Guest guest Posted March 27, 2006 Report Share Posted March 27, 2006 If you can afford to rent from him, then do that. You'll have full autonomy of your practice while having exposure to his clientele. If you work for him, do not expect to practice TCM. You'll be dancing to the beat of his drum. Particularly if the patients are PIP or Workman's comp. Also, by no means sign any contracts that keeps you from working anywhere within a certain radius of his practice should the relationship go sour. Fernando , < wrote: > > Hi All, > > I'm wondering if you can offer some recommendations and information for me. > Thursday I will be interviewing with a chiropractor who is looking for someone to > offer acupuncture part-time in his " very, very busy " clinic. He is open to all > financial options: me paying rent, receiving a percentage, and offering me > straight salary. He's asked me to come to our meeting with a clear idea of what I > want. Having not worked in this type of setting before, I have some questions that > some of you might be able to help me with. If you have or currently work in a > chiropractor's office, these are my questions: > > How long are patient visits? Do you do away with TCM intake and diagnosis, and > just do " symptomatic " treatments? What do you write down for diagnosis - > biomedical or TCM? > > Do you use e-stim or other modalities in addition to acupuncture? (heat lamps, > hydrocollator pads, liniments, tui na, etc.) What do you find most effective for > the kinds of conditions I'd most likely see in a chiropractor's office? Do you > offer herbal medicine also, or only acupuncture? > > Do you find it best for a patient to receive acupuncture before, or after an > adjustment, or does it make no difference? Or is it best to receive these > treatments on different days? > > How often do you see clients, and for how long? > > How many patients do you see hourly? What is your schedule like (how much time do > you spend on intake/assessment, treatment, conversation; how often do you move on > to a next client)? How many treatment rooms do you use? > > I'm trying to figure out how to estimate what patients will be paying. Since I've > been running a cash practice, I'm not familiar with fees that are typical for > insurance, workers' comp, etc. Do you know where I can find that info? > > If you were in my shoes, would you choose to pay rent, take a percentage, or ask > for salary, and why would you make that choice? I'd like for his staff to handle > all billing. And I know that everything except a straight salary means waiting for > payment to come in... but I'm not sure what salary amount would be reasonable. Any > ideas? > > Would you recommend that I keep my acupuncture records separate from the > chiropractic records? I think I'd need to... Do you think I should have access to > the chiropractic records? > > I've been treating patients so far mostly for internal disorders. I have > successfully treated pain, but I think more of my pain patients would have come in > more often if their insurance covered acupuncture, and therefore would have had > better results. > > If there are other consideratis I haven't yet thought of, please share them with me > also. Thank you in advance for your help. > > Sincerely, > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2006 Report Share Posted March 27, 2006 Hi All, I'm wondering if you can offer some recommendations and information for me. Thursday I will be interviewing with a chiropractor who is looking for someone to offer acupuncture part-time in his " very, very busy " clinic. He is open to all financial options: me paying rent, receiving a percentage, and offering me straight salary. He's asked me to come to our meeting with a clear idea of what I want. Having not worked in this type of setting before, I have some questions that some of you might be able to help me with. If you have or currently work in a chiropractor's office, these are my questions: How long are patient visits? Do you do away with TCM intake and diagnosis, and just do " symptomatic " treatments? What do you write down for diagnosis - biomedical or TCM? Do you use e-stim or other modalities in addition to acupuncture? (heat lamps, hydrocollator pads, liniments, tui na, etc.) What do you find most effective for the kinds of conditions I'd most likely see in a chiropractor's office? Do you offer herbal medicine also, or only acupuncture? Do you find it best for a patient to receive acupuncture before, or after an adjustment, or does it make no difference? Or is it best to receive these treatments on different days? How often do you see clients, and for how long? How many patients do you see hourly? What is your schedule like (how much time do you spend on intake/assessment, treatment, conversation; how often do you move on to a next client)? How many treatment