The Future of Chiropractic is Collaboration
PERSPECTIVE
Ray Foxworth
D.C., FICC, MCS-P
I have been in practice for over 3 decades. To say that our business model has changed in that time would be a gross understatement. With each new generation, the expectations of quality and convenience have become more of a central priority. This requires us to re-evaluate the “lone-wolf’ business model of the last hundred years and shed our underdog mindset.
In my early years of practice, I worked diligently to educate other medical practitioners about chiropractic care. Most of them smiled and nodded politely, never hearing what I said. But it only took one to hear me out, ask questions, and do some research, to give chiropractic a chance. Little did I know that the interaction would change the direction of my chiropractic career. It led me to a position as the Staff Chiropractor for the G. V. Sonny Montgomery VA Medical Center, a board member position, and ultimately, Chairman for the Mississippi State Board of Health. Eventually, I moved my practice to the campus of a multidisciplinary spine center. Those early years were frustrating and exhilarating. Every opportunity gave me a chance to educate other medical professionals about chiropractic care and treat more patients that would never have given chiropractic a chance.
Working in a multidisciplinary setting at the VA, and at the spine center, taught me a lot about the importance of collaboration. Working with a group of providers allows us to call on the expertise of others when it comes to helping our patients and is often more cost-effective for everyone when we, as chiropractors, are coordinating the care. As a profession, we know that referring out can often result in losing the patient. But when we collaborate, we can refer for a consult with another specialty, which helps keeps us in control. Having a broader scope of knowledge and services available improves not only patient outcomes but patient satisfaction. Additionally, Em not alone, which means that I have others to shoulder the responsibility of compliance, billing, coding, etc. When I take a vacation, or a day off, my income is no longer dependent on my presence in the office. The freedom to attend school functions, social events, and take breaks, is priceless. It taught me about working smarter, not harder.
The best advice I received when I opened my multidisciplinary practice was, “Hire a consultant.” The rules and regulations vary from state to state, and the price tag for doing things the wrong way far exceeds the expense of getting good advice. When I transitioned back to private practice, I got a lot of help from a great consultant and a healthcare attorney that were well-versed in the model for my state.
There are financial benefits to operating a multidisciplinary practice, as well. In Chiropractic Economics' May 2018 Industry Salary and Expense Survey, 55 percent reported working alone, down from 64 percent last year. 30 percent said they operated as a multidisciplinary clinic, up from 25 percent last year; and 8 percent identified as an integrated clinic, a decrease from 11 percent last year. Additionally, there were huge variances between integrated, multidisciplinary, and DC-only practices when it came to billing, collections, and total compensation. (Fell, 2018) Consider the stats below:
Billings
Integrated health care practices reported the highest billings ($1,418,550), while multidisciplinary practices reported billings of $649,380, and DC-only practices came in at $530,430.
Collections
Likewise, integrated practices saw the highest collections ($1,092,940) while multidisciplinary clinics reported collections of $441,780, and DC-only practices had collections of $422,480.
Salaries and Total Compensation
Salaries rose across the board for two types of clinics, with DC-only and integrated clinics faring better salary-wise than multidisciplinary clinics. Integrated DCs had an average salary of $146,000 annually. DC-only clinics had an average of $112,650 followed by multidisciplinary clinics at $93,470.
Integrated practices vary widely, but often include:
Massage Therapy: Combining chiropractic care and massage therapy has excellent benefits. Massage relieves pain faster and loosens the muscles for a more effective adjustment. A study published in the European Journal of Physical and Rehabilitation Medicine stated that a combination of chiropractic and massage therapy were more effective together for the treatment of tension headaches.
Fitness Training: As our patients get older, they tend to lose muscle mass and function, which can lead to injuries. Offering personal training in your practice helps your patients build core strength to improve healing and minimize future injuries. Additionally, several studies show that exercise helps patients reduce chronic pain and improve their quality of life. (Cochrane Database of Systematic Reviews, 2017)
Physical Therapy: Chiropractic and physical therapy complement each other. Hiring a physical therapist in your office can help patients reduce inflammation while strengthening and stabilizing joints throughout the body. When combined with chiropractic care, patients have decreased pain, decreased muscle tension, increased range of motion, and improved outcomes.
Acupuncture: Acupuncture and chiropractic care are popular among patients, especially those who suffer from chronic musculoskeletal pain. (Barnes PM, 2008) The combination of acupuncture and chiropractic care work synergistically bringing added relief and comfort to your patients.
Nutrition: Proper nutrition is crucial to our overall health. Poor diet often causes inflammation and pain in our patients. Without proper nutrition, chiropractic care can only help so much. Helping our patients switch to a healthier, and nutrient-dense, diet helps to improve neurological function and patient outcomes.
Nurse Practitioner: An NP with orthopedic, or sports medicine, experience can perform basic in-office injections with ultrasound guidance. These include the small, medium, and large joints, tendon, and bursa, and hyaluronic acid for osteoarthritis. In some states, NPs must be supervised by MDs. Just another reason why it is essential to have the right consultant when moving to a multidisciplinary practice model.
We are operating in an age of patient-driven care. Today’s patients are more lifestyle-focused and place a much higher value on health and wellness. They go to the gym. “Athleisure” attire has given birth to “work leisure” attire. Our watches today not only transmit text messages from our phones to our wrists, but also track our heart rates and the number of steps taken per day. Restaurants tout gluten-free, organic, and vegan options. 5Ks, lOKs, and marathons, are social events. There has never been a better time to be a chiropractor. As my good friend Dr. Jay Greenstein, CEO of KaizoHealth, pointed out, “In today’s era of patient-centered care, patients are becoming savvier and more educated about treatments. You’ll be able to keep more patients, rather than discharge them to another type of provider, by having a multidisciplinary practice.” What’s not to like about that?
Dr. Ray Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA. A practicing Chiropractor, he remains "in the trenches" facing challenges with billing, coding, documentation and compliance. He has served as president of the Mississippi Chiropractic Association, former Staff Chiropractor at the G.V. Sonny Montgomery VA Medical Center, and is a Fellow of the International College of Chiropractic. To request a free one-page financial policy, email [email protected].
