Strategies for adding Functional Medicine to your practice.
Imagine a practice where there is no insurance to deal with because your patients pay cash at the time of service. It’s a practice where you can use all your skill and knowledge to solve difficult clinical problems that other doctors have failed to correct. And one where your patients are truly grateful for the efforts you make on their behalf. Interested?
It gets better because much of the income from this practice is generated by physician extenders who can perform their work even if you aren’t present at the office. What’s more, your average patient will spend perhaps five to 10 times what a typical family practice or chiropractic patient spends in your office now.
If you create a Functional Medicine (FM) specialty practice, you will reap all of the benefits mentioned above and more. If you are ready to get rid of your billing staff and software, along with your accounts receivable reviews, read on.
What exactly is FM? There isn’t one commonly accepted definition among practitioners, but what you will find are multiple descriptions of how FM doctors view health and disease and how they treat it.
FM sees disease as a problem that involves the whole body, and treatment is aimed at correcting any imbalances and problems that exist—not just attacking the specific symptoms of the patient’s chief complaint. Thus, a patient with fibromyalgia may require an endocrine workup and allergy testing in addition to trigger-point injections.
Common conditions
FM views most medical problems as being strongly correlated to inflammation. Doctors who practice in this specialty believe that if chronic inflammation is not treated, the patient will never be truly healthy. Traditional allopathic physicians agree that chronic inflammation is deadly, directly causing autoimmune disease, heart disease, stroke, and many other conditions.
Where they differ is on the emphasis they place on treating chronic inflammation and the methods they employ.
Another cornerstone of FM is the concept of a disordered immune system causing or contributing to poor health. This could be due to an overactive immune system (which itself can lead to chronic inflammation) as seen in conditions such as autoimmune thyroiditis, rheumatoid arthritis, or an underactive immune system as seen in many cancers and chronic infections. There are markers of chronic and acute inflammation that can be tested, such as C-reactive protein. Treatment aims at correcting such imbalances.
FM also focuses on the endocrine system. Most important are the male and female sex hormones testosterone and estrogen, DHEA, progesterone, thyroid hormones, and adrenal hormones. The levels of these different hormones may be too high or too low.
Correcting hormonal imbalances can be complicated as they can have multiple effects on one another. Simply put, it is not always enough to correct a deficiency in one hormone without making changes to several others.
In FM it is always important to balance hormones using bioidentical hormones rather than standard commercial preparations like synthroid; these bioidentical hormones are prepared by a compounding pharma- cist and are tailored to each patient.
Lastly, many doctors of functional medicine subscribe to the “leaky gut” hypothesis of illness. The idea is that for any number of reasons (e.g., autoimmune disorder, infection, or trauma) the permeability of the gastrointestinal (GI) wall becomes altered, allowing small amounts of toxic material to leak into general circulation, where it can travel and affect all the organs of the body.
Food allergies such as gluten intolerance are suggestive of this syndrome. Diagnosis may involve testing the stool. Treatment is aimed at reducing toxins in the GI tract and treating the causes of increased membrane permeability.
Getting started with FM
FM is a demonstrably complex field. The first thing you need to do is learn the clinical basics of FM. Fortunately, there are several courses available that can get you up to speed.
Moreover, a practice management consultant knowledgeable in this area can be a priceless resource in setting up the practice, monitoring its performance, and dealing with the day-to-day issues that arise. A consultant can also help with essential issues such as determining whether you have enough space, where you will treat these patients, and how you will schedule them. You won’t be able, for example, to do IV vitamin therapy if you don’t have enough space.
Adding FM to an existing chiropractic practice will generally add little to your overhead, but you should still analyze what getting set up will entail and formulate a business plan.
You must also decide who will be performing therapies and directly interacting with patients, and what their roles will be. Will you need to have a medical doctor on board?
While it is true that you can perform many FM procedures, an FM practice usually works better from a patient-satisfaction standpoint if you have an MD involved. Also, there are some highly profitable procedures that can only be done with an MD ordering or performing the therapy, such as IV nutritional therapy and chelation.
There is a definite tie-in between FM, anti-aging medicine, and aesthetics, and you may want to branch out into these fields someday. To perform these modalities, some level of MD supervision is necessary. For these reasons, it’s generally best to offer FM through an integrated practice model.
FM billing basics
Naturally, you will have to set prices for your services. Try to find out what the competition (if you have any) is doing. Some patients will want à la carte, pay-as-you-go pricing, but it is recommend to use discounted pay-in- advance pricing whenever possible.
For example: You can get patients to pay in advance for implantable testosterone pellets for four months to a year, where you package in tests and doctor visits. Obviously this does wonders for your cash flow and is good for patient compliance.
Even though insurance will not be a factor with your FM practice, you should still keep proper records and document just as you would if you had a third-party payer looking over your shoulder. You can still be sued and are subject to the same board discipline if you break any of their rules. Good documentation is your best defense.
Functional Medicine allows you to use your skills as a physician creatively and serve patients who have not been helped by traditional medicine. At the same time, it provides you with a lucrative practice that rewards you for your help and avoids the headaches of third-party reimbursement.
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.
