Integration is not a novel idea to the chiropractic practice. It has been done since our inception. B.J. Palmer employed medical doctors (physical therapy as a profession had not been created yet) in his own clinic.
It is my opinion that incorporating two like-minded and complementary professions in the same office leads to the greatest benefit for the patient. The chiropractor is a definite specialist in the neurological system and in spinal alignment; the physical therapist is a specialist in the muscular strengthening needed to maintain spinal alignment and in documenting the restoration of that strength and alignment.
It is this improved case management that should, and must, be the driving factor in your decision to integrate. This is a sound relationship that can be cultivated in your office to improve patient results, especially in advanced soft-tissue treatment techniques, as well as the documentation skills the average chiropractor lacks. This is a win-win relationship for all involved in the practice, from the patient all the way up to the DC.
I have never met a physical therapist who is not an expert in documentation. They are extremely capable in communicating what they are doing and why, so that their colleagues, MDs and insurance companies understand what is happening in the case, where it is going, and why it should be paid.
The physical therapist is able to provide only services that are within your scope of practice. They use the same codes you use, and you are not performing services in your clinic outside of your scope of practice. For this reason, I am commonly asked, "Well then, why should I hire a physical therapist if I can do all of the same services?" First of all, it is for better case outcomes. Second, most insurance companies pay an extra benefit if the service is provided by a licensed physical therapist. This usually averages an additional $3,500 per case. Finally, referrals to our integrated offices from the medical community range from 20-50 per month. This is a much greater number of medical referrals than the average DC receives. Because of these MD referrals, we are able to assist in changing the lives of many patients for the better; patients we would never have had the opportunity to treat if we were not integrated.
The overall benefits of integrating our practices with physical therapists include drastically increased patient outcomes, documentation standards, treatment planning, treatment protocols, new patients, retention and reimbursement.
With the extra time, the DC also has the opportunity to focus on practice expansion systems, such as new patient marketing, staff training and patient education; or the DC can take a two-week vacation without closing the office, or losing his or her patient base/income.
All in all, this can be a very attractive relationship for chiropractors, young or old, as long as they follow these guidelines.
- Build your practice to at least 100 patient visits per week before deciding to integrate. Integrating too early can cause a financial drain on the practice that adds too much stress to your life.
- Don't fill out all of the legal documents yourself. I am constantly told that all you have to do is set up a separate corporation or enter into a percentage-of-collections relationship. Federal guidelines prohibited structures such as these and can cause the chiropractor much undue stress and even attack from the federal government. A legal team that understands your state laws, chiropractic practice practice acts, physical therapy practice acts and all federal laws and statutes (especially Stark I and II) is an absolute must. I can tell you, speaking from experience, that even most "health care attorneys" do not meet the above requirements. Make sure they have reviewed all of the above before drawing up your contracts. These contracts should not cost more than $5,000 if the attorney is already familiar with the above-mentioned laws and statutes.
Integrating your office with a physical therapist can be an excellent form of clinical treatment for your patients. Your belief that muscle tone and health are contributing factors to improved patient outcomes is crucial to that decision. If you truly believe that having a combined approach from the DC and PT perspective would result in better clinical outcomes, PT integration may be just the right fit for your practice.
Dr. Brent Detelich, former president of the Stem Cell Institute of America (www.americastem.com), is a 1993 graduate of Parker College and a second-generation chiropractor. During the past five years, he and his medical team helped to train more than 300 practices on medical integration for the purpose of offering safe, effective and compliant regenerative therapies.