Establishing a multidisciplinary practice could position you at the forefront of patient-centered care, combining teamwork and compliance to deliver better outcomes, diversified revenue and a stronger market presence.
Collaboration is redefining the future of healthcare According to Chiropractic Economics’ Salary and Expense survey, multidisciplinary and integrative practices are one of the fastest-growing segments in chiropractic today. Nearly one in four chiropractic offices now includes medical providers, physical therapists or other licensed professionals under one roof.
Patients are driving this change. They want comprehensive, coordinated care combining chiropractic, rehabilitative and medical expertise. This evolution offers you the opportunity to play a central role in multidisciplinary partnerships, bridging structural correction, functional rehabilitation and regenerative therapies. But integration also demands careful attention to state laws, corporate structures and supervision rules governing how multidisciplinary teams operate.
Understand the corporate practice of medicine
A cornerstone of compliance in integrated practice is understanding the corporate practice of medicine (CPOM) doctrine. This doctrine, present in many states, restricts who can own or control a medical practice. It’s designed to prevent non-physicians from influencing clinical decisions for financial gain.
• Strict CPOM states, such as California, Texas and New York, allow only licensed MDs or DOs to own medical practices. DCs cannot employ medical providers or share in medical revenue directly.
• Moderate states permit DCs to participate through management structures providing non-clinical services.
• Non-CPOM states, such as Florida or Alabama, have more flexibility, allowing broader co-ownership arrangements.
Many successful multidisciplinary practices overcome these ownership barriers by separating clinical operations from business management through compliant management agreements.
Structure your multidisciplinary practice
The most common structure for a compliant multidisciplinary model in states that do not allow non-medical ownership is the MSO-MSA-PC arrangement:
- Professional corporation (PC) or professional limited liability company (PLLC): Owned by medical professionals who employ clinical staff and bill for medical services.
- Management services organization (MSO): Owned by the DC or business entity, providing non-clinical services, such as staffing, marketing and administration.
- Management Services Agreement (MSA): Defines the relationship between the PC and MSO, including management fees and responsibilities.
This structure allows you to share in the overall success of the enterprise while remaining within compliance boundaries. Other models, such as joint ventures or co-located practices, can work when properly structured with legal guidance from healthcare counsel familiar with your state’s laws.
Taxonomy and credentialing: A multidisciplinary mindset
Proper taxonomy classification and credentialing are essential. While a single-discipline chiropractic office uses one taxonomy code, an integrated practice must reflect its expanded scope. Two key codes for multidisciplinary operations include:
- Multispecialty practice: (Taxonomy Code: 261QM1300X)
- Physical medicine and rehabilitation: (Taxonomy Code: 208100000X)
Using these codes ensures payers recognize your practice as a legitimate multi-specialty healthcare entity. Every provider should also be credentialed individually under their correct taxonomy and license. Billing medical services under a chiropractic NPI or taxonomy can trigger compliance issues and denials. Accurate credentialing helps maintain proper reimbursement, compliance and payer confidence.
Employment regulation and requirements
A common compliance pitfall in integrated care is provider classification. Most medical and rehabilitative providers, such as MDs, NPs, PAs and PTs, must be classified as W-2 employees, not independent contractors. This is because they typically work under the practice’s direction, using its space, equipment and staff support.
Misclassifying employees as 1099 contractors can lead to tax penalties, back pay and legal exposure. Additionally, anti–fee-splitting and anti–self-referral laws, such as the federal Stark Law and Anti-Kickback Statute, prohibit splitting fees with contractors. For instance, paying a physician assistant $65 an hour and then collecting all or a percentage of the revenue they generate is illegal.
The proper approach is to pay providers a fair-market W-2 salary or hourly rate and structure any incentives through a compliant compensation or MSO agreement. This maintains both financial and regulatory integrity.
Nurse practitioners and physician assistants: Supervision and collaboration
Nurse practitioners (NPs) and physician assistants (PAs) are essential members of multidisciplinary teams, allowing practices to expand services and access. But supervision and collaboration requirements vary significantly by state.
