THE IDEA OF INTEGRATED CARE PRACTICES has been developing over the past couple of decades in an effort to bring together individual specialties to create a comprehensive care approach. It is a system still in development and has many faces depending on your respective role in health care. For doctors of chiropractic (DCs), it is an especially desirable concept of care for multifactorial conditions such as back pain, where multiple perspectives can enhance patient outcomes, while decreasing health care costs with a smarter utilization of health care resources.
For a multifactorial condition like back pain, multiple perspectives can be of extreme value, and successful examples of integrated care can be identified for chiropractors. From fully integrated spine centers involving a wide variety of specialties under one roof to smaller practices that include primary care, physical therapists and chiropractic physicians are becoming more common. For those who wish to maintain practice autonomy, integrated care can still be offered when tight referral networks are built on mutual trust and respect.
The patient-centered focus of integrated care checks off another desirable box in that it allocates a system of care that reasonably picks up a patient at any point in his or her condition with any severity of pain and offers shared physician viewpoints to give care most likely to improve outcomes. It prevents a system that allows patients to fall through the cracks and experience delays in care. It also prevents the all-too-common occurrence of patients who feel compelled to navigate their own care, jumping from provider to provider with little consistency, communication or results.
Health care providers experience significant benefits in a healthy system. From centralized information to coordinated referrals, the providers who participate within these circles of care are respected, trusted and valued among their peers for the clinical perspective they bring to patients. The teamwork involved in interdisciplinary care covers a wide array of benefits from curbside consults, increased exposure to available therapies, shared costs, training and improved outcomes, to name a few.
The Path to Success
There are, of course, barriers large and small. With so many different roles and participants, a variety of interests, politics, legal concerns, financial and power struggles and other issues only complicate the path to success. But this should not deter the independent chiropractor from pushing forward in healthcare integration. It starts with the most basic introductions between an MD and a DC. Here are five suggestions for meeting and building relationships with MDs:
1) PATIENTS’ MDS: All patients who cross your office front door should be asked for consent to share medical information and progress in your office with their primary MDs as well as any other physician they have seen for the condition in question. ACA offers a very thorough consent form that is available for download atwww.acatoday.org/UserFiles/AuthorizationtoReleasePHI(1).doc.
Nothing speaks higher of your services than the improvement of a patient who is struggling with pain and disability and has exhausted all other methods. It’s advisable to wait until patient discharge to share a one-page summary report for non-medical legal cases. These reports trump standard letters of introduction and will help you build MD/DO relationships much faster!
2) SPECIALISTS: It can be easier to get time with specialists than with primary care physicians. Many of the patients who come to them for a surgical consult have not yet had an appropriate course of conservative care. If you can build trust and educate these specialists on your comprehensive approach, you can help them screen patients who don’t need surgical intervention. Some patients have had adequate trials but aren’t surgical, leaving little else to offer them. Your services provide a tangible offering to these patients. It is especially helpful that some managed care organizations now require a trial of manipulation in order to authorize reimbursement of surgical procedures. It’s also helpful that guidelines advocate manipulation for both acute and chronic pain.
3) GRAND ROUNDS: Grand rounds are educational meetings that take place at local hospitals, with teaching hospitals offering the largest variety and frequency. The emphasis is always on learning and the sharing of information relative to patient care. Attendance allows you to sit among your community of health care peers and is a prime opportunity to meet community physicians; it also provides a learning opportunity. Attendance is free, and it’s as simple as showing up and finding a seat. To find grand rounds in your area, try a Google search with the keywords “grand round” (or continuing education) and the name of your local hospital. Try to find out who is in charge of grand rounds, and network your way to presenting a chiropractic case or new research. One important note: Some hospitals have groups of physicians who gather to review a specific patient case and offer insight referring to them as grand rounds.
4) SHADOWING: Shadowing allows you to observe physician-patient interactions. Shadowing works by utilizing existing medical relationships (new or established) and asking if you might shadow for a morning or afternoon as a silent observer. Time between patients allows you to ask questions on how physicians chose a certain medication or therapy and even to share your experiences on similar cases when appropriate. The insight you gain and the rapport you build is invaluable. Not every MD allows shadowing, but it’s worth inquiring.
5) NETWORKING: Existing MD relationships should be utilized for networking. Don’t be afraid to ask specialists, such as neurologists, whom they like to work with in primary care or any other specialties, such as whom they refer to for orthopedics. It helps begin the process of developing an integrated care approach, even if it isn’t under one roof, and it helps you expedite the process of meeting primary care doctors who are notoriously difficult to get time with. Additionally, ask if you can use their names when you reach out to other MDs. This is rarely met with resistance, and on occasion the MD will offer to make an introduction on your behalf. This provides you with a warmer lead that is more likely to get you through the door and indicates implied trust and support in your abilities.
Simple outreach by independent chiropractic physicians can help enhance medical comprehension and is a powerful opportunity for each of us to enhance patient access to our care. It’s also the first step to building and participating in integrated practice settings.
Dr. Acampora is the author of Marketing Chiropractic to Medical Practices and the founder of Aligned Methods, a company specializing in helping DCs establish informed working relationships with medical physicians.http://alignedmethods.com