Blog Picture Clearly Defining Medical Integration

Clearly Defining Medical Integration

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Dr. Dahan, the nation’s expert leading authority on medical integration answers important questions about the medical integration model and its future. 

  1. Please define medical integration.

Medical integration is the establishment of a health care center where patients are offered multiple varied services. The fundamental concept is that it is designed to operate as a “one stop shop” whereby a patient can receive the most comprehensive diversified care available without having to leave the premises and go anywhere else. In our context, typically, the medical integration center’s primary doctor is a “natural” health care provider namely a Chiropractor. After an extensive initial examination, the doctor will recommend several treatment options beginning with natural noninvasive care. Then, depending on the severity of the condition, the doctor may also recommend a comprehensive medical treatment which may include medications, invasive procedures, as well as a combination of alternative treatments.

  1. What trend do you see in respect to medical integration in America?

Manage care is here to stay. There is no question that as the manage care system expands throughout the country and people are looking to save time and money while getting the best health care available, medical integrated centers are going to be in greater demands. Typically, patients ask three questions at the doctor’s office: Can you help me? How long is it going to take? And, how much will it cost? It is only common sense that patients are very concerned about their health care. Hence, over the next several years, my opinion is that we are going to see a considerable expansion of integrated medical centers throughout the USA. Obviously, those practitioners who will have taken the opportunity early on and had the foresight to create well established integrated medical centers will most likely reap all the best and greatest benefits.  

  1. Is medical integration a financially sustainable business model?

Absolutely.

Healthcare is a service and must be treated as a business. First and foremost, it is critical that one pays close attention to the current business trends and developments and make sure to act accordingly. Let’s look today how the internet is affecting businesses who did not early on, pay attention to the rapid rise of online ecommerce. In today’s fast pace world, business owners and professionals must be vigilant and protect their future. For a medically integrated clinic to succeed today, social media must be one of the most crucial business components to consider. Indeed, irrespective of the location, the doctor of the future can succeed in such a model but at the same time must act prudently and intelligently using the latest resources available.  

In conclusion, it is very important for doctors today, to pay close attention to the many changes which will affect our health care profession. Our patients, our most important “assets” deserve the best of health care and therefore it is our responsibility as doctors, to ensure that we create health care facilities that will provide the latest and most beneficial health treatment options. 

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

Blog Picture New York State Education Departments Opinion

New York State Education Department´s Opinion

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MULTIDISCIPLINARY PRACTICES

Law, rules and regulations, not Alerts, specify the requirements for practice and violating them constitutes professional misconduct. Not adhering to this Alert may be interpreted as professional misconduct only if the conduct also violates pertinent law, rules and regulations, some citations of which are listed at the end of this Alert.

The health care professions constantly evolve. A variety of forces, sometimes in competition with one another, continue to shape and reshape the methods, procedures and the manner in which health care is provided to the public.

The practitioners who provide the care within that environment also must evolve in terms of knowledge, competencies and techniques. Change poses both opportunity and challenge in ensuring provision of care by competent, knowledgeable, and ethical professionals.
One change emerging in the contemporary practice environment is the increased collaboration of licensees from various professions practicing outside of organized facility settings (i.e., settings regulated by the State Department of Health). Most notably, licensees in the professions of medicine and chiropractic have begun to converge for the expressed purpose of delivering comprehensive services to patients whose conditions warrant a joint approach.
Collaborative arrangements between professionals have the potential for providing effective care in a convenient delivery system for patients. It is important, however, that all licensees participating in the collaboration uphold their respective professional responsibilities.
You should be aware of the following considerations when practicing or contemplating a practice with licensees from other professions:

Scope of Practice

• Practice only within the scope of your license.
• Refuse any delegation of responsibilities by your employer that is outside the scope of your chiropractic license.
• Only delegate duties and responsibilities that require a license in chiropractic or any other profession to a person who is duly licensed.
Professional Practice Entities and Employing Licensees