Nurse practitioners
Full practice authority states allow NPs to diagnose and prescribe independently. Reduced or restricted practice states require collaboration or supervision by a physician for certain functions, such as prescribing controlled substances.
NPs hold at least a master’s or doctorate in nursing and must be nationally certified in their specialty. Supervision ratios and physical proximity requirements differ by state and can limit how many NPs a physician can oversee.
Physician assistants
PAs traditionally worked under direct supervision, but many states now allow general or delegated supervision, where physicians review cases periodically rather than being on-site. PAs must hold a master’s degree and pass the national PANCE exam, with some states offering advanced designations for expanded duties.
Scope of practice and billing boundaries
A crucial compliance point: A DC or chiropractic assistant may not perform or bill for services “incident to” an MD, NP or PA. Doing so is considered practicing medicine without a license, a serious violation. DCs and their assistants must only perform services within their own licensure scope. Billing under a medical provider’s NPI for chiropractic or supportive care misrepresents the provider of record, potentially triggering audits, fines and even criminal penalties. Each provider must bill for the services they personally deliver.
Physical therapy supervision: The shift toward general supervision
Physical therapists (PTs) and physical therapist assistants (PTAs) are key players in multidisciplinary care. Historically, PTAs required direct supervision, meaning a PT had to be present during treatments. However, the Centers for Medicare and Medicaid Services (CMS) now allow general supervision in many settings.
Under general supervision, PTs remain responsible for patient care but do not need to be physically present during treatment. They must remain available for consultation and review documentation periodically. This change improves efficiency and patient access, particularly in multidisciplinary clinics. Practices should confirm each state’s supervision ratios and documentation rules to remain compliant.
Building a collaborative culture
Legal structures and compliance rules form the foundation, but it’s teamwork that makes a multidisciplinary practice thrive. Successful integration depends on open communication, mutual respect and clearly defined roles.
Hold regular team meetings to coordinate care, establish shared protocols for documentation and encourage internal referrals between providers. Foster a learning culture through continuing education and cross-disciplinary discussions. When each provider understands and values the contributions of others, patient outcomes improve and team morale soars.
The business case for integration
Beyond better outcomes, multidisciplinary care is a smart business model and allows for:
• Diversified revenue streams across chiropractic, medical and rehab services
• Improved patient retention through continuity of care
• Expanded payer opportunities with multiple taxonomy codes
• Stronger brand positioning as a comprehensive “one-stop” health center
Integration allows you to elevate your clinical reach and meet the growing patient demand for comprehensive, coordinated care, all within a compliant and ethical structure.
The bottom line
Building a multidisciplinary practice that includes DCs, MDs, PTs, NPs and PAs can be one of the most rewarding and profitable steps in your professional career. But it requires thoughtful planning and expert guidance.
Understand your state’s corporate practice of medicine laws, establish compliant corporate structures, update taxonomy and credentialing and ensure proper supervision. Work with legal counsel familiar with multi-specialty group practice laws and a consultant with proven multidisciplinary experience. The right advisors will help you stay compliant with both state and federal regulations, ensuring your practice grows on a solid, ethical foundation.
Final thoughts
Multidisciplinary care isn’t just a trend; it’s the future of healthcare. DCs who lead this movement are shaping a new era of patient-centered, collaborative and integrative care.
Editor’s note: Chiropractic Economics defines integrated practices as including DCs, MDs, DOs, NPs, NDs and PAs, and multidisciplinary practices as including PTs, MTs, nutritionists, acupuncturists, etc. The author’s use of “multidisciplinary practice” combines all practitioners under one term.
Mark Sanna, DC, ACRB LEVEL II, FICC, is the CEO of Breakthrough Coaching, a practice management company for chiropractic and multidisciplinary practices. He is a Board member of the Foundation for Chiropractic Progress, a member of the Chiropractic Summit and a member of the Chiropractic Future Strategic Plan Leadership Committee. To learn more, call 800-723-8423 or visit mybreakthrough.com.
