 2011 vs. 2013 Comparison of Collections vs Cost of Living Analysis, The American Chiropractor, 35
  3. Studin M. (2015) Personal Injury Collections by State: 2011 vs. 2013 vs. 2015 Comparison of Collections versus Cost of Living Analysis, The American Chiropractor, 37(6) 40, 42-43
  4. Studin M., Personal Injury Collections by State: 2011 vs. 2013 vs. 2015 vs. 2017, (2018) Comparison of Collections vs. Cost of Living, American Chiropractor 40 (1) pgs. 12-14, 16
  5. Herzog, R., Elgort, D. R., Flanders, A. E., & Moley, P. J. (2017). Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. The Spine Journal17(4), 554-561.
  6. Mafi, J. N., McCarthy, E. P., Davis, R. B., & Landon, B. E. (2013). Worsening trends in the management and treatment of back pain. JAMA Internal Medicine173(17), 1573-1581.
  7. Cost of Living Data Series 2017 Third Quarter 2017 (2017), Retrieved from: https://www.missourieconomy.org/indicators/cost_of_living/

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