rooms do you use? I'm trying to figure out how to estimate what patients will be paying. Since I've been running a cash practice, I'm not familiar with fees that are typical for insurance, workers' comp, etc. Do you know where I can find that info? If you were in my shoes, would you choose to pay rent, take a percentage, or ask for salary, and why would you make that choice? I'd like for his staff to handle all billing. And I know that everything except a straight salary means waiting for payment to come in... but I'm not sure what salary amount would be reasonable. Any ideas? Would you recommend that I keep my acupuncture records separate from the chiropractic records? I think I'd need to... Do you think I should have access to the chiropractic records? I've been treating patients so far mostly for internal disorders. I have successfully treated pain, but I think more of my pain patients would have come in more often if their insurance covered acupuncture, and therefore would have had better results. If there are other consideratis I haven't yet thought of, please share them with me also. Thank you in advance for your help. Sincerely, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2006 Report Share Posted March 27, 2006 Hi Andrea - I currently work in a chiropractic office in addition to working in a physiatrist's office (physiatry is basically rehab medicine - and the physiatrist in this office is an MD acupuncturist), so I have some experience with the settings that you are talking about. I think that an important question for you to ask/understand is what is the chiro's reasoning for bringing acupuncture into his office. Does he just want another service to bill for? Will you be seeing his patients or are you just expanding the services in his office and you'll be on your own in terms of building a patient base? Has he told you that you will be an integral part of their patient's treatment plan? Basically, what is his motivation for adding acu? In my case, I basically have my own practice that happens to be in a chiro office - I get maybe 15% of my patients from chiro referral (and often the referrals are for non-chiro problems). My practice is basically a cash practice. I have a percentage agreement set up for paying " rent " but the percentage I pay is ridiculously low (an 84/16 split in my favor, which includes use of linens and scheduling by their office staff, etc). In the physiatrist's office, I get paid per treatment and that's that. I see a lot of patients, but basically, I am allowing the office to bill for more acupuncture treatments (I am there the days that the MD is in another office). I am not sure what they bill for the treatments. This office is all worker's comp, PIP cases. I give simple TCM treatments or Dr. Tan balance treatments. When it is busy, I may be seeing 4 patients at once and I have maybe 5-10 minutes to check in with the patient and devise and implement my treatment. It really helps you think on your feet - but it is very different from my private practice. The advantage for me in this situation is that I don't have to worry about bringing patients in (I'm a new practitioner, building my own practice, so this aspect is refreshing!), I just show up and work. I also get some interesting cases and I experiment a bit with new treatments. The downside is being a part of a system that is, shall we say, not always in line with my personal ethics (lawyers and doctors should not work that closely in my opinion!). In addition, it can be frustrating to not feel like you have enough time to properly care for each patient. If you are just going to be another cog in their worker's comp/PIP machine, they will likely take care of billing for you. It would be nearly impossible (and maddening!) for you to do this on your own, especially if you are seeing a high volume of patients. It is difficult to recommend what to do in terms of salary/renting/percentage because I feel that this is largely based on your own personal financial situation. If you can afford to rent from him, this is probably the cleanest way to go. Another decent option is to set up a percentage agreement - the important thing to do in this case is to set a cap or maximum limit that you will pay him per month (so when your practice gets really busy, you are not paying him tons of money). If you can work out a straight salary, including benefits, I say go for it. Other questions - I don't think there is consensus on whether chiro or acupuncture should be administered first in one day. It is OK to do both treatments in one day - but it depends on who you ask as to whether chiro or acu should come first. Chiro patients are used to having e-stim, hot pads and other equipment used on them, so if you can incorporate these things, I would. Time per treatment will likely dictate if you are able to use these