Shared by: JHUBER@hcc.ctc.edu
John Huber DC - Manager

Chiropractic Technician Program

6-19-01

Most of the multidiscipline practices I have encountered do not 
involve a DC

due to financial limitations. The most common linkage is as a 
outsource

referral when pre-approved by an in-house gatekeeper. This type of 
linkage

works when all the providers are covered/credentialed by the same

grant/carrier. 



There are a number of barriers limiting DC participation in a

multidiscipline practice. DC laws/rules have a number of scope 
related

prohibitions that have impacts on advertising and billing. There are

specific laws/rules controlling advertising and office signage that 
make

promoting a multidiscipline practice very difficult. Medicare 
limits DC

billing to CMT (spinal adjustments) codes only and many other 
carriers allow

very limited evaluation/management components, therapy and 
radiology

services in addition to CMT when "medically necessary". In 
Washington State

DC patients must have a vertebral subluxation complex as defined 
by RCW

18.25.006(5).  



DC coverage by government/private carriers has been fairly broad 
since the

mid 1970s. Private practice DC income in Washington State has 
been in the

$60,000-$85,000 range on average. Most capitated or grant funded

multidiscipline practices can't come close to matching the private 
practice

pay range. Limited panel access, increasing number of DCs and 
more ridged

utilization enforcement may push down DC wages in the near 
future.



CAM integration into traditional medical clinics in Washington 
State have

been in areas where CAM interns are available form a CAM college. 
The

students work free and are supervised by the CAM college facility. 
Since

there is no DC college in Washington State free inclusion of DC 
services can

only occur when a willing DC donates some time. Most DCs are very 
busy with

their our practices and simply can not afford to volunteer their 
services. 



Currently the major problem with multidiscipline practices is that 
the

linkage is usually a financial relationship between the providers, 
rather

than focused on patient convenience/outcomes. The number of 
billable

services related to one patient visit becomes the focus of the 
practice

providers. A number of health care laws frequently get trampled in 
the

process (kickbacks on referrals, patient inducements, providing 
services

billed through another provider type, price fixing, medical

necessity/reasonable and necessary requirements and up-coding to 
name a

few).



True multidiscipline practice will need significant regulatory 
reform

(probably a long slow process). The perfect setting would be 
government

funded clinics focused on specific patients groups (military bases, 
veteran

hospitals, public health clinics for indigent/uninsured care and 
reservation

health clinics), since advertising/billing would not be as 
problematic. The

US Department of Defense is moving ahead with DC inclusion for 
active duty

military personal after a successful 2 year trial. Finances remain 
the

question mark. Will the taxpayer/insurance purchaser be willing to 
add on

CAM any time in the near future? Will CAM turn out to be an add-on 
cost?



John Huber DC - Manager

Chiropractic Technician Program

Highline Community College

206 8783710x3843