A troubling trend has happened as multidisciplinary practices have increased in popularity over the last few years.

More and more chiropractors are undertaking the conversion of their chiropractic practice into a multidisciplinary practice without the legal and managerial assistance of professionals experienced in this highly regulated area.

In a Chiropractic Economics survey, 28.7 percent of chiropractors responded they currently practice in a multidisciplinary setting, but only 24.7 percent of those who practice in a multidisciplinary setting responded they work with a practice-management/consulting group. If this is you, you are winging it.

In a traditional chiropractic practice, the necessity of keeping up with ever-evolving rules and regulations is more important than ever. A multidisciplinary practice brings its own unique, and at times complex, set of rules and regulations, and failure to comply can bring unforgiving penalties.

For the unwary practitioner, the result of winging it can be disastrous from both a financial and legal perspective. The lack of proper guidance often results in improper corporate structure, unmet professional staffing requirements, and scrambled accounting and billing practices. Noncompliant documentation of the services rendered places licensed and unlicensed staff members (including CAs and associate DCs) at jeopardy for post-payment audits by third-party payors and compliance audits by the Office of the Inspector General and other federal and state regulatory agencies.

Chiropractors had five common responses when asked what multidisciplinary practice concerns they had. A review of these responses should provide you with insight into some of the reasons why winging it is not an option.

• I don’t know the legal requirements. Multidisciplinary practice brings federal and state-specific legal requirements. In some states, a multidisciplinary practice requires a complex corporate structure composed of three to four unique corporate entities, while other states permit a single corporate entity that varies only slightly from that of a solo chiropractic practice. For this reason, it is essential to work with a healthcare attorney well versed in the legal requirements for multidisciplinary practice in your state.

• I don’t know the staffing requirements. The professionals most frequently associated with chiropractors in a multidisciplinary setting are massage therapists (21.3 percent), MDs (12.3 percent), physical therapists (PT) (11.2 percent), and acupuncturists (9.0 percent).

The Chiropractic, Medical, and Physical Therapy Practices Acts are state-specific and regulate the scope of practice of each of their respective professions. In addition, the Stark Laws mandate federal staffing and referral requirements.

In some states it is actually illegal for a chiropractor to employ an MD or PT. In others, you can hire professional staff with the same ease as lay staff members. An experienced consultant should be able to clarify the specific staffing requirements for your state.

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