Multidisciplinary practice: What’s working, what’s hype and how to integrate

This article will explore what is genuinely working in integrated or multidisciplinary practice, what is hype and how to integrate wisely without jeopardizing your license, reputation or financial future.

Chiropractors are entrepreneurs by nature. We are innovators, early adopters and often the first in our communities to embrace new ideas in musculoskeletal care, regenerative medicine and integrative health. That entrepreneurial instinct has fueled extraordinary growth for many practices. It has also, unfortunately, made our profession a target for confident-sounding consultants who promise explosive revenue while minimizing risk. In the last decade, multidisciplinary practices (MDPs) have become one of the most promoted and most misunderstood models in chiropractic. Some are structured thoughtfully and compliantly, providing exceptional coordinated care. Others are little more than revenue schemes dressed up in medical terminology. The difference between the two is not enthusiasm. It is structure, compliance and wisdom.

What’s actually working in integrated multidisciplinary practice

Let’s start with the good news. When structured properly, multidisciplinary practices can dramatically improve patient outcomes and create sustainable growth. Successful practices tend to share the following three characteristics:

1. Clear professional boundaries
2. Coordinated clinical protocols
3. Compliant billing structures

A well-built integrated practice meets professional staffing requirements. That may include chiropractors, licensed physical therapists, medical physicians and physician extenders such as nurse practitioners and physician assistants. Each provider operates within their own scope of practice, and services are billed under the license of the provider who performed them. Chiropractic services are never billed under a medical physician’s provider number, and physical therapy must be performed and supervised appropriately.

What works is clarity. Chiropractic services are billed under the chiropractor’s number. Medical services are billed under the medical provider’s number. Physical therapy services are billed under the PT’s number. There is no blending, no bouncing between tax IDs and no “creative” billing to enhance reimbursement. Clean documentation, clean billing, clean structure.

The practices that thrive long-term also develop coordinated care protocols. A collaborative treatment algorithm ensures providers function independently yet cohesively, preventing duplication of services and internal confusion. When this happens, patients experience continuity of care instead of chaos. Staff morale improves because everyone knows their role. This is what real integration looks like.

The corporate practice of medicine: Not a technicality

Now we must address the legal backbone of integrated practice: the Corporate Practice of Medicine Doctrine (CPOM). In roughly 30 states, CPOM prohibits corporations owned by non-physicians from practicing medicine or employing physicians to provide professional services. The principle is simple: Clinical decision-making must remain in the hands of licensed professionals.

The rationale behind CPOM is to protect the medical decision-making process from commercial influence. If non-physician-owned business entities control clinical care, treatment decisions may be subordinated to profit. The doctrine exists to prevent exactly that scenario.

Yet many chiropractors are told, “Don’t worry about CPOM; it’s outdated,” or “We have a template structure that works everywhere.” That advice is dangerous. CPOM varies significantly by state. Some states allow chiropractors to fully own multidisciplinary practices. Others require medical ownership structures. Some permit streamlined professional limited liability company (PLLC) models with dual membership classes. Others strictly enforce management services organization/professional corporation (MSO/PC) arrangements.

There is no universal template. Any consultant who tells you otherwise is oversimplifying complex state law.

MSO and MSA: Where structure matters

In CPOM states, many practices use an MSO structure with a management services agreement (MSA). The MSO provides business services. The PC provides clinical care. The MSO cannot simply charge a percentage of collections that functions as disguised fee-splitting. Instead, fees must reflect fair market value for actual services rendered.

This is where consultants often lead chiropractors astray. Percentage-of-revenue management fees are frequently marketed as “standard.” In some states, that arrangement may be considered unlawful fee-splitting. Additionally, licensed providers receiving compensation for patient care should generally operate under a single tax ID as W2 employees when appropriate. Misclassifying providers as 1099 contractors to avoid payroll taxes can create cascading regulatory issues.

A compliant structure requires ongoing scrutiny. Multidisciplinary practice owners should regularly review MSO invoicing, confirm fair market value and audit financial flows. This is not a “set it and forget it” system. It demands active governance.

What’s hype: Revenue-first schemes

Let’s talk honestly about what is not working. Across the US, chiropractors have been pitched integrated models promising dramatic increases in reimbursement by “adding a nurse practitioner or physician assistant to the practice.” In some arrangements, an MD’s license is used to bypass chiropractic visit caps or modality limits. This is often marketed as “optimizing reimbursement.” In reality, it may be viewed by regulators as abuse of billing privileges.

Other hype includes overuse of ancillary services, such as imaging, labs and therapies, ordered at unusually high rates, sometimes tied to questionable financial relationships with vendors. Sham leases, consulting contracts or administrative agreements may disguise per-test or per-patient kickbacks. These arrangements are often sold with polished slide decks and bold revenue projections.

