Long, long ago in another world of health care, chiropractic was pretty much isolated from allopathic medicine. Chiropractors and medical doctors didn't interact very much. Most medical doctors either had no idea what c hi ro p ra c t i c t re a t m e n t was all about, or they shared the inaccurate ideas and beliefs of their elders, that chiropractic treatment was dangerous and harmful. On their pail, chiropractors preferred to practice without the interference of a medical community that misunderstood the value of their training and approach. It is hard for anyone involved in health care today to believe thai is how things were up, until only a few years ago. Fast forward to the present. The mullidiscipliiuiry team approach to practice is being debated in chiropractic circles across the country. Today, chiropractic is being delivered in hospital-based programs, and chiropractors have joined the staffs of some of the most prestigious medical institutions in the country. Anesthesiologists and chiropractors are now regularly working side-by-side in the hospital setting, performing chiropractic manip-ulation under anesthesia. And, research and articles supporting these therapies appear in mainstream medical journals on a regular basis. In the private practice setting, chiropractors work, along with physical therapists and orthopedic medical specialists, on the sports medicine teams responsible for the care of our most important dancers and athletes. Finally, more and more chiropractors across the country are embracing a multidisciplinary model of practice, delivering the services of chiropractors, medical doctors, and physical therapists to their patients under one root'. Il is wonderful lor the \ chiropractic profession j that ill is revolution is j occurring, but these | changes are raising many j questions among chiro- j praetors. Why did it take I the medical profession so long to realize the value of chiropractic, and why are all of these changes occurring so rapidly in the last several years? How will this increased interaction with the medical community affect the chiropractor's identity as a provider of '"alternative", "holistic" care? What are the benefits for patients and for chiropractors in associating with an MD and incorporating physical medicine and rehabilitation services into their practices? One of the reasons that medicine is embracing chiropractic and vice versa has to do with the huge changes in health care reimbursement. This has to do. in part, with the fact that a new generation of MD's and DCs are graduating into their respective professions with the benefit of new studies and research behind them. They do not carry with them the baggage of the old prejudices and false beliefs of the generation that preceded them. With the advent of managed care, medical doctors have been forced to deal with some of the same economic challenges that chiropractors have dealt with from the beginning of the profession. There is a growing sentiment among MD's and DCs that. "We're all in the same boat", when it comes to getting reimbursed for our services. Like many chiropractors, you may be seriously considering forming a multidisciplinary practice. More than likely, you are concerned about the increased expenditures in time, money, and energy that will be involved. Becoming a multidisciplinary practice is a big step to take, from both a personal and a business standpoint. But. then, when have you ever gotten a big return without taking a big step in life1? Deciding to become a chiropractic physician was a big step. Attending professional school for all of those years and then graduating was a big step. Opening a practice of your own was another big step. You can be proud of the fact that you are the person who took these steps, and you will be very capable of taking this step as well. Let\s review some of what you and your patients can expect when you become a multidisciplinary practice. But. first, one very, very important caveat. When you become a multidisciplinary practice, you are going to create, within your chiropractic office, a comprehensive physical medicine and rehabilitation facility. You will enter a world that may be totally new to you. Do not attempt to do this without getting expert advice. Setting up a multidisciplinary practice is complex and highly individualized. You will need help from experts in the areas of medical-legal issues, diagnostic testing, medical staffing, and coding and billing, just to cite a few. Your office may need to be restructured in terms of staffing and physical space. Should this complexity inhibit you from moving foreword'? Of course not! Just be sure you have the advice of experts in the field from day one. I have seen multidisciplinary practices that were horrible failures, and I have had the pleasure of working in several that were and are tremendously successful. In all of these cases, what made the difference between success and failure was careful planning and the use of expert consultants to set up the practice to run correctly from day one. Once you have decided to take the next big step in your career and form a multidisciplinary practice and have chosen the proper consultants to advise you. what can you expect? How will things be different? Will the good things you have now in your practice,- the relationship you have with your patients, and the wonderful miracle of chiropractic-remain unchanged? The answer to this question is a resounding. "Yes". As the Chiropractic Director and CEO of your multidisciplinary practice, you will remain the business leader and provider of chiropractic care. Your patients will continue to come to see you to receive chiropractic care. The medical doctor will be responsible for medical screenings and will oversee the physical therapy, but your relationship with your patients will not change. If structured appropriately, your practice's identity as a chiropractic practice will not change, and new patients in need of chiropractic care will continue to seek you out. What will change is your ability to offer your patients tremendously expanded services. Your patients will be pleased and impressed that you have expanded your office so that you can provide them with more complete care. I was always impressed, when I worked as the medical physician in multidisciplinary practices, with how appreciative the patients are to be treated by a team of experts, all assembled under one roof with one goal: to help the patient. Another advantage to being a multidisciplinary practice is that you are able to provide additional diagnostic services for those patients who would, otherwise, have to be referred out of the office. Patients appreciate this convenience, as well as the knowledge that they are in a state-of-the-art facility, where even the most sophisticated neurodiagnostic testing can be performed on premises. ; Because you are now considered, in part, a medical facili- : ty. neurodiagnostic tests will be ordered and reviewed by your MD. You can expect excellent reimbursement for tests : that are appropriate. Because of their usefulness, complexi ty, and the need for certified technicians and an MD to read them, these tests are reimbursed highly by insurance compa- i nies. Your patients will benefit from state-of-the-art-diag- | nostics. and your practice will, too! j The expanded reimbursement that you will realize is not I limited to diagnostic testing. In most cases, the benefits that insurance companies allow for medical treatment and physi cal rehabilitation services greatly exceed what is allowed for chiropractic care alone. You will realize a financial benefit, and your patients will be able to continue their care in your office without being cut off. midstream, by their insurance j company. | You will also experience increased referrals to your prac- ! tice when you become multidisciplinary. Your old referral sources will realize that you now offer more services, and they will refer to you those patients that they have been sending elsewhere. You won't only receive referrals for chiropractic treatment, as you did before: you will get referrals for physical therapy, medical evaluation of injuries, and j diagnostic testing. The attorneys you work with will be j pleased with the increased documentation you will be able I to provide, and happy to have their clients receive all of j their treatment under one roof. More importantly, once you become a multidisciplinary practice, you become part of the huge mainstream medical community in your area. You will begin to receive referrals from the medical doctors in your community: and. for the first time, you will have success in marketing your practice to your MD neighbors. For example, in many of the practices I worked in. orthopedic surgeons would regularly refer patients into the practice for physical therapy and chiropractic care. You will be able to send the chiropractic message to the medical community, because you will be a part of that community! More complete services and better care for your patients. Increased referrals and revenue for your practice. Acceptance and respect from the mainstream medical community. These are just some of the benefits you will receive when you make the move to multidisciplinary practice. So. what are you waiting for'.' Take the first step, right now. You will never look back. Marc H. Semer, MD. FACIP, has spent years working as an ardent supporter of the chiropractic profession. He has served as the Medical Director in five multidisciplinary practices. Dr. Sencer is the Vice President of MD Solutions, a Medical Staffing Company specializing in the needs of chiropractic practices. Through MD Solutions. Dr. Sencer has placed MD's and physical therapists in chiropractic practices across the country. He can be reached at 1-800-665-0106, or online at www.mxinedicalsolution.com.o
