One of the profession’s most talked subject, today is the concept of medical integration. Many names indeed have been used to describe such association:

• DC/MD/NP/PT
• DC/MD/PT rehab center
• Integrated healthcare
• Holistic/wellness care

Nonetheless, they all mean pretty much the same thing.  In this article, we will basically discuss the pros and cons of such arrangement. Having assisted in the establishment of over 1256 centers in 45 states, I can honestly tell you that the medical integration program is certainly NOT for everyone.

CONS

Legal:  It has been very interesting to see how many attorneys have over a short period of time, called themselves “healthcare specialists” in an attempt to share in the medical integration legal process. The very fact that there are many very serious medical integrations suits currently pending, as well as many investigations questioning the validity of many of these infrastructures, should certainly let you know that only qualified health care attorneys should be considered. Indeed, given to the various laws which differ from state to state, only competent and qualified attorneys should be involved. Your attorney should not only be familiar with all the particularities which exist in your own state but also the various federal rules and regulations which may apply.

Philosophy: A doctor wishing to consider medical integration, needs to be very well “anchored” in chiropractic philosophy. Frankly, chiropractic is an art, a science and a true belief. If after the medical integration, the medical doctor (or newly added health care professional) questions either the values or treatment benefits from the DC, the challenge may indeed tip the scales and what was a very successful chiropractic center may end up as a very poor medically integrated center with most patients receiving a medication and a bunch of diagnostics tests for no true legitimate medical value other than financial rewards.

Liability: Increasing services beyond the scope of a DC license will definitely increase liability, especially since many services added may not even be understood by the DC (i.e. treatment protocols beyond the DC scope of practice, prescription Rx…) 

HMO’s, PPO’s: (managed care) Generally, being contracted by an HMO means to agree to a reduced fee for a contracted service.  Adding “extra” services under a non provider within the same center may potentially be considered breach of contract and get you kicked off the plan. This in turn can decrease your patient load and hence your revenue. This is one of the many issues which need be addressed by your a qualified attorney.  

Complexity:  The ever-changing codes (CPT) rules and reimbursable benefits are indeed all very complex. Integrated medical centers demand a great deal of attention to details in all aspects of practice management. The added consulting cost (which is too often ridiculously high) can add unnecessary stress to an inflated monthly budget.

Truths: There are too many overstated sales pitches trying to convince you that “you just cannot survive without an integrated medical practice”. This is probably one of the biggest untruthful sales pitch and ridiculous comment I have ever heard. The integrated medical center is NOT for everyone. Period!

PRO’s

Having owned and practiced for almost 12 years in two integrated centers (with 5 physicians, 1 DC, 2 PTs, 1 acupuncturist and 5 massage therapists), I cannot help but believe in the integrated model. I guess, you can say that I am partial to medical integration because of my experience and successes. Let’s review the concept and compare from the list of cons written above.   

Legal:  Hiring a very well qualified attorney should alleviate most of your worries and able you to sleep better. Large experienced health law firms spend enormous amount of time researching the most complicated and intricate rules and regulations and often represent many integrated medical centers. After all, the medical integrated clinic is not new to the general health care medical community. Therefore, only consider the most serious law firms with qualified expert knowledge. They are well worth your peace of mind, and future.

One-Stop Shop – The patient, the most important asset of your practice, receives the fullest comprehensive care available.

Every Patient Benefits – In a medical integrated setting, patients with all types of healthcare problems will be treated even if the condition is strictly medical (e.g. medication refill, diabetes testing, physical checkup, etc.)

Limited insurance coverage- A fully accredited medical integrated center is hardly ever restricted to any insurance limits or prejudice given the diversity of providers.

Greater Financial Reward – Across the country as a generally accepted established protocol, the medical fee schedule is higher in billing with quicker reimbursements, and less issues with collections.

Patients are more comfortable – 80% of the population has been and continues to be seen by medical doctors and other medical institutions. Owning a medically integrated center will make you part of the widest and most prevalent healthcare system while keeping “your philosophy intact”.

HMO’s, PPO’s, & IPA’s – The managed care arena is set up to minimize expenses while improving the efficiency of its health care delivery system. In a medically integrated center, the best of all worlds is present to offer just what the future of health care is demanding.

Patient Retention – Because our society has been so “ingrained” in believing that medicine is “the only” answer to all health issues, MD’s, DC’s and PT’s working together will prove that there are many alternative treatments available for the same condition.

Liability – Multiple specialists working together in under one roof, have a greater understanding of a patients needs and conditions and therefore would most likely minimize liabilities.

Competition – Our generation of patients expect only the “best of all worlds,”, i.e. efficiency, timing and savings. The medical integrated clinic can deliver the most unadulterated genuine care available.

Growth – Your center can offer as many services as needed:

1. Medical: general medicine, neurology, physiatry, orthopedic care…
2. Musculoskeletal: Chiropractic, physiotherapy, massage therapy…
3. Rehabilitation: physical therapy, physical medicine, occupational therapy….
4. Diagnostics: EMG, NCV, EEG, SSEP, SEMG…
5. Ancillary services: blood work, durable medical equipment, in-office testing…
6. In-patient: hospital privileges, emergencies…
7. Out-patient: medical referral, medical network…

Workers Compensation (W/C) – Employers, adjusters and patients attempting to receive efficient, thorough, diversified care will find medical integrated centers, a most viable solution.

So, where should you start?

First Step: Evaluate your philosophical position about your profession:

Do you truly believe and love what you do?

Do you understand your patients needs?

Do you breathe, talk, walk, think, act and practice chiropractic?

Is the intent to integrate your clinic to enhance your services?

If the answers to the above question is yes you may continue your search.

Second: Analyze your demographics.

How many medical integrated centers are in your town?

What do your patients think about the idea of medical integration?

How many MD’s in your town?

Third: Staffing, management, and finances.

Are you a good manager? (Or do you have one?)

How are your staff’s organizational skills?

Are your financially stable (some what)?

Finally:

Are you ready for a change?

Being a consultant for many years to over 1256 clients nationwide, it often breaks my heart to see some doctors truly struggle to try to find happiness with the medical integration process. Happiness is where YOU are TODAY!! If you are not genuinely happy with yourself today, the medical integration idea will not make matters any better. It may certainly increase your income, but again, what is money if you are not happy?

I trust what this article has given you a better objective view on what I believe to be the best of all worlds. The medical integration is indeed not for everyone, but for those few, it is a true dream come true.