Then there are “ghost owning doctors.” Medical directors who appear on paper for multiple clinics without documented, ongoing involvement are a major compliance red flag. Regulators increasingly scrutinize these arrangements. A medical director must actively participate in clinical oversight. Anything less may be interpreted as a sham.

The hype always sounds confident. It often comes wrapped in urgency. “You’re leaving money on the table.” “Everyone else is doing it.” “The insurance companies don’t care.” These statements are not legal opinions. They are sales tactics.

Billing pitfalls that trigger audits

Blended billing is one of the most common and risky practices. Billing all services under an MD, NP or PA, regardless of who performed them, is a fast track to audit exposure. The provider who performs the service must be identified on the claim. Chiropractic services performed by a DC must be billed under the DC’s provider number.

“Bouncing” patients between tax IDs to maximize reimbursement is equally dangerous. Stark regulations prohibit certain self-referral arrangements in which physicians have financial interests across entities. A multidisciplinary practice operating under one tax ID must bill accordingly.

Standing orders are another compliance trap. Billing for medical services before the medical provider examines the patient and establishes a diagnosis is illegal. Yet some consultants encourage pre-loaded care plans assuming medical billing authority without proper evaluation.

Duplication of services, such as billing manual therapy under both DC and PT provider numbers, also creates risk. These patterns are easily flagged by payers’ algorithms.

Audits today are data-driven. Outlier billing patterns do not stay hidden.

The real-world cost of getting it wrong

Healthcare fraud does not require malicious intent. It can arise from ignorance, poor advice or blind trust in the wrong consultant. Unfortunately, regulators do not distinguish much between intentional fraud and reckless disregard.

Civil penalties under the False Claims Act can include treble damages and penalties exceeding $20,000 per claim. Anti-Kickback Statute violations may trigger criminal penalties, exclusion from federal programs and imprisonment. State boards may impose license suspension or revocation. Even if charges are ultimately reduced or settled, legal defense costs alone can be financially devastating.

Beyond fines, the reputational damage can be permanent. Insurance payers may terminate contracts. Credentialing can become more difficult. Referral relationships may dissolve. The emotional toll on your family and staff cannot be overstated.

Most chiropractors who find themselves in this situation did not wake up intending to commit fraud. They followed confident advice that minimized risk and overstated reward.

Build wisely: A practical road map

If you are considering integration, start with legal counsel familiar with group healthcare practice laws in your specific state. Do not rely solely on templates, seminars or colleagues in other jurisdictions. State law variation is profound.

Second, ensure your corporate structure aligns with CPOM requirements in your state. Whether that is a PC/MSO model, a dual-class PLLC or full chiropractic ownership depends entirely on local statutes. Your attorney should review ownership, governance rights, compensation methodology and fair market value documentation.

Third, implement a formal compliance program. Designate a compliance officer. Conduct baseline and annual audits. Confirm fee schedules are reasonable and customary for your region. Regular meetings with your accountant to review MSO invoicing and payment flows are essential.

Fourth, develop an independent yet coordinated care protocol adopted by all providers. Integration without protocol is chaos. Integration with protocol is synergy.

Finally, maintain adequate working capital. Many schemes require expensive equipment purchases and front-loaded fees. Cashflow strain leads to desperation, and desperation leads to shortcuts.

Confidence vs. competence

One of the most consistent patterns I see in coaching is chiropractors being swayed by false certainty. Consultants who speak with authority, show polished spreadsheets and dismiss regulatory concerns often sound more persuasive than cautious attorneys who speak in probabilities and statutory language.

Confidence is not competence. Enthusiasm is not compliance.

True integration is not about squeezing more reimbursement from the system. It is about improving patient outcomes while building a stable, legally sound business. That requires humility, collaboration and a willingness to hear “slow down” when everything inside you wants to accelerate.

Final thoughts

Multidisciplinary practice can be extraordinary. It can elevate your clinical impact and expand your service mix in meaningful ways. But integration is not a shortcut to easy money. It is a sophisticated business model operating within a heavily regulated industry.

What’s working is coordinated care, compliant structure and disciplined governance. What’s hype is revenue-first models that blur billing boundaries, minimize CPOM constraints and treat legal nuance as optional. The difference between the two may determine whether your practice becomes a legacy or a liability.

Before you sign an agreement, before you bring on a medical director, before you restructure your tax ID, sit down with a qualified healthcare consultant and legal counsel in your state. Protect your license. Protect your family. Protect the profession.

Integration done wisely is powerful. Integration done casually is perilous. Choose wisely. 

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.