Tips For Chiropractors Integrating Their Practices

By: Jeff Cohen

Inspired by many medical integration consultants and coaching organizations, chiropractors have vigorously pursued medically integrating their practices in the past handful of years.  Led by both the desire to provide effective healthcare solutions and to capture more of the healthcare dollar that their patients are already spending (elsewhere), chiropractors are smart to consider it…slowly!

Too often, there are stories of chiropractors who felt both excited and pushed to sign on the dotted line at integration seminars, only to find later on that (1) the advice they got upset their lawyers, (2) they didn’t understand the complexities and risks that accompanied their practice expansion, and (3) it didn’t work!  What are some of the greatest areas of disappointment for those where the integration didn’t go smoothly?

A. Using integration to fix an underlying business problem. For instance, if you’re medically integrating your chiropractic practice because your chiropractic patient volume has fallen off, first try to understand why your core business is down.  For instance, do you actively pursue marketing?  Is it effective?  What about someone inside your organization who is responsible for sales?  Do you have someone comfortable offering what you provide and talking money? Since it’s typical for medical integration patients to come from your core chiropractic business, a down chiropractic business will not deliver the patients needed to support a robust medical integration line of services and products; and

B. Walking blindly into legal complexity. Most chiropractors enticed by the promise of medical integration simply skip over the legal nuances.  For instance, are they informed of the self referral problems associated with creating a second TIN for the medical entity?  Are they aware of the unique physician supervision requirements of state and federal law?  Have they been informed that it is illegal for a second entity to be formed and referred to if that second entity provides certain specific services?  Is the chiropractor simply buying into a model that they have been informed is “how it’s done.”  If they are, they will likely find that one size fits none.  Its very common, for instance, for chiropractors who have formed a medical entity to back off when they’re educated about the state and federal self referral restrictions.  It’s very common or them to be surprised to learn that not every state requires a “management model,” which is far more complex than a direct services model (which Florida about 12 other states embraces).

The top five tips, therefore, in considering expanding your chiropractic practice into a medically integrated practice are:

1. Before you sign, get legal advice in writing. Do not simply give the lawyer the consulting agreement (or the consultant’s forms to review).  Ask the lawyer to educate you about the laws, the options and the risks associated with those options…and to put it in writing.  To do that, the lawyer will need to know a lot about your core chiropractic business.  Expect to reveal all the pertinent details and to spend a couple hours doing so.  Insist on being well informed!  And if your integration consultant refers you to their lawyer, their “guy” and the guy spends an hour and charges you a flat low fee and basically says “It’s all good” (but never went over exactly what you have, all the key laws, options and risks) and nothing more, run!  Get your “own guy.”
2. Design the best model for you. The model proposed by the consultant may work for many people, but not for you.  You must slow down and see if the model will work for you.  And if not, modify it.
3. Talk with references. Find out how it is to work with the integration consultant you like.  Take your time here.  Talk to lots of people and see whether their experience has been a good one.
4. Identify your key operator and include him/her at every step. If you have your own chiropractic practice, you understand there is a huge difference between being a business owner and a business operator.  And you therefore understand that no business becomes anything just because you have a terrific idea.  You need “boots on the ground” to take primary responsibility for implementing and operating this new line of service.
5. Create accountability. Set a regular meeting (weekly, bi-weekly, monthly) to (a) identify the deliverables of your consultant and key operator, and (b) make sure those steps have been taken.  Keep in mind what some very smart person said “What gets measured gets done.”