• Avoid employing licensees in medicine or being the controlling entity in a practice with licensees in medicine or any other profession authorized to perform procedures beyond the scope of your chiropractic license, which includes physical therapy or nursing. With the exception of medicine, dentistry and veterinary medicine, the law allows for licensees in health professions to form a Professional Limited Liability Company (PLLC) or Partnership (PLLP) together as a multidisciplinary practice. It is advisable to seek legal counsel on the formation and operation of such entities to ensure compliance with the law.
• You may hire licensed massage therapists, certified nutritionists or certified dieticians to work in your practice as employees, since your license authorizes you to perform the services provided by these practitioners.
• Remember, you are responsible for the acts of all your employees and staff, licensed and unlicensed.
• If you own a professional practice, you are responsible for overseeing the patient care provided by all associates, other licensees, technicians, and everyone else employed in your practice. If you are an employee of another licensee, chiropractor or physician, it is the employer who bears ultimate responsibility for overseeing the patient care provided in that practice. Therefore, while you remain responsible for the direct care you provide to patients, “absentee owners” may be subject to professional misconduct violations, as well.

Referrals

• Avoid making direct referrals to physical therapists since they are authorized to practice only on referrals from physicians, dentists, podiatrists or nurse practitioners. If you feel your patient may benefit from services provided by a physical therapist, inform your patient of the referral requirement. You may assist him or her to locate a licensed professional who can make a direct referral.

Collaborating with Physicians

• If you are offered a position in a medical practice, remember that the owner/physician must have some level of professional competence in the services you will be providing. As the practice owner, the physician is responsible for appropriately identifying patients you may be able to help, how you can help them, what contraindications there may be to your services, and what outcomes to expect so your work may be monitored. Be sure the owner/physician of the practice is trained as an osteopath, physiatrist, or orthopedic specialist, or has had additional training in manual therapy before accepting an offer of employment in such practice.
• You may not work for or with a physician as an independent professional sub-contractor or consultant (see “fee-splitting” cited at the end of this Alert). If you are employed by a physician, you cannot be authorized to “direct patient care” or be given “complete control” over patients in that medical practice beyond your scope as a Doctor of Chiropractic. However, you remain responsible for the chiropractic care you provide patients. If your physician employer directs you to do something contrary to your clinical judgment, you should exercise that judgment in resolving the directive with your employer.
Source: http://www.op.nysed.gov

Blog Picture ACA´s Views MULTI DISCIPLINE PRACTICES MDP

ACA´s Views MULTI-DISCIPLINE PRACTICES (MDP)

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Submitted by: ACA Insurance and Managed Care Committee

The American Chiropractic Association is the preeminent professional organization representing doctors of chiropractic in the United States. We have an obligation to our membership and to the profession as a whole to comment on topics that support or harm the profession and the public it serves. The topic of Multi-Discipline Practices (MDP) is receiving increased attention in the media, as a quality option for treating patients.

The goal of this policy is to provide general education as opposed to specific legal or practice advice. It is incumbent upon each doctor of chiropractic to determine relevant state or federal laws, local board regulations and/or association recommendations that may be preemptive.

Background: The ACA fields an increasing volume of calls from doctors of chiropractic as to the advisability of entering into a MDP, and who also seek more detailed information on its acceptance, structure and operating philosophies. At the same time, ACA receives complaints from payers that certain arrangements appear to emphasize financial gain for providers rather than clinical appropriateness and the best interests of patients. With respect to providing education to both the chiropractic and insurance professions, ACA established a Fraud Sub-Committee under the Insurance and Managed Care Committee to research and provide commentary on this topic and others.

These recommendations are not all-inclusive, but are intended to encourage thoughtful consideration and examination.

ACA RECOMMENDATIONS

Scope of Practice: The ACA encourages state associations and licensing/examining boards to adopt rules, regulations and laws that define the scope of practice for doctors of chiropractic and specifically comment on new and emerging practice arrangements including but not limited to Multi-Discipline Practices. Attention to the provision of ethical care and accepted treatment standards is important, as is identifying potentially illegal or unethical practice(s) that may constitute a danger to the health, safety and welfare of the public or that violate state statute. The Arizona Board of Chiropractic Examiners under section ARS 32-924(15) and a Chiropractic Practice Alert issued by the New York State Education Department Office of Professions http://www.op.nysed.gov/chiroalertmulti.htm may provide a model for discussion and action in other states.