things. This situation can be a way to get more herbal patients. Not that you will always be treating the chiro problems with herbs (though I think liniments, plasters, etc are all good ideas for chiro patients) but inevitably the chiro patients will bring up other problems that they may be dealing with. This is something that you should clarify with the chiropractor - if you get herb patients from his chiro patient referrals, will the deal be the same in terms of compensation? How will you deal with the sale of the herbs themselves? The consultation fees? This is getting really long. Hopefully I offered a fresh perspective. You can email me off list if you want to go into more detail. Good luck- Adam , < wrote: > > Hi All, > > I'm wondering if you can offer some recommendations and information for me. > Thursday I will be interviewing with a chiropractor who is looking for someone to > offer acupuncture part-time in his " very, very busy " clinic. He is open to all > financial options: me paying rent, receiving a percentage, and offering me > straight salary. He's asked me to come to our meeting with a clear idea of what I > want. Having not worked in this type of setting before, I have some questions that > some of you might be able to help me with. If you have or currently work in a > chiropractor's office, these are my questions: > > How long are patient visits? Do you do away with TCM intake and diagnosis, and > just do " symptomatic " treatments? What do you write down for diagnosis - > biomedical or TCM? > > Do you use e-stim or other modalities in addition to acupuncture? (heat lamps, > hydrocollator pads, liniments, tui na, etc.) What do you find most effective for > the kinds of conditions I'd most likely see in a chiropractor's office? Do you > offer herbal medicine also, or only acupuncture? > > Do you find it best for a patient to receive acupuncture before, or after an > adjustment, or does it make no difference? Or is it best to receive these > treatments on different days? > > How often do you see clients, and for how long? > > How many patients do you see hourly? What is your schedule like (how much time do > you spend on intake/assessment, treatment, conversation; how often do you move on > to a next client)? How many treatment rooms do you use? > > I'm trying to figure out how to estimate what patients will be paying. Since I've > been running a cash practice, I'm not familiar with fees that are typical for > insurance, workers' comp, etc. Do you know where I can find that info? > > If you were in my shoes, would you choose to pay rent, take a percentage, or ask > for salary, and why would you make that choice? I'd like for his staff to handle > all billing. And I know that everything except a straight salary means waiting for > payment to come in... but I'm not sure what salary amount would be reasonable. Any > ideas? > > Would you recommend that I keep my acupuncture records separate from the > chiropractic records? I think I'd need to... Do you think I should have access to > the chiropractic records? > > I've been treating patients so far mostly for internal disorders. I have > successfully treated pain, but I think more of my pain patients would have come in > more often if their insurance covered acupuncture, and therefore would have had > better results. > > If there are other consideratis I haven't yet thought of, please share them with me > also. Thank you in advance for your help. > > Sincerely, > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 28, 2006 Report Share Posted March 28, 2006 Andrea: Some short answers to your questions. I would prefer rent as long as it is not too exorbitant. I would treat pretty much like you are use to treating. Insurance will probably lower your hourly rate. The nice part is the office is billing. You can see what your net rate would be and if it is acceptable to you. Many patients are insurance dependent but you have to decide if you can make a living that way. Using two rooms would certainly help - insurance or not.. I would strongly recommend acupuncture after the chiro tx. Some patients want one stop service, so you might have to do it right after they have been treated. Otherwise you may want it on a different day. I'm sure others can contribute more. Good luck. Anne wrote: > Hi All, > > I'm wondering if you can offer some recommendations and information > for me. > Thursday I will be interviewing with a chiropractor who is looking for > someone to > offer acupuncture part-time in his " very, very busy " clinic. He is > open to all > financial options: me paying rent, receiving a percentage, and > offering me > straight salary. He's asked me to come to our meeting with a clear > idea of what I > want. Having not worked in this type of setting before, I have some > questions that > some of you might be able to help me