Issue 2 - January 2003

The convenience healthcare trend hits chiropractic
Multi-discipline practices are gaining popularity— but are they for you?
By Linda Segall

One-stop shopping. As consumers, we’ve become so accustomed to it that we think nothing of picking up a carton of milk, a can of peas and cup of espresso while filling up our gas tank. And we browse the aisles searching out spray paint, computer software and five-inch TVs while waiting for our prescriptions to be filled at the pharmacy. The big-box discount department store where you can fill your cart with everything from apples to toy zebras has become the general store of yesteryear.

It was just a matter of time for the convenience trend to hit the healthcare market in the form of multi-discipline practices.

Like it or hate it, the multi-discipline practice is becoming as much a way of healthcare life as the corner 7-Eleven. And because of that, it’s important that you understand what multi-discipline healthcare is and why it is gaining acceptance among the chiropractic profession.

What is it?
Most healthcare professionals agree that a multi-discipline practice is a group practice comprised of two or more disciplines or medical services. But definitions vary. For example, Mark Sanna, DC, president of Breakthrough Coaching Inc., explains that “a multi-discipline practice provides both allopathic and holistic therapies with a two-pronged ‘corrective’ and ‘wellness’ approach.”

On the other hand, Ed Sharp, president of Sharp Management and Consulting, defines it as simply “one office that has more than one medical professional service offered.” The most common specialties associated with a multi-discipline practice are usually chiropractic, physical therapy and medical doctors, says Sharp. But he emphasizes that multi-discipline is not limited to these areas.

Why the growing popularity?
Sanna sees two trends in chiropractic in the decade ahead. The first trend is consolidation. Just as group medical practice has become the common model for the practice of medicine, it is becoming more prevalent in chiropractic. “Chiropractors across the country are finding safety in numbers,” says Sanna. “They understand that consolidating services in the form of joint practice is a more cost-effective, stable manner in which to deliver healthcare to the maximum number of patients.”

The second trend that Sanna sees is diversification. “Multi-discipline practices provide a consolidation of location along with a diversification of services delivered at the location.”

The benefit of these trends is growth: “When you operate your practice correctly, legally, and with proper professional guidance, adopting a multi-discipline model will grow your practice considerably,” states Sanna.

Another way to think about multi-discipline practice is that it is a way to keep patients in-house instead of referring them out, says Sharp. “Luckily this will mean greater revenues and profits for the owners.”

Another, more pragmatic, benefit of a multi-discipline practice is improved reimbursements. “Chiropractic has traditionally placed a greater emphasis on treatment over diagnostic testing. It is frustrating for chiropractors to be repeatedly denied reimbursement due to inadequate documentation and the claim by insurance carriers of a lack of medical necessity,” says Sanna.

“Your multi-discipline practice will bring together the resources and the technology required to objectively document the necessity of care without having to overcome the special hurdles that have been placed in the path of the chiropractic profession,” he adds.

Beware of pitfalls
You can grow your practice and make more money by establishing a multi-discipline practice. But you can also find yourself in a legal and management quagmire, if you are not careful. “A few high-profile practices have found themselves in the investigative limelight due to their questionable business practices,” says Sanna. “Their professional corner-cutting and unabashed greed have created an environment of distrust for the model among chiropractors who tend to generalize their unscrupulousness to all multi-disciplinary practices.”

Sanna points out a case in which several unscrupulous practices and practice-management consultants hired medical doctors as “ghost” multi-discipline practice owners. “In several cases, the medical doctor involved… had never even met the chiropractor and had never even visited the practice location!” says Sanna. “Your medical doctor must have a bona fide role in the day-to-day operations of your multi-discipline practice.”

In most states, a chiropractor cannot legally hire a physical therapist or MD directly, says Sharp. “A corporate structure has to be set up to handle this problem. It is usually costly and has to be run according to laws not usually associated with having just a chiropractic office. Then there are the general problems of running any clinic, such as marketing, staff hiring, space allocations, office efficiency, planning … If you don’t know how to control and run a chiropractic office, this will definitely be a challenge.”

The solution to avoiding this pitfall is planning – with a competent healthcare attorney and a consultant who is experienced in setting up multi-discipline practices. “Do not attempt to [establish this type of practice] without getting expert advice,” says Sanna. “You will need help from experts in the areas of medical and legal issues, diagnostic testing, medical staffing and coding and billing, just to name a few.”

A multi-discipline practice can either be “a God-send or it can be a nightmare,” reflects Sharp. And remember that running this type of practice requires good management skills — something a lot of doctors have not cultivated, he says. “Make sure you have the management skills to run it. Don’t think that running it by committee will work, either. Those other doctors you plan to hire probably don’t know how to manage, either!”

Linda Segall is editor of Chiropractic Economics. Her expert sources for this article include Mark Sanna, DC, president of Breakthrough Coaching Inc. (www.mybreakthrough.com), 800-7-ADVICE and Ed Sharp, president of Sharp Management and Consulting, 727-669-0655.