It is also recommended doctors of chiropractic maintain a current license in good standing in the state in which they practice, and comply with the full letter and intent of that state’s chiropractic scope of practice statute. All care provided by a doctor of chiropractic must fall under the applicable scope of practice regardless of who recommends or orders it.

Seek Expert Opinion and Counsel:

To assist associations, boards and individual providers, ACA may be contacted for information on the National Association of Chiropractic Attorneys (NACA) as one source of possible legal counsel.

There are many potentially complex legal issues that one should keep in mind before getting involved in a Multi-Discipline Practice. You may consider seeking legal advice on specific issues, including the following:

  • All licensed healthcare providers are held to administrative, civil and criminal law considerations. In addition, state and federal law impacts compliance, formation, ownership structure and operational issues and may present certain complexities requiring the advice of an attorney specializing in professional limited liability (PLLC), Partnership (PLLP) and/or other arrangements.
  • A federal health care criminal statute, along with related state health fraud statutes, criminalize any “scheme or artifice” intended to obtain reimbursement from any healthcare plan or entity under false pretenses. Federal mail fraud concerns are included in this level of analysis, among other potential violations. (18 u.s.c. 1341, 1343)
  • Another issue deals with legal concerns regarding federal and state anti-kickback laws. These are enforced for the most part by civil versus criminal sanctions. This requires a comprehensive review and careful consideration of “safe harbor” provisions of the Civil Monetary Penalty Act (42 u.s.c. 1320a-7a).
  • Legal prohibitions against self-referral for some healthcare services, or “Stark Laws” (42 u.s.c. 1395 nn) are enforced through civil sanctions and relate to the provision of certain designated health care services. Mini-Stark laws may also exist at the state level and should be considered in any MDP analysis.
  • The Internal Revenue Service (IRS) may also have specific compliance standards in the reporting of MDP revenue, investment gains and/or other financial situations.

Another source of advice may be the local or regional FBI (add website), or your state Attorney General’s office as to types of activities in the health care industry that may prompt investigation or indictment. Currently we are not aware of any national MDP directives or policies employed by the FBI, but we understand that initiatives exist in certain states.

The Department of Health and Human Services Office of Inspector General ‘Compliance Program for Individual and Small Group Physician Practices’ (65 Fed. Reg. 59434, Oct. 5, 2000) found at http://oig.hhs.gov/authorities/docs/physician.pdfis also another source to consult, and your malpractice carrier may also have additional recommendations based on risk management protocols and actual claim experience.

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The Challenge of Medical Integration

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Although many doctors speak about the many advantages of medical integration, it would be naïve to think that there are no negative issues associated with such a complex business model. Having spent over 26 years as a consultant, I have had the privilege to help thousands of doctors realize their dream practice. Yet, being the longest practicing consultant for medically integrated centers, I have had ample opportunities to see how this innovative idea has developed and become so popular today. So, what are some of the negative drawbacks with medical integration?

Basically, there are three major areas to be concerned with:

  • Legalities
  • Billing and Coding
  • Medical supervision and communications.
  1. Legalities

Given the very intricate detailed laws associated with medical integration, the best way to create a safe and sound integrated medical center, is to retain the services of a qualified health care attorney with in-depth knowledge and understanding of the Chiropractic and medical scopes of practice. Before opening the doors of a newly created medical center, it is critical that the infrastructure falls well within legal parameters both at the state and federal level. One only need to look at the current active legal investigations to realize that medical integration is a serious business model which must be properly set up and operated with unadulterated honesty and integrity. Unfortunately, throughout my 26 years as America’s longest practicing consultant for integrated medical centers, I have seen many doctors pay a very heavy price for not wanting to follow “the rules”. What is even more ludicrous, is that many doctors as well as unscrupulous consultants believe that they can do whatever they wish or whatever they consider is right and think they can get away with it. This alarming and risky reasoning can only lead to disastrous results. 

