Chiropractors and medical doctors (or D.O.s) have had a long and somewhat complex relationship.  Though they approach healthcare issues differently, there are many instances where they share care or even work together.  Such "M.D./D.C." relationships are legally complex, but often prove to be rewarding in many respects.  Properly constructing the arrangements is critical, especially since government regulators and payers tend to view such arrangements with skepticism, alleging that the true reason for the combination is for chiropractors to avoid coverage restrictions. 

The core legal issues the parties need to be aware of include:

Corporate practice prohibitions.  Most states prohibit (or regulate) who can own a medical practice or a chiropractic practice.  So called "corporate practice restrictions" for instance often prohibit a medical doctor and a chiropractor from jointly owning a clinical practice. Additionally, many states do not permit a chiropractor employing a medical doctor and vice versa.  That leaves essentially two models for consideration-a direct employment model and a management type of model.

Legal structure.  Getting this right is important, especially with respect to self referral restrictions.  If federal patients dollars are involved (e.g. Medicare), some very complex and powerful federal laws (e.g. Stark and the Anti Kickback Statute) come into play.  And many states have their own self referral restrictions.  Single legal entity?  Multiple legal entity?  It depends on things like the payer mix, state regulation, and the type of services provided.

Do you have a clearly defined set of goals for 2011 and beyond?  Do you have set revenue targets and partner compensation goals - and a plan to reach those goals  month by month?  If you know what your expected revenue and patient volume should be, what are the implications for staffing, additional equipment or other infrastructure issues?  As you oversee this progress are you carefully tracking key performance indicators ("KPI's")? 

If you have trouble answering those questions, you may be like many physician practice managers: you are finding yourself too busy working "in the practice" rather than "on the practice".   We are pleased to announce that a friend of the Firm, Bruce Rector of The Rector Group, is offering a strategic planning session for medical practices that can help you answer these questions and frame a plan to get the practice to the next level.  The focus is on a high impact gathering of key leadership  employees with clearly definable goals, tasks and accountabilities as the outcome - at a price that creates a compelling return on investment. 

You can learn more about this at: www.therectorgroup.com

Disclaimer: The Florida Healthcare Law Firm does not receive any compensation for running articles such as this one. Our only aim is to ensure that our clients receive helpful information from reliable sources.

By: David Swart, Co-Founder, Doctor Dial 

When done the old-fashioned way, tasks such as confirming appointments, delivering lab results, and calling in pharmacy refills, means hours of manual tracking and daily phone calls by office staff.  Other expenses involved in communicating and following up with patients include postage, office stationery and even outsourcing key functions such as collections. Advances in technology have made it possible for practices to work smarter, save money and provide better customer service through the automation of simple, repeatable tasks.

Did you know that patient no-shows for many healthcare providers average 30%? Basic automation tools on the market today have been shown to increase patient communications and decrease no-shows. Additionally, think of the ways practices would benefit from a system that could fill last minute cancellations, deliver pre-visit and past due billing reminders and track patient's histories in order to ensure that they receive timely reminders of periodic or follow-up visits. Doctors and staff alike would be freed up to concentrate on other critical practice functions.

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