Are you ‘up’ on integrated-healthcare basics?

Are you ‘up’ on integrated-healthcare basics?
By Marc Sencer, MD

Take this short quiz to assess your knowledge of some integrated practice “basics.” The question may have more than one correct answer, which means the usual test-taking tricks won’t help! Either you know it — or you don’t!

Q: You are the CEO of an integrated group practice that you founded more than 10 years ago as a solo chiropractic office. The practice providers include a physical therapist, an associate chiropractor, and two MDs.

As a chiropractor, you also treat patients in the practice. One of the MDs in the practice asks you for a policy on the indications for ordering of non-steroidal anti-inflammatory medications in the office. You should:

A: The correct answer is C. As a chiropractor, in most states you may not direct the practice of medicine. This is especially important for clinical areas, such as the prescribing of medications — a function that is clearly outside the scope of chiropractic.

The fact that you are the CEO, founder, and possibly the owner of the majority of shares in the practice is irrelevant here. Only the medical director, not the CEO, should be responsible for making medical-policy decisions and creating medical protocols for the practice.

You should, of course, have a discussion with the MD to be sure you are both comfortable with the policy and to provide your input, both as CEO of the practice and as a chiropractic physician.

When you interview a prospective MD candidate for your practice, discuss your respective philosophies concerning medical issues such as medications, pain management, referrals outside the practice for consults or tests, and other issues that could present a source of disagreement and friction later on. The two of you should agree on all of these issues before the MD is offered a contract.

B is incorrect. It is irrelevant if the policy is communicated verbally or in writing; you must avoid directing the practice of medicine, regardless of how you communicate. Policy statements regarding medical practice should come from the medical director.

D is also incorrect, for the same reasons as B. The employment agreement does not typically include specific treatment protocols. It should, however specifically state the MD’s duties, hours, and responsibilities.

For the medical director this will include the creation and implemen-tation of medical treatment protocols. In addition, the agreement will have language that directs the MD to perform to the standard of care, act professionally, and follow all rules and regulations pertaining to his profession.

By the way, just as it is inappropriate for you to formulate medical policies, MDs in integrated practices should not direct chiropractic treatment or create protocols for chiropractic care.

This is your area of expertise, and is generally outside the scope of a MDs training and practice. If there are multiple DCs in the practice, it is a good idea to have a director of chiropractic services responsible for creating and implementing chiropractic protocols.

Remember: Although you may be in charge of the business of your integrated practice, always delegate clinical responsibility to the appropriate professional.

Marc H. Sencer, MD, is the president and founder of MDs for DCs, which provides intensive one-on-one training, medical staffing, and ongoing practice management support to chiropractic integrated practices. He can be reached at 800-916-1462 or www.mdsfordcs.com.