  1. Billing and Coding

Another issue which requires close attention is the convoluted billing and coding system. 

Certainly, one must realize that billing and coding for an integrated medical center is quite complex. Not having a great understanding of how to combine billing codes for services rendered, will create confusion and therefore hinder the ability for any clinic to collect what is truly due. These errors will undoubtedly cause a cash flow shortage and therefore limit the clinic to keep its doors open. Hence, having a qualified and well-trained billing team is not a “luxury” option but an absolute obligation. Unfortunately, today, many consultants have very limited knowledge of the billing reimbursement exceptions which vary from state to state. Therefore, many unscrupulous consultants simply avoid these billing variations issues leaving their clients in the dark. Regardless, the clinic owner should make sure that the staff is well trained in the medical integration billing model before taking such a leap of faith and causing unnecessary added stress to an already complex operation. 

  1. Medical supervision and communications.

It is well known that medical integrated centers treat larger volume of patients. To ensure proper case management, doctors in these multidiscipline centers will need to learn how to efficiently communicate and internally refer to one another. Hence, it is critical that proper protocols are established from the beginning. Just as important is the supervisory role of the medical director. Indeed, due to the wider scope of practice, integrated medical centers offer a wide variety of treatments. As is well known, the treatment of many of these newly added conditions will often require direct medical supervision to ensure compliance and to ensure that none of the doctors are practicing outside the scope of their license. This obviously, could also negatively affect any possible malpractice issue. I am pleased to report that most of our clients nationally have indeed been very fortunate and hardly ever had any issue in this area.    

To end on a positive note, one must know that while there are definite explicit requirements to successfully operate an integrated medical center, with professional guidance, experienced advice and genuine intend, one can set up an amazingly beneficial and lucrative center representing the wave of the future. 

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

 

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What Sort of Budget Do I Need for Medical Integration?

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While broadening your scope of practice to offer more services is a noble idea, medical integration certainly requires a financial commitment which makes many doctors feel uneasy and even apprehensive.   

Understandably, many doctors are worried about the “unknown” financial investment one will need to consider. Even though many positive feedbacks have been publicized about medical integration, the negative aspect we mostly hear today, is the huge initial monetary commitment it requires.

But does medical integration actually “demand” a big financial investment?

Given what we know today, do these “new” doctors have valid concerns?

What is the “true” cost consideration to open an integrated medical center? 

There is no doubt that the success of an integrated medical center is based on its viability to survive through the many changes it will experience in its infancy. So, let us explore the two main initial areas of concern. In my 26 years of experience as a consultant, and the longest practicing consultant in the nation for medical integration, I can outline two major financial areas for creating an integrated medical center. 

  1. Qualified legal representation
  2. Professional medical and support staff
  1. Qualified Legal representation:

To ensure that a newly integrated medical center is “properly” established, there can be no option but to retain the services of a qualified health care attorney. The national amount for legal fees for medical integration, ranges from about $3000 on up. Again, according to your attorney’s advice, you may need to have multiple contractual agreements in place. Indeed, depending on each individual state requirements, there maybe the need to create one or more corporate entities which may add to the cost of your legal representation. Just as well, setting up new corporations will invariably add accounting expenses. With over 26 years of experience as a consultant, I am proud to say that I have extensive experience in this field and by having assisted over 1256 centers in 45 states, I can unequivocally state that in regard to legal representation, on must make sure to only work with qualified health care attorneys. I can assure you that carefully following this advice will save any doctor, years of anxiety and thousands of dollars.   

  1. Professional medical and support staff:

Secondly, one of the ongoing expenses that a newly medical integrated center will incur, is the addition of medical and support staff. The professional licensed medical team and added staff members will add significant fees to the clinic. Hence, the clinic owner must be prepared to assume the added expense and expect these constant recurring costs to increase over time as the clinic grows. It is however critical that the owner creates a well outlined plan with a sound budget. As the saying goes “Not having a plan, is a plan to fail”. Why would anyone invest time and efforts into any venture without having a solid budget in place? Over the past many years of my professional life as a consultant, I have spoken to thousands of doctors who did not take the time and conscientiously sit down and clearly develop a concrete budget with proper allocations and ended up regretting not taking my advice.

