One of the most talked-about subjects in the chiropractic profession right now is the formation of multi-discipline centers.
Many names have been used to describe this type of association:
- MD/DC/PT;
- DC/MD/PT rehab center;
- Integrated healthcare;
- Holistic/wellness care.
All of these different labels mean pretty much the same thing. The information that follows is a discussion of the pros and cons you may want to think about if you are considering this type of arrangement. An integration program can be a boon for a chiropractic practice that is ready for it, but it is certainly not for everyone.
Possible Pitfalls
You should be on the look-out for potential problems in the following areas:
Legal: The fact that there are several serious lawsuits currently pending, as well as investigations questioning the validity of many of the infrastructures, should point to the importance of working with a qualified attorney who specializes in health-care law. The attorney you work with should be informed about the specific laws of your state, as well as the federal rules and regulations that apply.
Philosophy: If you are thinking of integrating your center, you should be well-anchored in your chiropractic philosophy. Indeed chiropractic is an art, a science and a true belief. If after integration the medical doctor questions either the values or treatment benefit of chiropractic care, the challenge may tip the scale and a successful chiropractic center could end up as a poor medical/ chiropractic clinic, with patients receiving unnecessary medications and diagnostic tests. Choose the MD you plan to work with extremely carefully, and make sure you discuss his or her philosophies regarding chiropractic and natural healing.
Liability: Increasing services beyond the scope of your license will definitely increase your liability, especially since many services added may be new to you and your staff. You need to learn how the new structure of your practice could affect your agreements with HMOs and PPOs. Generally, being contracted by an HMO means you accept a reduced fee for a contracted service. Adding “extra” services under a non-provider within the same center may potentially be a breach of contract and could get you removed from the plan. This in turn can decrease your patient load and hence your revenue. Be sure to do your homework before you make a change.
Complexity: The ever-changing coding (CPT) rules and reimbursable benefits are quite complex. Multi-discipline centers demand a great deal of attention to details in all aspects of practice management, including coding rules. The added consulting cost can increase your monthly budget.
Truths: If anyone tries to tell you “you just cannot survive without an integrated practice,” it is a scare tactic. As stated earlier, the multi-discipline center is not for everyone.
Focusing on the Positive
Having practiced for almost 10 years in my own multi-discipline center (five physicians, one DC, two PTs, one acupuncturist, five massage therapists), I cannot help but believe in it. Here’s why:
Legal: Hiring a reputable attorney from a well-established health law firm familiar with your state’s laws can put most of your worries to bed. These law firms spend an enormous amount of time researching the most complicated rules and regulations. After all, the integrated clinic is not new to the medical community. Only consider the most serious law firms with national recognition. They are well worth your peace of mind.
One-stop shop: The patient, the most important asset of your practice, receives the fullest comprehensive care available.
Patient benefits: In a multi-care setting, patients with all types of health-care problems will be treated even if the condition is strictly medical (e.g. medication refill, pregnancy test, cholesterol check-up.)
Insurance coverage: A fully accredited medical setting is hardly ever restricted to any insurance limits or prejudice.
Potential financial rewards: 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 familiarity: 98% of the population has been and continues to be seen by medical doctors and medical institutions. Owning a multi-discipline clinic will make you part of the widest and most prevalent health-care system, while keeping your philosophy intact.
HMOs, PPOs and IPAs: The managed-care arena is set up to minimize expenses while improving the efficiency of its health-care delivery system. In an MD/DC/PT rehab center, that’s possible.
Patient retention: Because our society has been so “ingrained” in believing that medicine is “the only” answer to all health issues, MDs, DCs and PTs working together will prove there are many alternative treatments for the same condition.
Liability: Multiple specialists working together in one setting may have a greater understanding of a patient’s needs and conditions and therefore could minimize liabilities.
Competition: The new breed of patients expects only the “best of all worlds” — efficiency, timing and savings. The one-stop shop clinic can deliver the most unadulterated genuine care available.
Growth: Your center can develop as many entities as needed:
- 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 testing;
- contracting: MRIs, CTs, diagnostic ultrasound;
- in-patient: hospital privileges, emergencies;
- out-patient: medical referral, medical network.
Personal Injury (PI): The multi-discipline center has the most comprehensive documentation back-up necessary to satisfy the PI legal protocols.
Workers’ compensation (W/C): Employers, adjusters and patients attempting to receive efficient, thorough, diversified care will find multi-care centers a viable solution.
So where do you start if you believe that in your case, the pros of multi-discipline practice outweigh the cons?
First: Evaluate your philosophical position about your profession:
- Do you truly believe in what you do?
- Do you understand your patients’ needs?
- Do you breathe, talk, walk, think, act and practice chiropractic?
- Is the intent to integrate your clinic to enhance your services?
If the answers to the above questions is yes, you should continue your search.
Second: Analyze your demographics:
- How many multi-discipline centers are in your neighborhood?
- What do your patients think about
the idea? - How many MDs in your town?
Third: Staffing, management, and finances:
- Are you an effective manager? (Or do you have one?)
- How are your staff members’ organizational skills?
- Are you financially stable?
Last but not least: Are you really ready for a change? Professional satisfaction is where you are today. If you are not genuinely happy with yourself today, the integration package will not make matters any better. It may certainly increase your income, but again, what is money if you are not happy?
The multi-discipline system is not for everyone, but for those who know it’s right for them, it can be a professional dream come true.
