Am I joining forces with "the enemy?"
There's a lot of buzz these days about integrative healthcare and for a few it's akin to crossing enemy lines.
However, I am one of the many new generation D.C.'s.
We learned of the Wilk v. AMA lawsuit in school, but didn't live through that degree of opposition. We respect the struggles of our chiropractic ancestors but honestly can't wrap our head around that level of scrutiny.
I myself, look forward to conversations with 'traditional' medical providers and recently had an opportunity fall in front of me.
So, I'm asking you, fellow bloggers and readers alike for a little guidance...
I've been invited by a local M.D. to join his satellite clinic as part of his specialty team of physicians. He'll offer primary care full time and have a rotation of specialists throughout the week.
It's an attractive idea to me because the location is in an area I already draw patients from - but compliance is an issue because of the distance. I'm hoping to see those established patients more as well as direct referrals that may not otherwise consider chiropractic care.
Aside from the obvious "overhead vs. profit margin investigation" - what are the pros and cons? Has anyone had an experience working with another provider outside of our profession? Are there any resources available?
Please comment below - I'd love to hear your thoughts.
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Dear Dr. Palmer
There are no negatives at all, provided however the fundamental structure of the integration is truly patient-centric and the operation itself above board. The invitation clearly demonstrates that the animous between professions is diminishing. Remember the Wilk v AMA was not a “clinical medicine” lawsuit...it was a “political medicine” lawsuit.
Clinical medicine for the most part was not even aware of what the political arm of their organization was doing (save for a few). So with that division in mind, the local medical physician obviously has a grasp on the needs of his/her patient and wants to provide for those needs in an integrative way.
Many of the people entering the practice will present with a neuro-musculo-skeletal complaint, or some other ailment for which there is a “stress” component. Obviously this MD understands the benefits of a non-drug, conservative and integrative approach and deserves applause. Your only challenge will be to balance that “compliance” which you recognize as a distance factor.
Who knows ... in a year you may have a working relationship which will cause you to move your practice compltetly into this integrative clinic and partner.
I do not know what the financial arrangements are (and care must be exercised to make that arrangement legal) but the concept is excellent. The patient will benefit and your reputation will be enhanced - provided the reputation of the medical clinic is good.
Have your attorney review the contract. Malpractice implications are involved as well as contract obligations and division of economics and responsibility.
There are no drawbacks or caveats only the usual caution in any relationship...are the people compatible... if that exists, success will follow.
Dr. Sportelli
Posted by: Dr. Sportelli | March 11, 2009 at 11:42 AM
Erin
In 1966 I discovered, after participating in the front lines, to acquire a regulatory law for our profession in Massachusetts that the real enemy was within our own ranks.
For many years prior to 1966 we blamed the medical enemy for our legislative failures when the reality was that we were a house divided. It was not until we coalesced under strong persuasive leadership that we were able to accomplish the dream of bathing under the sunlight of legislative legitimacy.
That truth holds true today. I look at your opportunity as a marvelous step toward integration and collaboration, all for the purpose of patient benefit.
Should you move forward with this endeavor you will be a pioneer in a new and exciting model of delivery. I must echo Dr. Sportelli ... be clear as to your expectations and that of the MD. Be sure that legal counsel reviews any documents that present anything less than a win-win agreement.
I interface on a daily basis with DC's who have moved in the integrative direction and not one has regretted that decision.....Go For It!!!!!!!
Posted by: Dr. Richard Vincent | March 11, 2009 at 12:23 PM
We work with those outside of our profession evertie we make or receive a referral. The ony difference here is that you are working at the same facility. As Dr. Sportelli emphasized, the contract must be reviewed carefully. Will you be an employee? Is he/she going to do the billing? Will this be an independent contract? What is the business relationship of a rotating specialist in his clinic? As long as your position in this clinic is clear for malpractice and IRS purposes, the rest is going to be up to whether the fit is good.
Congrats on the opportunity and good luck!!!
Posted by: John DeMatte IV | March 11, 2009 at 12:28 PM
Dear Dr. Palmer,
I agree with the above statements that if done properly, a multidisciplinary practice can indeed, be fruitful to everyone involved. Make sure that an attorney reviews the contract.
From a compliance issue, Stark Laws and the Anti-Kickback Statute requires that there is no compensation based on the number of patients you bring in or the amount of services performed. In other words, your pay is not on a sliding scale based on what you bring in.
Next, make sure that the medical doctor does not "rubber stamp" continuing care that is referred to you. Upon re-evaluation, if the medical doctor continually sends the patient back to you, regardless of the outcome or progress of your care, this could be considered fraud. In one recent case, the M.D. "examined" the patient and sent the patient back to the DC for continued care. This occurred over and over. Ultimately this resulted in the patient being seen by the chiropractor for 246 visits. Since there was fraud involved all medical personnel, including the chiropractor were hit with huge fines.
Check to see how the billing will be done. One recent seminar that was advocating multidisciplinary practices stated that if the manipulation was billed under the MD NPI number, that they could charge $100 for the manipulation. This is fraud. You must bill under your NPI number as performing the service, which is then paid to the corporation.
The bottom line is that any fraud by the corporation, even if done without your knowledge, may lead to fines, conviction and possible revocation of your license. You are responsible for the actions of the corporation. This is referred to as "Duty of Care."
For the patient, this could be a fruitful relationship. Legally, make sure that a healthcare attorney and a Medical compliance officer is overseeing the actions of the corporation.
Posted by: Mario Fucinari DC, MCS-P | March 12, 2009 at 01:14 AM
I had known a few collegues when I practiced in Ohio that went the route of a multi-discipline practice. In each case it was the chiropractor's practice and the MD came in one to two days per week doing different services ranging from exams to injections. I strongly agree with Mario about the "rubber stamp" scenario. Be careful and do your research on this venture.
If all of the professionals are there to support each other and simply provide the best care and opportunities for the patients I think it's a wonderful thing. Other than the convenience, the logical thing here for me is the fact that you have support system built in. Assuming the MD really wants the advantage of having a DC on staff then that allows you to be in a situation where you know you can comfortably refer this patient for a medical consult knowing they will remain under your care.
However, I am not familiar with any situations where the MD owned the practice and the DC came in as a compliment. I look forward to seeing how this plays out. Please keep us informed and good luck to you.
Posted by: Adam V Downs, DC | March 16, 2009 at 01:45 PM
Dr. Palmer, Daily we hear and read about the new model of health care in which multiple doctors of multiple specialties practice together for the benefit of their patients. Personally, I don't have all health care answers, and while many benefit from chiropractic, they also benefit from medical or concurrent management involving multiple specialities. Practicing in the same location sure makes that scenario convenient and may also be an additional selling point to some managed care organizations.
I would strongly recommend that you perform thorough due diligence as your reputation will be linked with any provider you have a relationship with. Make sure they are ethically of the highest caliber and financially stable. Being aware of their licensing history and if they have had any board sanctions is imperative. It's also paramount that each party has reasonable and shared expectations for the relationship as a "win-win" for both the doctors and patients should be a goal. Best of luck and I look forward to hearing how it all turns out.
Posted by: Wayne C. Wolfson, D.C. | March 16, 2009 at 09:44 PM