with. If you have or currently > work in a > chiropractor's office, these are my questions: > > How long are patient visits? Do you do away with TCM intake and > diagnosis, and > just do " symptomatic " treatments? What do you write down for diagnosis - > biomedical or TCM? > > Do you use e-stim or other modalities in addition to acupuncture? > (heat lamps, > hydrocollator pads, liniments, tui na, etc.) What do you find most > effective for > the kinds of conditions I'd most likely see in a chiropractor's > office? Do you > offer herbal medicine also, or only acupuncture? > > Do you find it best for a patient to receive acupuncture before, or > after an > adjustment, or does it make no difference? Or is it best to receive these > treatments on different days? > > How often do you see clients, and for how long? > > How many patients do you see hourly? What is your schedule like (how > much time do > you spend on intake/assessment, treatment, conversation; how often do > you move on > to a next client)? How many treatment rooms do you use? > > I'm trying to figure out how to estimate what patients will be > paying. Since I've > been running a cash practice, I'm not familiar with fees that are > typical for > insurance, workers' comp, etc. Do you know where I can find that info? > > If you were in my shoes, would you choose to pay rent, take a > percentage, or ask > for salary, and why would you make that choice? I'd like for his > staff to handle > all billing. And I know that everything except a straight salary > means waiting for > payment to come in... but I'm not sure what salary amount would be > reasonable. Any > ideas? > > Would you recommend that I keep my acupuncture records separate from the > chiropractic records? I think I'd need to... Do you think I should > have access to > the chiropractic records? > > I've been treating patients so far mostly for internal disorders. I have > successfully treated pain, but I think more of my pain patients would > have come in > more often if their insurance covered acupuncture, and therefore would > have had > better results. > > If there are other consideratis I haven't yet thought of, please share > them with me > also. Thank you in advance for your help. > > Sincerely, > > > > > > > > > Subscribe to the new FREE online journal for TCM at > Times http://www.chinesemedicinetimes.com > > Download the all new TCM Forum Toolbar, click, > http://toolbar.thebizplace.com/LandingPage.aspx/CT145145 > > > and > adjust accordingly. > > Messages are the property of the author. Any duplication outside the > group requires prior permission from the author. > > Please consider the environment and only print this message if > absolutely necessary. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 28, 2006 Report Share Posted March 28, 2006 Andrea, I've worked in a chiropractic setting for 9 years, so I have some thoughts! Your regular rates should work. There are no differences between treatments given in a chiro office or your own. TCM diagnosis is fine for your notes and for doing treatments, but you will need to code with pain codes (724.2 for low back pain, 723.1 for neck pain, etc.) when dealing with insurance or motor vehicle accidents. Because you'll likely be doing a lot of musculo-skeletal injury work, channel diagnosis is most common and things tend to be very straight-forward. I agree with Anne, pay rent if you can. What works best is to pay the chiro a percentage (say 20%) of what you charge your patient at first. In other words, pay a certain rate per PATIENT YOU SEE rather than rent in the beginning. When you get to a certain amount per month (say $900 or so, depending on where you are), then begin paying rent. I wouldn't go for a salary. Chiropractors (at least in my experience with the ones I've dealt with) are used to going through lots of people in a day or week. Some work in assembly-line fashion, and you could get worked to death and he or she could be making tons of money on you. That's likely to lead to resentment. (At least for me!!) Also, you will likely be doing lots of musculo-skeletal work. That happens to be my preference and focus, so I love it. I hope you are comfortable with musculo-skeletal pain and dysfunction. Chiropractic and acupuncture work beautifully together, if both are decent practitioners. Most treatments do best if the patient receives acupuncture after chiropractic. Occasionally, if the chiro has a difficult getting an adjustment at a particular level, an acupuncture treatment first can be the ticket that allows it to happen. Also, there are times I needle during adjustments and the results can be pretty amazing. Treatments are still an hour, and you will develop lots of patients separate from the chiropractor. Another reason to pay them a percentage or to pay rent. I use lots of e-stim, lamp heat with liquid