Students and alumni agape at the frenzied growth of integrated health clinics often ask themselves whether multidisciplinary practice is right for them. Their interest bears witness to an inexorable trend toward service consolidation that is currently sweeping the country. Nor does the trend show signs of letting up as the buzzwords "multidisciplinary," "integrated" and "complementary" edge their way into daily parlance. The phenomenon conjures up a scenario where a diffusion of multi-specialty clinics approaches critical mass and suddenly emerges as the people's choice for health care.
The staying power for the integrated movement is evident in the mere fact that physician/chiropractor associations exist at all, given the Byzantine network of professional regulations and state statutes that hamper MD/DC associations. The multidisciplinary practice is rooted in the fertile soil of marketplace efficiency and consumer satisfaction.
Multidisciplinary Legal Structures and Professional Services
Laws traditionally enacted to regulate health professionals were designed to protect the public from unscrupulous dealings and to maintain high standards of conduct within the respective professions. However, many former statutes persist today as strewn relics that obstruct easy movement toward more comprehensive health care delivery. Judges are aware that fee splitting and the Stark legislation were not drafted to prohibit fruitful association among health professionals. Instead, they were born in an effort to protect the public from paying professional fees for nonprofessional services, thereby preserving professional accountability to the public it serves.
Today, attorneys are busy drafting legal documents that establish integrated health care facilities. They are aware that any innovative legal structures they christen to navigate outdated legislation will secure judicial acquiescence only if the structures further society's current needs and continue to enjoin those acts the statutes were designed to proscribe.
Insurance companies were the early ones to see that nonprofessional duties performed within health care offices such as billing, word processing, filing, inventory and marketing, though undoubtedly contributing to the financial success of professional business, did not require the level of expertise and education demanded of health professionals. These insurance companies quickly set about adopting legal structures permitting them to receive compensation for nonprofessional peripherals. Network, group and staff model HMOs currently permit health professionals to associate and provide a variety of professional services, while the nonprofessional insurance "support entity" benefits financially. Many integrated health clinics that similarly enjoy legal relationships that foster interprofessional association must remain mindful of relevant state and federal professional compensation proscriptions. The clinics characteristically consist of two business entities: one offering professional health services while the other manages nonprofessional business affairs amounting to building and equipment rental, billing services, and administrative and clerical support.
"Healthy" Reconciliation between Allopathic and Chiropractic
Multidisciplinary settings that provide both allopathic and holistic therapies are able to handle health problems with a two-pronged "fix it" and "prevent it" approach. Patients whose health provider:
The pivotal role played by diagnostics in multidisciplinary settings has caught the attention of managed care insurers who had characteristically restrained patient access to tests that could preclude extraordinary treatment efforts and lifetime disability, while at the same time bemoaning the exorbitant costs of extensive therapies. HMOs greatly influence the growth of alternative care in the United States. Landmark's recent second nationwide survey on HMOs and alternative therapies indicates a growing responsiveness among HMOs to add complementary therapies to their offerings. Presently, two-thirds of HMOs (67 percent) offer at least one form of alternative care -- the most common being chiropractic (65 percent) and acupuncture (31 percent). User demand and cost-effectiveness drove the movement toward acceptance of alternative therapies by HMOs.
New Millennium Health Care Efficiency
DC-managed multidisciplinary clinics seem to be the most likely candidate to usher in a holistic/allopathic blended health care system. Chiropractors are trained to watch for indications that suggest nascent health problems (having long referred to these as subluxations). A patient's file may include readouts from state-of-the-art devices that measure, display and document indications of unhealthful developments eliciting further diagnosis and treatment. Since it is the multidisciplinary group that performs many of the tests and therapies, individual professionals avoid many of the irksome billing code idiosyncrasies that often lead to denial of claims.
Nor do patient histories confine themselves to neat divisions that distinguish one health discipline from another. Prior injuries, family predispositions and an array of lifestyles present conditions that call for the expertise of assorted professionals. Multidisciplinary clinics provide the sort of expertise that slices through the tangle of red tape separating the patient from optimal health care.
Integrated Corner Cutting
MD/DC clinics recently endured the scrutiny of federal subpoenas issued to uncover instances of fraudulent billing practices relating to medical treatments performed absent the medical physician. Separating the baby from the bath water requires that we distinguish legitimate and fruitful multitherapy association from fraudulent and inappropriate professional billing abuses. "Multidisciplinary clinics that misuse their group's billing are asking for trouble," says Dr. Ehsan, a chiropractor whose company consults and establishes MD/DC clinics.
While integrated clinics are enjoying the unprecedented attention of an adoring public, an unhappy few continue to bear the infamy that attends professional corner-cutting. A word to the wise: "Practice scrupulously within the parameters of legally recognized business structures." When providing services incidental to a physician's diagnosis or treatment, among other things, make certain that the services are:
1. integral and incidental; 2. under the direct supervision of the supervising doctor; 3. performed by the doctor's employee; and 4. customarily rendered in a doctor's office.
Summary
An astute and demanding American public is bringing dynamic changes to the health care field that is influencing legislative action and technological advancement. While changes to health care delivery discussed above are noteworthy, they are not remarkable since the marketplace will continue to improve product and delivery systems as it has done historically in innumerable business settings. What drives the burgeoning holistic/allopathic (integrated) care movement is the redefinition of health itself, accommodated by a marketplace that is shaping itself to fit fundamental shifts in the consciousness of "well-being." We occupy a unique historical perspective. We are the first generation to witness the large-scale commitment of 21st-century American capital, technology and talent in support of a philosophy that views health as a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
