Integrated Practice Provider Collaboration
PRACTICE MANAGEMENT
Michael Carberry
The term “integrated practice” has been a buzzword for much of the past decade. Most opinion papers and news articles on the future of healthcare delivery promote some form of practice collaboration among professionals of different disciplines.
The reasons for practice collaboration should center, first and foremost, on patient outcomes. Fortunately, for most chiropractors, we live in a free market economy—well, at least a semi-free market at this point, but that is a discussion for another time. The point is that business decisions should be driven by the desire for the business to eam a profit. This is healthy as long as the business conducts itself in an ethical manner. For most businesses, “ethical” means playing by the mies. A coffee shop does not have an ethical duty to sell the most nutritious beverages. They only have a duty to follow the laws of the jurisdiction in which they do business, and generate a profit by providing, in abundance, that for which the majority of customers ai e willing to pay money. In this instance, that includes good tasting coffee and/or complementary products.
For a healthcare business, there is the additional factor of an added ethical duty to do what is in the best interest of the patient. Considering the coffee shop example, it should be clear that not all businesses have this additional ethical duty. Therefore, any decisions to arrange a healthcare business must serve the interests
of the patient first.
The first priority should be that collaboration among various providers in an integrated setting should improve patient outcomes. Clearly, if the business is arranged so that each provider can give input to the direction of patient care, then this goal can be achieved.
Some business owners attempt to achieve this sort of collaboration by joining a “group practice” or by renting space inside another provider’s office or in a building with multiple provider offices. While this might foster some collaboration on individual patient cases, it is unlikely. The benefits of this sort of arrangement for the patient include convenience to see other providers, should they need to do so, or be referred down the hall. The benefit to the business owner is the possibility of developing a referral network among providers in that location. All of these aie good outcomes, but this arrangement falls short of the ultimate goal, which would be true collaboration on each patient case.
To achieve this ultimate goal, all providers must work in the same business and under the same roof. This model allows for the needs of the patient to match the needs of the business. In this arrangement, there is no conflict between the financial needs of a particular provider (“I don’t want to refer him out because I need the business”) and the needs of a patient. Since all work for
the same business, the patient can get what he or she needs and it can benefit the company. Despite the fact that you might have squirmed a bit reading that last sentence, it is a reality some doctors occasionally face when they are straggling financially.
Collaboration among several providers in a single business is best achieved with the use of a “team meeting.” I developed the team-meeting concept for small integrated clinics when I first hired medical providers to work with me to care for my own patients. I had observed the team-meeting concept being used in a hospital where my wife, a physical therapist, had once worked. I immediately figured out how to apply that concept to my practice with great success. It allowed for true collaboration to benefit the patient and increase the efficiency of our personnel.
In order to have a successful team meeting, each provider needs to evaluate the patient and/or diagnostic data from the other provider’s evaluation. Nuances of healthcare law must be followed. These nuances aie very important when a limited-scope provider, such as a chiropractor, is working with a provider who has a larger scope, such as a medical doctor or nurse practitioner. It becomes even more important to understand the law when a limited-scope
^The philosophy of the providers and their treatment styles should complement the mission of the business. 5 5
provider (or layperson), owns or manages a business that employs a provider with a larger scope. These laws and requirements aie easy to follow once known.
A successful team meeting occurs after a patient’s initial evaluation. For example, in a clinic where a medical doctor and a chiropractor aie working together, the medical doctor would most likely do tlie initial intake and then send the patient to the chiropractor for evaluation, which might include diagnostics that fall under the DC ’s scope of practice. This could happen on the same visit. Once all of tlie data is gathered, the MD and DC both would be present in the team meeting, along with other key staff, such as rehab assistants, medical assistants, chiropractic assistants, and whatever other providers might be involved in the patient’s care. The team meeting should be fast paced and cover all of tlie new patient files. During this team meeting, treatment orders aie generated and signed offby tlie appropriate providers. Also covered at tlie team meeting would be any data from patient follow-up evaluations so that decisions can be made about how to proceed with patients already under care. A team meeting can be held once a day duiing clinic down times.
In addition to the “mechanics” of how different providers collaborate, there must also be an understanding between the
providers about what each one can offer a patient. Since most providers aie used to working in isolated settings, be aware that this kind of education is probably needed. Take formal steps to allow this to happen, especially when a new provider joins the team. This is best accomplished hi a formal setting, such as a meeting or presentation. When less-formal measures aie taken, it often results in casual conversation, which does not always meet the objective.
Business owners of integrated health centers must ensure that they hire only those providers whose philosophy of heath care matches that of the rest of the team. And the team philosophy should be set by the owner, who is the visionary. For example, if the philosophy is to focus on more natural methods, then everyone needs to be on that same page, regardless of discipline. If the services provided are to be focused on musculoskeletal conditions, then the owner may not desire to hire a doctor who wants to treat everyone for mental conditions with psychotropic drugs. The philosophy of the providers and their treatment styles should complement the mission of the business. A hospital that focuses on heart transplants might not want to perform liver transplants, and it’s okay for the CEO of that facility to make that decision for the business. Therefore, a doctor who is employed there and deems a liver transplant necessary would need to either provide the service elsewhere or refer the patient out to another facility. In fact, a hospital is a great place to look if you want to start to understand integrated practice because hospitals are the original integrated healthcare center.
At first glance, an integrated practice can seem overwhelming to most chiropractors. When you consider that most DCs are both the owner and doctor in the clinic, it may make the thought of multiple providers almost impossible to confront. However, once the basic concepts are understood, and the mechanics ofhow this type of business functions are learned, it becomes very easy. In fact, many would say that it is easier to run a successful integrated clinic than it is to run a successful chiropractic practice. Many of the typical barriers to success
encountered by a chiropractic practice are nearly nonexistent for a multidiscipline healthcare center.
Regardless of the path you choose to take with your practice, keep in mind that the primary goal is patient care. Do all that you can to provide your service in great abundance to your community so that both you and your community can continue to flourish and prosper.
Michael Carberry, DC, is the president and founder of Advanced Medical Integration (AMI), a consulting group that assists practice owners to integrate medical services with chiropractic and rehab services. To learn more about AMI, visit AMIdoctors.com. Dr. Carberry first brought medical services into .T his original chiropractic practice in 1995. Since then, Dr. Carberry has owned several medically integrated clinics in multiple states. Dr. Carberry also lectures nationally on business systems and chiropractic philosophy. You can contact Advanced Medical Integration at 888-777-0815.
