Walk through almost any state association convention or expo hall and you are bound to come across doctors who are considering opening a multidisciplinary practice or converting their chiropractic practice to such a model.
Often there will be an assortment of consultants who are happy to help them along the way. If you take a deeper dive, however, you will hear a wide variety of ways that doctors and consultants seek to arrive at this goal. For the doctor thinking about making such a move, this can be a dizzying experience. What is the right way to do this? And should it be done at all?
To be sure, the rewards of a multi- disciplinary practice can be great.
Similarly, the risks can be enormous and those rewards can vanish in an instant if a practice is not following certain key guidelines pertaining to compliance. Many a well-meaning doctor has been led down the wrong path by other well-meaning individuals. This decision is likely the most important professional decision you will ever make other than the one you made to become a doctor of chiropractic in the first place.
Clarify your perspective
How do you make the move to multidisciplinary practice the right way?
Begin by asking yourself why you are doing it at all. If your motivation is purely financial, stop! Take a good long look and ask yourself what your “greater why” is.
Making such a move with money as the prime motivator will always lead to problems down the road. If your motivation is based on service, you are on a better path.
Get proper legal advice. There is no other way to say this any clearer: Be sure to hire an attorney who specializes in healthcare law in your state.
Each state has its own set of laws that determine who may or may not be able to own a company that provides medical services. Some chiropractors are shocked to learn they might not be able to own their practice any longer because their state law does not allow a chiropractor to have ownership in a medical entity or to share in fee income from medical services. In such circumstances, having the best legal advice possible is invaluable.
Don’t skimp on hiring the right attorney. And never try to copy what your buddy from chiropractic college is doing. They may be doing it all wrong. Make the investment in hiring the best healthcare attorney you can find.
Locate the talent
Once you are clear with your corporate structure, you can begin recruiting the healthcare team you wish to add to your practice. Depending on the services you plan to add, hiring an MD or a DO may be the best way to go. In many places, hiring a midlevel provider such as a nurse practitioner or physician’s assistant can be a smart choice, as they can often provide many of the same services as an MD at less cost.
Here again, be certain that your state law allows for the scope of care you would want the midlevel provider to deliver. Some insurance plans, including Medicare, may require a physician-level provider to deliver certain types of services. Know what can and cannot be done with the providers you are talking to and do not assume that they know the right answers.
The No. 1 pitfall in so many multidisciplinary practices is not allowing for independent treatment protocols. Each professional member of your team must be allowed to set their own treatment protocols without interference.
As a doctor of chiropractic, you cannot be seen as dictating to your MD how to practice medicine. Similarly, your physical therapist cannot tell you how to practice chiropractic. It should be spelled out in your practice compliance manual that each licensed healthcare professional will set his or her own treatment protocol for each patient under their care and do so within their scope of license.
By the book
Another key point is ensuring all services performed are based on medical necessity. There are consultants who advise their clients to have all patients follow a certain track once a patient enters the practice.
For example, the practice might want all patients to see the medical doctor first and get the same battery of tests. But this is looked upon with suspicion by both insurance carriers and state boards.
If those tests are necessary for diagnostic and treatment purposes for that patient’s condition, fine. But if this is not the case, let the doctor beware.
Without question, insurers are masterful at analyzing data—their bottom line depends on it. If they suddenly see that your practice is doing an extraordinary volume of services that it has never done before, or is falling outside the realm of what is considered normal, you can expect them to take a peek. Be sure you can support your billing with solid documentation of medical necessity.
Having a multidisciplinary practice does not give the chiropractor license to bill adjustments under the name and license of the medical doctor.
There is no shortage of horror stories about this. Some chiropractors may even use the defense that their consultant told them it was OK.
It should also be common sense that each provider in a practice bills for only those services that they personally provided. In the end, regardless of what any consultant may say, you are responsible for knowing the laws that govern your practice.
The most successful multidisciplinary practices are those that provide a wide menu of services to the patients that require them, and do so in a coordinated manner. This coordination and documentation of care is the hallmark of a practice that has a mission to do the right thing for the right reason.
If you have a multidisciplinary team, set a time each week to have a huddle about the patients who are receiving care from more than one specialty in the practice. Document each provider’s plan of care and the expected outcomes. If the patient is not tracking as expected, decide what will be done to move the patient in the right direction so that procedures are not duplicated.
From a reimbursement and compliance perspective, a multidisciplinary practice places more balls in the air to juggle, and it may not be right for everyone. If you do elect to enter this world, don’t go it alone. Yes, it can be highly rewarding when proper attention is brought to the creation and implementation of your vision. But don’t destroy your future through greed or ignorance. It is easier to do it the right way, right from the start.
Kathy Mills Chang is a certified medical compliance specialist (MCS-P), a certified chiropractic professional coder (CCPC), and certified clinical chiropractic assistant (CCCA). Since 1983, she has provided chiropractors with reimbursement and compliance training, advice, and tools to increase revenue and reduce risk. Kathy leads a team of 20 at KMC University and is considered one of our profession’s foremost experts on Medicare, documentation and compliance. She or any of her team members can be contacted at 855-832-6562 or firstname.lastname@example.org.
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