Trend toward teamwork: Consider the advantages of integrated practice

On the whole, the health of the U.S. population is less than optimal, especially given its position as one of the most powerful countries on the planet.

Somewhere along the way, despite being the land of opportunity, education, freedom, and hope, the U.S. has witnessed a sharp rise in rates of childhood and adult obesity, with comorbidities of diabetes, increased risk of cancer, heart disease, and joint disorders.

Accordingly, you are likely seeing an increase in the number of patients who are coming in because of stress, anxiety, depression, hyperactivity, ADD, fibromyalgia, general fatigue, and pain.

It makes you wonder what is going on—because this doesn’t make sense given the medical advancements in these areas.

Perhaps this state of affairs is caused by market forces and the incentives provided by government programs and insurance carriers, who only pay when people are sick. In addition, healthcare professionals and doctors are given the responsibility to care for the community and their patients. They’re supposed to be teachers who educate patients on attaining complete health.

In an ideal world, like-minded providers would work together to provide the best care, using their knowledge and specialties to optimize patient health and function and eliminate preventable diseases. Given today’s level of knowledge and technology, it’s remarkable that we still experience so much self-caused (and avoidable) disease.

A natural response

For its part, the medical community has been taking steps to respond to the state of the nation’s health, and integrated practices have been instrumental in these efforts. Practices have been integrating partly out of the need to survive but mostly to provide better service to patients.

In California, for example, the state legislature left chiropractic out of the insurance exchange basic policy established in accord with the Affordable Care Act. Whether this was intentional or merely an oversight remains unclear, but there’s no question that today’s practices need to evolve to survive.

In the past, integrated practices were usually only seen in the workers compensation clinic model. They have since progressed and now you also see integrated practices in insurance, Medicare, cash-only, and personal-injury models.

Most investors will tell you the key to investment success is diversification, and medical practices are not entirely different. Having a diversity of services offered by multiple providers helps generate revenue from various sources, which protects against the risks faced by those who are dependent on one type of service or payer. The latter can be hit hard in the event of changes in legislation or reimbursement.

Addressing the whole patient

At times you may see patients who might be better off with less or even no medication. But as a chiropractor you generally can’t talk about changing medications with patients as it is considered practicing medicine without a license.

Medical doctors can legally discuss and help titrate patients off medications where indicated.

If all you offer is chiropractic and you only perform adjustments, you are most likely going to assume everyone needs is an adjustment. As the saying has it: If all you have is a hammer, everything looks like a nail. Similarly, medical doctors who have been trained in medicine and surgery are likely to think everyone needs a pill (or surgery if the medication doesn’t work).

An integrated model allows for the entirety of a patient’s needs to be addressed and treated.

Some DCs perform only minimal exams, checking posture but rarely, if ever, taking blood pressure readings, asking if the patient is on medications, or looking into organ and systemic functions.

As a DC, you can say you are only interested in neuromusculoskeletal conditions, but if every doctor says they are only interested in (fill in a specialty), who is going to integrate, coordinate, and ensure all aspects of the patient are being addressed and treated?

You are.

Divisions of labor

So how can you move into this more active position in patient care? By offering care, assessments, examinations, and providing what is best for the patient.

You can take comprehensive histories, perform thorough exams, and refer to an MD any procedure you think necessary but for which you are untrained or limited by your scope of practice. MDs are well suited to auscultate the heart and lungs, do an EKG, order blood labs, and assess medications.

You can carry out orthopedic and neurological tests, providing the postural advice, therapies, adjustments, nutrition and supplement guidance, and lifestyle instruction that encourage healthy behavior. MDs can review lab results, interpret the toxicology screens, assess medication interactions, and monitor the effects of lifestyle interventions.

For example: Suppose you have a patient who is overweight with joint pain, diabetes, hypertension, and poor posture. You’d conduct a thorough exam recording patient height, weight, body mass index (BMI), blood pressure, joint range of motion, and the orthopedic and neurological tests performed. The MD would order labs to monitor cholesterol, blood glucose, and liver health.

While you work with the patient on diet, nutrition, and supplements that can help with weight loss, the MD would recommend specific caloric targets and protein-consumption goals to induce weight loss while monitoring potassium and glucose levels.

The patient starts losing weight, the cells start shrinking and recognizing glucose, sugar starts getting into the cells as it is supposed to, and the patient is on the road to get off diabetic medication. Diet modification, exercise, and adjustments work to lower blood pressure as well.

Further integration into this program of care is conceivable. You might suggest massage to work out tired or tight muscles as well as acupuncture to assist with weight loss, stress reduction, and pain management. Each provider offering patients the best care results in optimal health and normal healthy function.

The stage is set

There is room for you to make a positive difference; most patients in the U.S. are lacking key facts about health and wellness. Many don’t know:

• how much water they should consume.
• how much protein they should intake (and how to calculate it).
• how many calories their body burns per day and how many calories they should eat to lose weight.
• the importance of vitamins, when they are needed, and how the body uses them.

The general lack of knowledge about these items has resulted in a largely sick population. Yet a majority of the diseases you see are preventable.

Yes, there are those few genetically based or rare cases you can’t do too much about, but for most of your patients, it goes back to taking the time, providing all that they need, and educating them for a life of health—not just a moment of relief or a quick fix. In an integrated practice, you and your team can address the broadest spectrum of needs your collective skills allow.

Stephanie Higashi, DC, is CEO and founder of Health Atlast, a multidisciplinary healthcare franchise. She can be contacted through healthatlastnow.com.