Successful practices must invest time to create and manage a budget, prepare and review a solid business plan and regularly monitor financial reports and performance. A structured planning can make all the difference to the growth of your business. It will enable you to concentrate resources on improving profits, reducing costs and increasing returns on investment. The key benefit of business planning is that it allows you to create a focus for the direction of your integrated medical center and provide targets that will help your clinic grow. It will also give you the opportunity to stand back and review your performance and the factors affecting your clinic.

Sound business planning will ensure:

  • A greater ability to make continuous improvements while maneuvering around obstacles as you acquire more patients.
  • Sound financial information on which to base future decisions managing your medical staff.
  • Improved clarity and focus on new medical services you wish to add to your clinic.
  • A greater confidence in your decision-making.

I can unequivocally attest to the fact that my clients who have followed this advice, have greatly enjoyed the financial rewards of success earlier in the game and with less worry.

So, in conclusion, I must again reiterate as I often do on my Dr. Dahan Daily Live Radio Show, that medical integration is simply not for everyone. If you wish to succeed, you must do your homework seriously so that you can have a strategic plan of action with a well-designed detailed step by step managerial program to lead you to success.

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

 

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How Long Does it Take to Fully Establish a “Successful” Medical Integrated Center?

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                    This is one the most often asked question. As a consultant since 1994 and operating today the nation’s largest consulting firm for over 1256 medically integrated clinics in 45 states, there is a vast diversity of expectations from practitioners. Truthfully, every single center can be very successful “when and if” properly established. Nonetheless, what remains today a difficult and undeniable challenge, is that countless of doctors assume that medical integration means “instant” success with substantial profits and all within a very short period of time.
 
For anyone considering medical integration, below is a short list of the 10 minimum requirements to consider:
 
Medical integration is NOT for everyone.
Medical integration must be set up by adept expert health care attorneys.
Medical integration requires that the DC have a well anchored genuine Chiropractic philosophy and belief.
Medical integration is conscientious work and demands uncompromising efforts based on ethical values.
Medical integration establishment must be first and foremost to enhance patients care by offering more services.
Medical integration requires a firm budget supported by a very well designed managerial plan.
Medical integration requires innovative marketing backed by an adequate allocation.
Medical integration takes time, hence the need for patience and diligence.
Medical integration must start “modestly” and grow progressively.
Medical integration services must continuously be reviewed to maintain sustainable success.  
 
Lastly, the practitioner must know that every business endeavor must be thoroughly researched to succeed. As a long time practicing national consultant, I have heard way too many negative experiences which left many doctors feel cheated about medical integration. One of the best way I recommend to anyone who is interested, is that before joining any group, ask them for a free 15-30 days no obligation trial period. If they really want your business and are honestly wanting to help you, it should be an easy answer.

The Nation’s #1 Medical Integration Program

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. 

In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

 

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Will DCs “Lose Their Identity” and Possibly Be Affected Emotionally with Medical Integration?

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This is an argument made by many people who are just not well informed. As a matter of fact, an integrated medical center will place the DC at the forefront of the clinic by making him/her the primary care physician with many clinical options readily available all under the same roof. 


Indeed, every patient will be offered the opportunity to choose between conventional medical care and an alternative wholistic approach before starting any treatment protocols. It is well known that when health care practitioners work together in the same clinic, it creates a positive synergistic environment. This in turn, will even enhance the patient’s experience which will most likely lead to greater results. Obviously, this will increase patient satisfaction, generate more referrals, strengthen the clinic’s reputation and introduce the doctors as the city’s “most sought” after health care providers. Lastly, this great expansion will obviously highly increase the clinic revenue and make it much more profitable. 


So in conclusion, it is very clear, that an integrated medical center will not only NOT jeopardize the DC’s practice philosophy but actually intensify it by providing complimentary care to many more people.         

The Nation’s #1 Medical Integration Program

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. 