moxa, cups, gwasa, etc. Again, working with a chiro doesn't change your medicine. It will change the type of conditions you see, however. BY ALL MEANS, keep your records separate. Some day that patient may be yours and only yours, but you wouldn't have access to their records. YIKES!! Also, legally, I believe you'll need to keep them separate. That doesn't mean that you can't write about what the chiro has said or done, and vice-versa, but keep your own! I hope this helps! If you have any further questions, contact me off-line. Good luck. Barbara Beale, MS, MAcOM, LAc, ATc _____ Chinese Medicine Chinese Medicine On Behalf Of Anne Crowley Monday, March 27, 2006 8:01 PM Chinese Medicine Re: working in chiropractic setting Andrea: Some short answers to your questions. I would prefer rent as long as it is not too exorbitant. I would treat pretty much like you are use to treating. Insurance will probably lower your hourly rate. The nice part is the office is billing. You can see what your net rate would be and if it is acceptable to you. Many patients are insurance dependent but you have to decide if you can make a living that way. Using two rooms would certainly help - insurance or not.. I would strongly recommend acupuncture after the chiro tx. Some patients want one stop service, so you might have to do it right after they have been treated. Otherwise you may want it on a different day. I'm sure others can contribute more. Good luck. Anne wrote: > Hi All, > > I'm wondering if you can offer some recommendations and information > for me. > Thursday I will be interviewing with a chiropractor who is looking for > someone to > offer acupuncture part-time in his " very, very busy " clinic. He is > open to all > financial options: me paying rent, receiving a percentage, and > offering me > straight salary. He's asked me to come to our meeting with a clear > idea of what I > want. Having not worked in this type of setting before, I have some > questions that > some of you might be able to help me with. If you have or currently > work in a > chiropractor's office, these are my questions: > > How long are patient visits? Do you do away with TCM intake and > diagnosis, and > just do " symptomatic " treatments? What do you write down for diagnosis - > biomedical or TCM? > > Do you use e-stim or other modalities in addition to acupuncture? > (heat lamps, > hydrocollator pads, liniments, tui na, etc.) What do you find most > effective for > the kinds of conditions I'd most likely see in a chiropractor's > office? Do you > offer herbal medicine also, or only acupuncture? > > Do you find it best for a patient to receive acupuncture before, or > after an > adjustment, or does it make no difference? Or is it best to receive these > treatments on different days? > > How often do you see clients, and for how long? > > How many patients do you see hourly? What is your schedule like (how > much time do > you spend on intake/assessment, treatment, conversation; how often do > you move on > to a next client)? How many treatment rooms do you use? > > I'm trying to figure out how to estimate what patients will be > paying. Since I've > been running a cash practice, I'm not familiar with fees that are > typical for > insurance, workers' comp, etc. Do you know where I can find that info? > > If you were in my shoes, would you choose to pay rent, take a > percentage, or ask > for salary, and why would you make that choice? I'd like for his > staff to handle > all billing. And I know that everything except a straight salary > means waiting for > payment to come in... but I'm not sure what salary amount would be > reasonable. Any > ideas? > > Would you recommend that I keep my acupuncture records separate from the > chiropractic records? I think I'd need to... Do you think I should > have access to > the chiropractic records? > > I've been treating patients so far mostly for internal disorders. I have > successfully treated pain, but I think more of my pain patients would > have come in > more often if their insurance covered acupuncture, and therefore would > have had > better results. > > If there are other consideratis I haven't yet thought of, please share > them with me > also. Thank you in advance for your help. > > Sincerely, > > > > > > > > > Subscribe to the new FREE online journal for TCM at > Times http://www.chinesemedicinetimes.com > > Download the all new TCM Forum Toolbar, click, > http://toolbar.thebizplace.com/LandingPage.aspx/CT145145 > > > and > adjust accordingly. > > Messages are the property of the author. Any duplication outside the > group requires prior permission from the author. > > Please consider the environment and only print this message if > absolutely necessary. > > > > Quote Link to comment Share on other sites More sharing options...
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