June 23, 2011
I am a chiropractor and see a potential for incorporating different types of practitioners into my practice for the benefit of my patients. How do I go about doing this?
Well Dr. G, this is a loaded question that has a long answer and depends on your independent circumstances, so you should start by calling me so we can discuss. But, for the sake of the listserv, my general answer is you have to understand the current hierarchy in NY created by the corporate practice of medicine. As a chiro, you are prohibited from directly employing certain other licensees, for instance, a physician or PT. Now, there are nuances created under law to consider as well when thinking about structure, for instance, you may partner with a PT under a PLLC structure. As indicated, from a structural standpoint, there are many rules and regulations governing multi-disciplinary practices.
Common arrangements that I have been seeing more frequently are management companies - whereby a professional with an infrastructure controls the space another practitioner is using at their location, and the professional charges the practitioner for assistance with administrative services. Such arrangements are inherently suspect, as authorities pre-suppose the arrangement is established merely to pay a party for referrals - which is prohibited. So, to form an appropriate management arrangement, you need to adhere to available guidance so that the structure meets certain requirements to pass muster. In order to meet applicable guidelines, I recommend working with competent healthcare counsel familiar with these types of arrangements.
Another structure available is simply to license out space to another practitioner and for that practitioner to operate completely independent from your practice. As with all healthcare arrangements, a license arrangement must be in compliance. Some of the applicable structural requirements for such an arrangement are that a flat fee be imposed, set on an annual basis and that the arrangement is fair market value for the license provided - whether that be space, equipment and/or personnel.
In sum, there are a lot of rules and regulations governing interactions between practitioners - mainly to discourage abusive billing practices and kick-back arrangements. However, finding the right structure and creating a successful multi-disciplinary practice certainly benefits all involved - the practitioners and the patient. And, in fact, multi-disciplinary practice is the model that is being encouraged in the market - with the concept of increasing communication and transparency in care through coordination.
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