Doctors of physical therapy and integrating PT into chiropractic care protocol to thrive in the new health care paradigm

WHEN I WAS NEW TO PRACTICE prior to working with doctors of physical therapy, I recall asking a local chiropractic mentor what advice he had for “surviving” in our profession. He was retiring mainly due to decreasing insurance reimbursement. What he recommended was to carefully study whether to participate in insurance networks where there’d be a risk of them exerting control over the practice or use a fee-for-service/cash practice model where I had sole control over the practice.

Diversifying to benefit patients with doctors of physical therapy

Five years later, I was navigating the cash-based practice world well, in part because insurance networks did not permit me to participate in their networks as a new provider.

I realized that I wanted more. I wanted to grow and add additional services, disciplines and providers, so I became part of a consulting group. My coach at the time suggested that I join insurance networks that most patients in our surrounding area were members of.

She explained that if my goals were to grow and help more people, patients who have certain insurance coverages would want to use the benefits they have and are paying for. If I didn’t accept that insurance, it would be another obstacle the patient had to face to come see the disciplines we offered.

So, I decided to play in the arena of third-party payors and became multidisciplinary, adding physical therapists and additional chiropractors. The road has had many ups and downs but the choice of an insurance model vs. cash and being multidisciplinary is one we all must make, then adapt to its ever-changing status to thrive, not just survive.

Change is always coming

The key is simple — be open to change and realize that your practice today may look totally different in five years. What should be driving us in our decisions to adapt to change or not, is the lopsided ratio of people who use our care versus people who don’t.

The question to ask ourselves is do we have something good to offer our patients in our communities? Yes.

Here are my three reasons for encouraging you to consider change in 2021 and evaluate taking the leap of adding products and additional services: supplements, custom foot stabilizers or services like physical therapy, massage therapy, functional medicine or medical services to your practice:

1. Patient benefits
Patient outcome is the number-one decision driver at our practices. Comprehensive care given from a chiropractor and a doctor of physical therapy completes the three pillars of structural health (mobility, alignment and stability) with short- and long-term results.

Also, the impression created for patients that multiple providers are helping them increases the perceived services they are receiving. I can’t tell you how often I hear from patients: “It’s so great you have multiple providers and multiple disciplines here.” When patients receive great chiropractic care with complete, progressive, thorough physical therapy care the patients respond faster — bottom line.

2. Protocol consistency
Every new patient has a consultation, examination, diagnostic testing, 3D foot scan and movement screen to determine all variables that need to be addressed for short-term relief and long-term recovery. At our clinic we have something called the DMR approach:

• Diagnosis: disc herniation? flat feet? weak VMO/glut med?;
• Management: chiropractic, physical therapy, custom foot orthotics to correct structural imbalances and stabilize the body from the feet up, and supplements;
• Rehabilitation: our goal is to graduate patients and give them simple tools to help maintain their specific patterns of structural imbalance to avoid future relapse.

3. Doctors’ and providers’ benefits
What skill are you, the chiropractor, best at? Adjustments. What are the doctors of physical therapy and PT providers best at? Skilled manual therapies and therapeutic exercise instruction.

The challenge is, if you agree in addressing muscle imbalances that may be contributing to subluxation like I do, the chiropractor’s time spent with patients on “physical therapy” versus time spent providing your adjustment is extremely disproportionate and leaves the patient confused as to what exactly you are — a chiropractor or a physical therapist?
The solution here is simple: Together we are better; focus on what you do best; collaborate for the benefit of the patient.

4. Practice benefits
If you are an in-network insurance provider, you know the insurance companies want chiropractors to fall within parameters, including visit limits, services per visit, dollar amounts per case, etc. When you the chiropractor are focusing on just the adjustment side of the care — it’s a lot easier to stay close to what the insurance companies are wanting.

Let’s be honest here, my life is a lot better when the numbers of the practice are in the black and not the red. Reimbursement amounts for manual therapies and therapeutic exercises are much more favorable when administered by a physical therapist.

Elevating your practice by being open to change

So, what will it be for 2021? Play the game or stay the same?

My practice mission statement is: “To create high-quality, state-of-the-art facilities for patients to visit, where providers offer high-quality care and to be a catalyst in elevating chiropractic to the level it is worthy of by creating these facilities with the goal that the providers achieve a high quality, balanced life through our systems of care and business operations.”

That mission statement hasn’t changed in 15 years, but what has changed is what our practice looks like, disciplines we have added, products we have taken on, etc. I am certain that in five years from now our practices will again look very different. We as health care leaders need to lead the charge in changing for the benefit of our profession and of course, our patients.

TOM SCHMIDT, DC, CCSP, is the owner, founder, clinic director and treating provider at Life Wellness Center in Lakeville and Eagan, Minn. He is a graduate of Concordia College in Moorhead, Minn., and Northwestern College of Chiropractic in Bloomington, Minn.