Maryland and Oregon Join California by Endorsing Practice Management Guidelines

In order to improve the professional image of chiropractors as they expand their practices, the Maryland Chiropractic Association (MCA) and the Oregon Chiropractic Physicians' Association (OCPA) board of directors have approved new guidelines for practice management companies. The draft adopted by the MCA late last year and the OCPA just recently reads as follows:

The MCA/OCPA are committed to improving the access to and use of chiropractic services. This access is impeded whenever the image of the chiropractic profession is damaged by chiropractic doctors who engage in improper or unethical practices. Unfortunately, many unethical practices are taught by practice management companies. The MCA/OCPA hereby calls upon all practice management companies to adhere to the following standards:

1. No student should be signed to a practice management agreement until after he graduates from chiropractic college. Many students are naive and enter into practice management contracts without understanding their practical effects.

    

2. It is recommended that practice management contracts be on a fee for service basis, rather than a percentage basis, and should be terminable by either party on reasonably short notice. Percentage agreements have several pernicious effects and raise substantial ethical issues for both the practice management company and the doctor.

a. For the doctor, percentage agreements often impede or prevent a doctor from being able to obtain an operating loan if the doctor wants to open an independent practice. Additionally, paying over a percentage of a doctor's professional fee raises serious and substantial concerns as to illegal fee splitting and unlicensed practice of chiropractic by the practice management firm. Finally, the substantial burden of meeting such practice management fees can easily lead to such doctors becoming so debt burdened that they will be "debt motivated" to overtreat.

b. For the practice management company, gross percentage agreements create a strong financial incentive to advise every doctor to set up a high-volume, high-overhead practice, irrespective of whether such a practice can ever return a profit to the doctor. Such agreements also raise substantial issues as to fee splitting, unlicensed practice of chiropractic, violation of Maryland's/Oregon's Franchise Act, and violation of Maryland's/Oregon's Seller-Assisted Marketing Plan Act.

3. No practice management company should ever advise or teach any doctor to say or do anything that is not completely honest, ethical, legal, and truthful. The teaching of deceptive billing practices has resulted in increasing resistance by payers to reimburse chiropractic care. The teaching of patient solicitation under the guise of "research," "surveys," or any other false pretense is wrong and is condemned by the MPA/OCPA. The teaching of such practices can only have the long-term effect of harming both the chiropractic profession and the public.

4. Practice management companies should not engage in self-dealing with their doctor-clients by advising these doctors to purchase or lease equipment or other items or services from companies owned by or affiliated with the practice management company, and should not accept kickbacks or commissions for sending or referring their doctor-clients to any other company. It is a direct conflict of interest for a practice management company to have a financial interest in the very transactions to which the practice management company is advising its doctor-clients. The MCA/OCPA condemns such practices.

5. The MCA/OCPA also urges all practice management companies to allow their seminars and teaching materials to be open for review by neutral monitors. The MCA/OCPA also declares that each chiropractic college has a duty to its students to protect them from improper activities by practice management companies and to instruct their students in practice management and business planning. The MCA/OCPA calls upon each chiropractic college to exercise their authority to carefully regulate the on-campus activities of practice management personnel.

Editor's Note:

These guidelines are identical to those endorsed by the California Chiropractic Association on May 20, 1990. (Please see "California Chiropractic Association's Resolution on Practice Management groups" in the June 20, 1990 issue.)