by Mark Sanna, DC, ACRB Level II, FICC •
President & CEO Breakthrough Coaching •
Multidisciplinary practice, once considered a rare phenomenon, is now a marked trend in the healthcare industry. Market forces and decreases in revenue are driving practice consolidation within chiropractic — a movement already familiar to the medical community, where less than 30 percent of medical doctors remain in private practice.
Honor your unique professional roles.
Chiropractors and physical therapists offer different but complementary approaches to patient care. While chiropractors focus on the spine and nervous system, physical therapists focus on musculoskeletal conditions, rehabilitation, and movement. When these two professions work together, they can provide a comprehensive approach to patient care that addresses both physical and physiological aspects of injury and illness.
In addition, chiropractors and physical therapists can share information and collaborate on treatment plans to ensure patients receive the best possible care. Communicating and referring patients to each other when necessary can provide a seamless continuum of care and improve patient outcomes. Moreover, working together can also benefit the healthcare system as a whole. By focusing on preventative and non-invasive treatments, chiropractors and physical therapists can help reduce the burden on hospitals and other medical facilities and lower overall healthcare costs.
Is adding a PT to my practice right for me?
“Yes” is not the right answer for everyone. It’s not the saving grace for a practice that is not financially sound. It’s great for practices that are ready to go to the next level. A chiropractic practice should consistently see at least 100 insurance-reimbursed office visits per week and at least 20 new patients monthly before considering adding a PT to the healthcare team. In addition, your state must have a favorable legal and reimbursement climate for multidisciplinary practices.
Many states allow a chiropractor to hire a physical therapist as an employee. In these cases, consult with a local healthcare attorney to ensure your current Articles of Incorporation will allow you to include the service of a physical therapist. Some states require simple changes to the existing Articles of Incorporation. Some states do not permit a chiropractor to hire a physical therapist and require a medical doctor as part of the ownership corporate structure. It is essential to work with a knowledgeable healthcare attorney to ensure that your entity complies with all state and federal laws. You should also review these laws annually with an attorney to ensure you comply with any changes.
What can I expect financially?
Many carriers provide a separate benefit for services provided by a PT. This allows patients to utilize the chiropractic benefit for chiropractic services (exams, adjustments, etc.) and have additional services provided by the PT (exams, rehab, modalities). Physical therapy coverage may reduce limitations for reimbursement for a DC-only practice. Perform a sampling of insurance verifications for the most common carriers currently represented in your practice. Verify both DC and PT benefits. If there are benefits for services provided by a PT that are not covered when provided by a DC, adding a PT may be right for you.
Isn’t hiring a PT expensive?
Starting salaries for PTs vary per area of the country. A quick search on Indeed.com or Glassdoor.com will provide a range for your geographic area. As with all practice-building activities, your minimal goal should be to realize a 3:1 return on this investment. You should be able to cover four months of increased overhead to allow the revenue stream to begin. In a post-pandemic world, credentialing new staff members with insurance payors can be a major roadblock, slowing reimbursement for 3 to 6 months. This gap can be covered by current cash flow, cash on hand, or a line of credit. Be sure to figure in the cost of any equipment you may need to purchase to allow your PT to provide quality service to your patients. Starting with “low-tech” rehab equipment is often fine for most practices.
How do I hire a PT?
Physical therapists are in high demand in many markets. It is best to develop a multi-pronged approach. Cast as wide a net as possible. Do not drop single lines into the water. Having as many channels working as possible will increase your chances of hiring in a shorter period. Remember, you do not have to hire the first person you meet! Be sure to find the right fit regarding the volume of patients to be seen, case management goals, and practice philosophy.
Consider:
- State Board lists
- PT school websites
- APTA website
- State and local Association websites
- Ads in local papers and websites
- Staffing agencies
How can a PT help grow my practice?
Many patients do not have chiropractic as part of their healthcare paradigm. This includes many medical physicians. An on-staff PT increases the perceived standard of care your practice provides. It can make your practice a more desirable destination for referrals. One of the most significant yet overlooked aspects of creating a multidisciplinary practice is that you will attract referrals that you might not receive in a DC-only practice. While not reality-based, some members of the medical profession view a referral to a chiropractor as a referral to a lesser standard of care. Referrals to a physical therapist are not viewed this way. Marketing your multidisciplinary practice to medical doctors fosters the quality and quantity of referrals that you desire.
Enlist the marketing skills of your PT to help you market your practice for referrals. Set aside dedicated practice-building hours for your rehab department. This can be orchestrated by the clinic director and implemented by the physical therapist. Design referral pads that highlight your practice’s physical therapy services and deliver them to nearby medical offices. For added impact, offer in-service programs at those offices explaining the services your multidisciplinary practice provides. Learn who actually makes the referrals and build relationships with those individuals. Oftentimes it is not the medical physician but the office manager or front desk personnel who act as referral coordinators.
Maximize health from the inside out.
Chiropractors have attempted to change the healthcare system from the “outside-in” for over a century. When chiropractors and physical therapists work together, they can provide a comprehensive and integrated approach to patient care. They can improve patient outcomes, reduce healthcare costs, and improve the quality of life for patients. By collaborating, they can ensure patients receive the best possible care, avoid unnecessary procedures and treatments, and maximize optimal health and wellness.
Dr. Mark Sanna is the CEO of Breakthrough Coaching. He is a Board member of the Foundation for Chiropractic Progress, a member of the Chiropractic Summit, and a member of the Chiropractic Future Strategic Plan. To learn more, visit www.mybreakthrough.com.
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Why is the Discount Challenge prize amount $15,024? Because that is the average “per-occurrence” fine for Medicare inducements. That’s not $15,024 per patient, that’s not per provider, that’s PER VISIT. Stinks, doesn’t it? To us, the prize amount is worth the investment if we can help our profession better understand proper discounting.