During the past few years, the chiropractic profession has become increasingly intrigued by the multi-disciplinary approach to practice.
Many chiropractors, who were always independent, self-serving and sure of themselves, have seen their incomes drop, their rights limited, and their paper-work increase.
Is it possible to drop from $200,000 to $300,000 in collections per year to $150,000, yet still remain calm and confident? How can any doctor deal with setting up shop, practicing for several years, developing well-learned techniques, proliferating services, acquiring hundreds of new patients and then practically overnight seeing his or her dreams shattered by a few letters: “HMO,” “PPO” and “IPA”?
What’s the answer to tackling these ever-increasing challenges? Give up? Keep on fighting some of the richest investment companies in the country, the insurance companies? Turn your center into a “full-cash only” center and pray you can bring in thousands of patients?
To many, the answers are not clear. However, some chiropractors have decided to look into teaming up with MDs. There are about 792,000 MDs nationwide, of which 182,000 are in the musculoskeletal field.
A multi-discipline practice allows a chiropractor and an MD (or DO) the ability to join forces and render treatment under one roof, with benefits to the doctors as well as the patients. Chiropractors who work together with MDs, physical therapists (PTs), and other medical professionals can offer patients a fully integrated, holistic and convenient approach to care.
The “alternative” holistic approach has gained tremendous recognition in the past couple of years. About 83 million people in the U.S. (42% of the adult population) used at least one alternative therapy in 1997. Usage among those aged 35-49 is even higher, at 50%. The estimated number of visits for “unconventional therapy” in 1997 (629 million) was greater than the number of visits to all primary care medical doctors nationwide (386 million).
Americans spent $21 billion out-of-pocket on visits to alternative practitioners in 1997. This figure does not include money spent on retail products, such as herbal products ($5.1 billion), books, classes, and equipment ($4.7 billion). By comparison, out-of-pocket expenditures for physician visits were $29.3 billion, and for hospitalization they were $9.1 billion.
We must ask why 42.1% of U.S. residents surveyed used at least one of 16 types of alternative medicine. Visits to alternative practitioners increased from 427 million in 1990 to 629 million in 1997, exceeding the total visits to primary care physicians.
Time to Refocus?
However, the question remains, given these statistics, why is it that many chiropractors are experiencing a significant drop in their incomes? Have we lost our focus? Have our adjustments/treatment become such routine procedures that the results are not effective anymore? Is it possible that we have become hesitant to advertise the fact that our techniques are effective for so many different conditions?
The real answer is simple. The insurance companies and managed care have essentially agreed that chiropractic is here to stay. No one will be “cut off” – only cut down. Many plans include chiropractic care in their benefits, but with a maximum of $250, or 12 office visits, whichever comes first.
In other words, you are invited to dine with the President and you will indeed receive a formal invitation, but you must enter through the staff door and you must order the chicken (there will be no second helping). On the other hand, many doctors in integrated practices, when converted properly, have enjoyed the formal invitation, entered through the main entrance, and have eaten filet mignon with the other guests, enjoying the recognition and respect due to all healers.
Benefits of Multi-Discipline
The multi-discipline approach to medicine can allow you to practice at a greater profit with fewer restrictions. Do keep in mind there are specific legal ramifications that need to be addressed in establishing and running a multi-discipline practice. The concept follows a model and practical medical protocol that the insurance companies are determined to follow. Be sure to seek professional advice.
Some of the advantages of multi-discipline practice include:
Potential for growth – Your center can develop as many entities as needed, including:
- Medical: general medicine, neurology, physiatry, orthopedic care;
- Musculoskeletal: chiropractic, physiotherapy, massage therapy;
- Rehabilitation: physical therapy, physical medicine, occupational therapy;
- Diagnostics: EMG, NCV, EEG, SSEP, SEMG;
- Ancillary services: blood work, durable medical equipment, in-office testings;
- Contracting: MRIs, CTs, diagnostic ultrasound;
- Inpatient: hospital privileges, emergencies;
- Outpatient: medical referrals, medical networks.
- One-stop “shopping” – The patient, the most important part of your practice, receives the fullest, most comprehensive care available – all under one roof. In a multi-care setting, patients with all types of health-care problems can be treated, even if the condition is strictly medical (e.g., medication refills, pregnancy tests, cholesterol check-up, etc.). Our generation of patients expects only the best of all worlds – efficiency, timing and savings. The one-stop shop clinic can provide that.
- HMOs, PPOs and IPAs – The managed care arena is set up to minimize expenses while improving the efficiency of the health-care delivery system. In an MD/DC/PT Rehab Center, the best of all worlds is present to deliver the type of healthcare that’s being demanded. In addition, a fully accredited medical setting is generally not as restricted by insurance limits as a chiropractic-only practice. Across the country, as a generally accepted established protocol, the medical fee schedule is higher in billing, better in reimbursement, faster in payment and easier in collections.
- Patient comfort – The majority of the population has been and continues to be seen by medical doctors and traditional medical institutions. A multi-discipline center can help make you part of the widest and most prevalent health-care system in the country, while allowing you to maintain your professional philosophy.
- Patient perception – Our society as a whole has been ingrained in believing that the traditional medical model is the only answer to all health issues. However, MDs, DCs and PTs working together will help prove to patients that there are many holistic, alternative treatments for the same condition.
- Liability issues – Multiple specialists working together in one setting may have a greater understanding of a patient’s needs and conditions and may therefore minimize liabilities.
- Personal Injury (PI) – The multi-discipline center can provide comprehensive documentation back-up needed to satisfy PI legal protocols.
- Workers’ Compensation – Employers, adjustors and patients attempting to receive efficient, thorough, diversified care will likely find multi-care centers to be a viable solution.
The multi-discipline approach to practice can help provide a viable solution to limits set by HMOs, PPOs and IPAs. Integrating the skills of a chiropractor, medical physician, and any other allowed health-care specialist can help you develop a comprehensive network to compete aggressively and profitably in both the managed care and the retail fee-for-service environments.