Take a methodical approach toward practice integration.
Have you thought about integrating your practice but decided it’s just too complicated? Are you unsure how to go about adding medical practitioners to your current practice? There is a systematic way to navigate the seemingly daunting puzzle of start-up integration.
Look at the big picture
The first step to successful integration that many DCs overlook or minimize is creating a clear picture of what the practice will offer to prospective patients and how the new services will be profitable.
It is essential to go over the numbers and create a sound business plan. This includes your profit projections and a realistic prediction of where the patients to support the new services will come from.
If external marketing will be necessary to bring in those patients, review the basic marketing plan and budget. The cost of providing the new services must be included in your projections. In short, you should have a pretty good idea of what the integrated practice will look like in its daily operations—and where the potential profit lies.
After performing your due diligence, the next thing to consider is the corpo- rate structure of the new integrated practice. Acceptable structures for integrated practices incorporating MDs and DCs vary from state to state.
Some states (e.g., Illinois and Florida) allow a chiropractor to hire an MD. Other states require that the MD own a portion of the medical corporation (or even all of the shares in it).
In these states, the corporate structures that legally protect your financial interest in the practice are more complex, and you will not be able to use your present entity to simply hire a medical doctor. Use a healthcare attorney with experience in MD-DC integration to set up the corporation if having an MD own shares in the practice is required.
Hire the right staff
The next step toward integration is deciding what personnel you will need to provide the services you want to add, and whether you will need them to work full- or part-time.
There are many variations: Some doctors opt to forgo Medicare by hiring a physical therapist, creating a DC-PT integrated practice. In a few states, such as New York and South Carolina, a PT cannot work in a practice owned by either a chiropractor or a medical doctor.
Some practices use nurse practitioners to provide most of the one-on- one patient care. In most states there must also be a supervising medical physician. Many doctors go this route because of the decreased overhead associated with NPs as opposed to MDs, but having to pay a collaborating physician could eat up some of these savings.
Also, you become dependent on two professionals to provide treatment. For example: If either the collaborating physician or the nurse practitioner suffers a major illness or resigns, all medical treatment must stop.
Some procedures can be performed by midlevel or lower-level personnel, and some require an MD to act in a supervisory role or actually perform the procedure. This is the main deciding point regarding whom you will hire.
While looking for these personnel, also be working on protocols for the practice. These include clinical procedures for the new practice; charts for the medical personnel to use; and front desk protocols for scheduling appointments, dealing with no-shows, recalls, billing, and collections.
This should be completed so that everyone in the office is comfortable with their protocols and paperwork— both physical and digital—and ready to see the first patient. Don’t start seeing patients until the training process is complete; that’s a recipe for chaos.
A practice management consultant can help you with preparing the chart (which is usually different than the one you use for chiropractic treatments) and ancillary forms. The consultant should also guide you through the clinical protocols and help with billing and collections questions.
Marketing matters
During the pre-opening phase, put your marketing plan into action. Your new website should be operational once you have the new personnel contracted and on board. Credentialing should begin as soon as possible.
The steps above are not a comprehensive list. Other details such as opening a new bank account and purchasing equipment have not been addressed. But you will need a complete checklist with every detail included prior to opening.
Practice integration does not have to be frightening. If you construct a road map to success and progress methodically, you can navigate your way to the practice of your dreams.
Marc H. Sencer, MD, is the president 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 through mdsfordcs.com.