In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

 

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What Changes Can the DC Expect with Medical Integration?

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New Staff:
Hiring new staff is a positive sign of growth, expansion, advancement and success. But this increase in staff number will also escalate your expenses, responsibility, training and management which may be stressful if not done in an organized manner. It is an accepted fact that a newly established integrated medical center will invariably need to hire more staff as it grows and becomes more successful. The real question is: will it be stressful and chaotic or well thought through and pleasurable?

Clinic Size:
Only eight hundred (800) square foot of minimum space has typically been necessary.

Clinic Schedule:
Office hours are mostly the same, except that usually after the first 4-6 months of initial organization, the clinic becomes much busier and requires more hours because of the volume which has increased drastically.

Equipment:
Initially, because of the overall initial investment and managerial expansion of tasks, it is recommended not to purchase any new equipment. Unfortunately, many unscrupulous consultants convince their clients to invest a large sum of money with the misguided expectation that the return on investment (ROI) will be well worth it. What the clients are not often aware of, is that these consultants benefit from substantial financial kickbacks from the equipment suppliers and therefore will try and convince the client to make the purchase as soon as possible.     
Truthfully, it is preferable and highly advisable to purchase equipment only when needed and when the clinic is in a stable financial situation. Just as well it is critical to make sure that the staff will be well trained in the use of the equipment. It is sad to say but, a national review of clinics inventory clearly shows that there are thousands of clinics which have purchased way too many pieces of equipment while never really amortizing the initial cost or even get the full clinical benefits. So about how much equipment will indeed be necessary to operate a successful medical integrated center? The cost will be about $8,000 to about $18,000. Again I advise all my clients, that this money will be necessary only when the clinic is stable financially. I cannot overemphasize, the importance to make sure that the clinic expansion be progressive, calculated and very well planned. This will make the difference between a well-liked center where patients truly feel that the broadening services has been indeed a blessing to everyone both clinically and financially

Other related articles:

Financial Projections for a Startup Medical Practice

FINANCIAL FORECASTING FOR MEDICAL PRACTICES

HEALTHCARE CLINIC BUSINESS PLAN TEMPLATE

MEDICAL PRACTICE BUSINESS PLAN Financial Model Excel Template – SALE – 30% DISCOUNT

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5 Best Ways to Improve Employee Efficiency in an Integrated Medical Center

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5 Best Ways to Improve Employee Efficiency in an Integrated Medical Center

Managing hundreds of my clients’ clinics for the last 26 years has taught me that irrespective of how many staff members a clinic adds, you first need to make sure that your employees’ time is used proficiently. As a matter of fact, I can say that unequivocally that my top producing and most successful clients are those who spend valuable time making sure that their staff members are very happy with their jobs.

So, here are my recommendations:

Take the time to train:

Although learning on the job can be effective and may even seem that you will save time and money, studies have shown that requesting employees to learn on the fly can be extremely inefficient. Instead of having your staff work with no little or no guidance, take the extra day to teach them the necessary skills to do their job properly. Then don’t just stop there. There are many ways you should support your employee’s development with individual mentoring, classes, seminars… Remember, the better trained they are and the more productive they will be.

Match Tasks to skills:

If you truly want to maximize your employee’s efficiency you need to clearly and honestly evaluate your employee’s skills and match them with the best suited position. An extroverted, friendly and creative person would probably be best suited for a front desk reception to welcome your patients and make everyone feel comfortable. Asking your employees to be “great” at everything is just not reasonable. So, before giving an employee a task ask yourself: is this the person best suited to perform this task? If not, find someone else whose skills match your needs. 

Set Focused Goals:

So many articles have been written about making sure that goals are “SMART”- specific, measurable, attainable, realistic, and timely. Each time you want to assign a new task, ask yourself if it fits these requirements. Statistics have shown that applying the SMART method will save you much aggravation and will show your employees that you are well organized and conscientious about your office growth.

Incentivize and Reward:

Employees like many of us like to be recognized when a job is well done because it makes, they feel appreciated and is also encourages them to continue increasing their productivity. It is well known that the people who refer the most patients to a clinic are the ones who truly feel loved and special by the doctor. Give employees the opportunity to shine and when they do, make sure you acknowledge them with great praises. 

