Name: Andre Nadeau, D.C.

Age: 55

Title: President, Andre Nadeau Chiropractic

Company: Nadeau Chiropractic & Wellness Center, Augusta

About: Provides chiropractic services, nutritional counseling, physiotherapy and supplementation to patients. Website: www.nadeauchiropractic.com

What’s your biggest challenge right now?

Keeping up with all the health care changes and dealing with the insurances; dealing with MaineCare and Medicare. (MaineCare is Maine’s Medicaid program, a federal- and state-funded program that pays the medical expenses for those who qualify based on income, among other guidelines.) A large percentage of my business depends on this because we’re a chiropractic office and we deal with insurance all the time. We just got done working with MaineCare, giving MaineCare patients access to chiropractic care for a number of visits that would be beneficial. We’ve been working on that, gosh, for 18 months.

My office runs very strict when I am seeing patients, and I will do nothing else. I will spend my spare time, my day off working on issues like that. Because of the way I have my staff set up, I would say that 85 percent of my time, I see patients. I have staff around me that can handle billing, handle accounts payable and accounts receivable and collections. I oversee all of it; however, I don’t do the day-to-day work in it.

We have the same challenges as all other businesses. Employees can be challenging from time to time. Right now, we’re in a good space, and I am pleased with the people that we have. We went through a spell about a year ago where it was difficult. As the unemployment (rate) goes down, it’s hard to find people to fill positions. Right now, we’re in a good space, and I am content with what we have.

I am a very patient-centered facility. What I mean by that is that I realize it’s very difficult for people to get out of work to get to appointments. I start seeing patients at 7 a.m., so I can start seeing patients before work; and my office is open until 6 p.m., so we can see them after work. I know the reality that you can’t get out of work even if you need care. Sometimes those hours can be a little bit long.

What’s the best advice you’ve ever received?

If you want to expand your business, incubate the new process until it stands on its own, and then make it stand on its own. For example, I have some physical therapy equipment here. Instead of going out and starting having a full physical therapy division, we’re using the present office we have, and we are starting to incorporate it into treatments. As it starts to get more popular and starts to generate some revenue, it can now afford to stand on its own. So we don’t have to go into major debt, and yet it will pay for itself.

I have gotten (that advice) from seminars that I’ve attended. I am an avid reader of audiobooks and hard-backed books. I ask how can we make this a little better. I’ve heard it from multiple people and multiple presenters. I take it and I synthesize it down to how I can make this work in my profession, in my field.

I find that no matter how long you are in practice, you always realize there’s a lot more to learn. That’s why I keep the books in front of me, the seminars in front of me, because you can always learn.

How do you foster creativity in yourself or your staff?

When we are dealing, for example, with insurances, we do belong to a couple of organizations that have instructions on the rules of billing insurances. We have access to this (organization) and call them as needed. If we run into a brick wall, what I will do is contact other professionals and find out if they have experienced the same challenge, and what they do to get through with it.

I am very active in the Maine Chiropractic Association. I have been president of the association, so I keep a lot of connections in that group, which puts a lot of resources right at my fingertips for questions or challenges we might face.

I am a very strong supporter of professional organizations.

What’s your biggest fear?

I guess I would say the health care environment. It changes so rapidly that being able to keep up with the changes — for example, once upon a time you could go to just about any corner and you would find a primary care doctor running their own practice. Now, over 95 percent — from my understanding — are owned by the hospital. Now you have lost this independent practitioner, and that’s because of the changes that have come down the pike with health care, with insurance, primarily MaineCare and Medicare, things of that sort.

That unknown is the thing that makes you hesitate. It’s like, OK, I want to expand over here. What is the environment going to be once I expand? This brings me back to my term “incubation.” If I knew that insurance coverage was going to be consistent for the next 10 years, then you could make a move and say, “I want to expand into this,” and you know you could handle it from a business perspective. But at the rate they are changing, if you start today, it could be changing in 18 months.

Procedures change on a regular basis. Someone comes in with a painful lower back, and a really good therapy to give them pain relief is ice therapy. In the past you would do an interferential — which is an electrical stim. You would put ice on that, and you would do a chiropractic adjustment. They used to pay for each modality you would administer. Then (the insurance companies) say, “You know what? We’re no longer going to pay for ice packs. We’re not going to pay for cryotherapy anymore.” Well, they did, then they stopped.

When you have certain things you are planning on getting reimbursed for and they stop reimbursing, then I say, “What can I do with certainty?”

We had an insurance company, and everything was going really, really well, and we had a certain number of visits. And then out of the clear blue, they say, “You can see a chiropractor but all visits must receive prior authorization from the insurance company.” That change occurred within 90 days. Everything was going well with the insurance company, then whoa. I have been involved in the last six months in getting that corrected, and this insurance company is open to discussions.

Now my patients say, “Just treat me, and we’ll pay out of pocket.”

But it’s not fair to the patient, if they have insurance that’s supposed to cover it, to be the one who has to pick up the tab.

That is an example of a sudden change that took place. And now what I have to do is take my days off, my spare time, and then I have to go get involved with the insurance companies and say, “Hey, what’s going on? Why is this happening?”

And meanwhile, you’ve got a backlog of events for patients across the state who have that insurance who are unable to pay. They can’t all pay out of pocket.

If I may speak to chiropractic for a moment, from a cost perspective, the research out there and insurance companies show chiropractic saves 20 percent to 40 percent on musculo-skeletal injuries for care. Because chiropractors prescribe no medication, there’s no concern for opioid abuse. We’re able to manage chronic pain without medication, and we are more cost-effective.

In the world of health care, chiropractic is extremely cost-effective. It has the highest patient approval rate of all health care providers in the United States. Does chiropractic work on everybody? Absolutely not. Do I have good referrals with neurosurgeons? Absolutely. To give the best possible care, you need to have a team.

Where will you be in five years?

My vision is my practice is going to be more integrated. What I mean by that is health care to me is very much like an orchestra. You need every instrument in that orchestra in order to make music, but it has to play at the right time. If the instrument plays at the wrong time, you get noise. It’s the same with health care. Acupuncture is extremely beneficial. Massage therapy is extremely beneficial. Chiropractic, nutritional counseling — all necessary.

If I break my leg in a car accident, don’t bring me to a chiropractor; bring me to an orthopedist who is going to put me together. Once it’s set, then bring me to a nutritionist to see what foods I need to help me heal quicker. Then bring me to my chiropractor because I am going to be limping for a while, so there will be stress on my back.

So I’m hoping in five years, we’ll have a greater integration of practitioners under a single roof. So when the patient comes in, they will be able to get the care they need in one facility and not have to travel across town.

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