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As multidisciplinary practices have increased in popularity over the last few years, there has been an emerging (and troubling) trend.
More and more chiropractors are undertaking the conversion of their chiropractic practice into a multidisciplinary practice without the legal and managerial assistance of professionals experienced in this highly regulated area.
In a recent survey performed by Chiropractic Economics, 28.7 percent of chiropractors responded that they practice in a multidisciplinary setting. But only 24.7 percent of these reported that they worked with a practice-management or consulting group. I call this winging it.
On a positive note, the survey also reported that multidisciplinary practices had 61 percent higher billings, 48 percent higher collections, and earned 81 percent higher salary than solo chiropractic practices. With the proper guidance, multidisciplinary practice can be highly profitable.
When asked what their multidisciplinary practice concerns were, chiropractors had five common responses. A review of these responses provides insight into some of the reasons why winging it is not an option.
1. I don’t know the legal requirements
Multidisciplinary practice must meet federal and state legal requirements. In some states, multidisciplinary practice requires a complex corporate structure composed of three to four unique corporate entities, while other states permit a single corporate entity that varies only slightly from that of a solo chiropractic practice.
For this reason alone, it is essential to work with a healthcare attorney well versed in the legal requirements for multidisciplinary practice in your state.
2. I don’t know the staffing requirements
The professionals most frequently associated with chiropractors in a multidisciplinary setting are massage therapists (21.3 percent), medical doctors (12.3 percent), physical therapists (11.2 percent), and acupuncturists (9.0 percent). State-specific chiropractic, medical, and physical therapy practices acts regulate the scope of practice of each of their respective professions.
In addition, the Stark Laws define federal staffing and referral requirements. In some states. it is actually illegal for a chiropractor to employ a medical physician or physical therapist. In others, professional staff can be hired by a chiropractor with the same ease as lay staff members. An experienced consultant should be able to clarify the specific staffing requirements for your state.
3. I don’t know the coding rules
The coding rules for both chiropractic and multidisciplinary practices are regulated by a federal agency, the Center for Medicare and Medicaid Services (CMS). They leave no room for creativity or practice-specific interpretation. CMS oversight views these regulations in black and white, with no shades of gray.
While CPT coding is an ever-changing process, the ACA Official MDP Policy Statement clearly provides that only services provided by a chiropractor may be billed under the provider number of a chiropractor. Likewise, services provided by other professional staff members (MD and PT) must specifically identify the provider of those services both on CMS-1500 insurance claim forms and in written documentation.
4. I don’t know the costs
Without proper management, the increased overhead associated with additional professional staff members can drain your bottom line and tax your ability to produce a return on your investment. In the area of financial management, it is essential to seek professional advice.
Before considering a multidisciplinary practice, a consultant should help you perform a careful analysis of your patient flow and demographics, the healthcare needs of your community, and the availability of professional staff for hiring, all in the context of your current financial circumstances. Do not undertake a multidisciplinary practice without capital sufficient to see your practice through start-up and into the growth and development phase.
5. I don’t understand the marketing
Approximately 10 precent of the general public seeks chiropractic care. This statistic has remained unchanged for decades. The fear factor associated with a visit to the chiropractor by many non-patients virtually evaporates when an MD or PT joins your staff. The number of individuals willing to consider chiropractic or refer a friend or family member to you as an alternative to traditional medical care increases many fold. In addition, it is common for medical physicians to refer patients to other healthcare professionals; unfortunately chiropractors are not yet in the typical circle of referrals.
The conditions that respond best to chiropractic care are the same conditions that most frustrate traditional medical professionals. In the absence of an acute healthcare crisis, many MDs are at a loss to care for conditions that have been documented to respond excellently to chiropractic care.
Conversion to a multidisciplinary structure places your practice in the center of the circle of referrals from the medical community. The right consultant can help you maximize the unique marketing opportunities of your multidisciplinary practice.
Mark Sanna, DC, is a member of the Chiropractic Summit, the ACA Governor’s Advisory Board and a board member of the Foundation for Chiropractic Progress. He is the president and CEO of Breakthrough Coaching. He can be contacted through mybreakthrough.com/MDP or at 800-723-8423.