Give Honest Feedback:

Performance reviews are essential and critical to measure employee’s efficiency levels. Be honest in your evaluation and don’t ever be afraid to discuss your employee’s performance. If your feel an employee is not pulling their fair share of responsibility, sit down with them and clearly outline their shortcomings. As soon as you have made your point clear, offer them a list of suggestions and directives to help them become better in their position. By properly guiding them and showing them how they can improve their ways, will encourage them to sharpen their skills and regain confidence in their position.   

Your staff is the backbone of your office. Train them, guide them, support them, thank them and they will outperform your expectations for a long time. 

The Nation’s #1 Medical Integration Program

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5147408/

A 5-Point Checklist to Improve Healthcare Employee Performance

https://journals.lww.com/joem/Abstract/2013/10000/Improving_Employee_Productivity_Through_Improved.3.aspx

https://www.verywellhealth.com/get-maximum-performance-from-your-employees-2317049

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What Research Has Been Done in Reference to Billing and Coding for Medically Integrated Centers?

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What Research Has Been Done in Reference to Billing and Coding for Medically Integrated Centers?

Managing a healthcare practice comes with a long list of complex challenges that need to be solved on a daily basis. Anyone who is involved in the operational aspects of a medical integrated office or healthcare facility understands that there are many situations that require making educated and rule-based decisions based on a variety of factors.

Dr. Dahan, COA’s senior consultant, has established over 1256 integrated medical centers in 45 states for the last 26 years and therefore has an unprecedented advantage over any competition. Since 1994, he has designed a comprehensive database of codes and billing methods for each state. Reports show that many clinics fail miserably to successfully collect on the services they perform because they are simply not trained properly. These clinics are performing the services, but they are not getting paid the full fees they deserve.

Here is a brief overview of critical protocols which require careful attention:

Diagnosis:

Doctors need to know how to choose the most relevant diagnosis which must not only reflect the correct code describing the patient’s condition but will also be accepted and reimbursed by the payor. The applicable diagnosis must also be listed in a precise order to demonstrate relevancy; this process done incorrectly will not only delay payment but could most likely deny full treatment approval.

Fee schedule and codes bundling:

Another common mistake is not knowing how to choose a legitimate fee schedule which must be precisely selected to support a reasonable percentile according to each local demographic. All codes must be skillfully organized and or bundled. However, although code bundling can be beneficial in many instances, there is potential for issues to occur when a patient requires a service that doesn’t fall into a set of codes that can be bundled. This again, can put a provider at risk for not being reimbursed for the additional services. In this situation, there is also unfortunately the potential for a healthcare provider to avoid performing a particular service or procedure, or to bill the patient more than they should, in order to ensure they receive full payment for all procedures provided. This tactic of over-billing is referred to as upcoding, and is an illegal medical practice.

CPT Modifiers:

In cases where procedures are altered from the norm, or additional services are added, code modifiers are used to reflect the changes for billing and reimbursement purposes. In some cases, a healthcare billing professional may forget to include the correct modifiers with their CPT codes, which again prevents the provider from receiving the full reimbursement for the services performed. Or, on the other hand, the payer may overlook a CPT modifier and therefore reimburse less than what is due to the provider.

When done correctly, CPT code bundling and using modifiers does improve the billing and collecting process for healthcare practices.

Reading the few comments listed above, one can easily realize why it is very important for all professionals to be properly trained and to understand how to use the different types of medical codes and modifiers correctly when considering medical integration.

The Nation’s #1 Medical Integration Program

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

 

https://www.medirevv.com/blog/6-actionable-tips-to-improve-medical-coding-operations

https://www.lightspeedinc.com/five-rules-to-improve-coding-efficiency-throughput-and-accuracy/

https://www.physicianspractice.com/coding/five-ways-improve-coding-your-medical-practice

https://www.m-scribe.com/blog/improved-medical-coding-efficiency-improves-your-bottom-line