February 2002

Wave of the Future?
Three Common Questions (And Answers) About Multi-Disciplinary Practice
By Marc H. Sencer, MD, FACIP

Q I have been thinking of converting my chiropractic clinic to a multi-disciplinary practice, but I am fearful due to questions of legality and stories I have read and heard. Is it “safe”?

A The answer is unquestionably yes. It is indeed “safe” to establish a highly legal, ethical, and conservative multi-disciplinary practice. Your first step should be to obtain legal counsel from a firm that is fluent in the health-care laws of your state. You should retain the most competent attorney available, as it is his or her name that will stand behind the corporate structure that is implemented.

Many of the stories you may have heard or read about unethical multi-disciplinary practices arise out of situations where the multi-disciplinary practice was set up as a sham. There were absentee owner MDs/DOs that had no knowledge of the practice, as well as fraudulent relationships with diagnostic testing companies, to name a few scenarios.

If you work with a practice management firm in transitioning into a multi-disciplinary practice, be sure the firm is familiar with your state and its specific laws and will hold you accountable to all local, state and federal guidelines. The only valid reason to create a multi-disciplinary practice is to provide the highest quality services to those patients who need them, and not merely for financial gain.

Q I have seen some of my colleagues attempt multi-disciplinary practice, only to close down due to a crippling overhead. Is there a way to do this with a reasonable overhead?

A Many chiropractors believe that establishing themselves as a multi-disciplinary facility means they must offer all the primary-care services that a typical general practitioner would offer. This may have been your colleagues’ recipe for disaster. That is a very high overhead model to follow. Why give up your identity as a chiropractor when you have worked so hard to establish yourself in your community?

By focusing on musculoskeletal conditions, like those you currently see, and providing these patients with additional services as warranted, you can limit your overhead and remain profitable.

Q I have heard a lot recently about the need to institute a Compliance Program for my practice. I can’t seem to get any straight answers as to what this is and what I have to do about it.

A The Office of the Inspector General (OIG), a division of the Department of Health and Human Services, has issued a Compliance Program Guidance for small physician practices. While it is not a law per se, when a government agency “recommends” something to you, you should give serious consideration to implementing it. However, if you implement a Compliance Program, you must follow it to the letter - there is no wiggle room.

The fundamental principles behind this program center on the reduction of various types of risks that exist in small physician practices. Some of the areas addressed are billing practices, patient confidentiality, staff training and education, the proper use of ICD-9 codes and diagnosis pointers. The OIG Guidance also calls for the designation of compliance officer(s) for the practice and the creation of a Compliance Manual.

It makes prudent practice sense to abide by the OIG Compliance Program, as it serves as an invaluable guide to reducing risk in today’s health-care environment.

Dr. Sencer has served as the medical director in five multi-disciplinary practices. He is the vice president of MD Solutions, a medical staffing company specializing in the needs of chiropractic practices. Through MD Solutions, Dr. Sencer has placed MDs and physical therapists in chiropractic practices across the country. He can be reached at 800-665-0106, or online at www.mymedicalsolution.com.