These days, it makes sense – no, in fact it is a necessity – to have other providers in your office who can supplement your income stream and/or help your business earn money apart from efforts you make with your own two hands.  Whether that means having a massage therapist on staff, hiring an Associate Doctor or having an Independent Contractor (of whatever type) in your office depends on the style of your practice, your volume, your available space and your budget.

Although the type or number of providers may differ as may their employment status (employee or independent contractor), the level of risk you incur should NOT be a variable factor.

Unfortunately, some chiropractors fail to take appropriate (or prudent) steps to protect themselves from these other providers and can place their business in great jeopardy in the process.  So today’s column is going to focus on just that: protecting your business from internal provider problems.

1. Beware of Unlicensed and Uninsured Massage Therapists

Many of you who have attended my seminars, read my previous columns or books are quite aware of my biases towards massage therapists. On the positive side, I believe massage is a wonderful complement to chiropractic care, as a simple and proven income stream when structured correctly and for the fact that patients generally love massage.

On the not so glamorous side, I hate the drama that comes along with many therapists.  I majored in English in undergrad and long ago was tired of drama – no matter what medium it takes. So when massage therapists exhibit poor work ethics, entitlement syndrome, a generalized lack of reliability, and more relationship woes in one week than some have had in a lifetime, my fuse is admittedly short.  In fact, I’ve had quite a few humorous “thank you” emails from those who have read my candid thoughts on massage therapists and how to handle them to know that I am not alone in my viewpoints.

That said, I am more than willing to tolerate the potential risks of insane LMT’s for a massive upside benefit to your patients and your bottom line.

BUT — there is one risk that I would not want to tolerate with regards to massage therapists — nor should you.  And here it is…

Unlicensed massage therapists and/or LMTs who are not covered by malpractice can ruin your day far more than any kooky, barefoot, bad juju massage therapist aura.
A brief clarification:  I understand that some states license massage therapists and some do not.  From a billing perspective, I am also very aware that, in some states, therapists bill for their services under your chiropractic license and in some states they may bill out independently.  These factors may play a role in whether or not your therapist needs to be licensed in your state, they do not automatically remove you from the risks associated with the therapists performing their services.

An unfortunately true story:

I received a disturbing call from a chiropractor seeking some advice.  The doc had previously purchased my Build a $300,000 Massage Practice in Your Chiropractic Clinic and implemented a healthy income from his massage therapists.  Unfortunately, he found out that his massage therapist had been performing massages in his clinic without a license for approximately the last 18 months. Of course, he practices in a state where a license IS required for massage and where insurance payers required services to be performed by a licensed therapist to be eligible for reimbursement.  Unfortunately, he also had been billing for the therapist’s services the entire time and receiving reimbursements.

Wait – it gets worse…

She mentioned the license issue to the office manager about the time it was due to be renewed. The therapist was very happy with her chiropractic employer who was keeping her busy and she enjoyed her working environment.  She wondered if the chiropractor would pay for her license since she was an employee of the clinic.  The office manager promptly made a note to discuss it with the doctor — and never did.

Not done yet — worse still…

Approximately 6 months after this conversation, the massage therapist also let her malpractice lapse because she presumed she was covered under the chiropractor’s policy as an employee of the clinic.  She had no intentions of looking for a job elsewhere so she didn’t feel the need to carry any
malpractice on her own.  And, you guessed it, she failed to inform her employer that she dropped coverage.

2. Painful Partnerships, Associates and Independent Contractors

This same scenario isn’t unique to massage; it could have happened to a chiropractor employing an Associate Doctor or Independent Contractor (of any specialty) as well.

Many chiropractors happily rent space to another chiropractor, an acupuncturist or a massage therapists (you’re probably losing money here – sorry, couldn’t resist!).  What they fail to check out is whether that practitioner is appropriately licensed, insured and/or covered by the owner’s liability policy.

Face it, doctor.  Your name is on the door.  It is you who will be sued when something goes wrong.  Worse, if you are billing for their services, it might be nice to know these practitioners are appropriately licensed or credentialed.  Even if they are billing under your license, they may need appropriate credentials.  At the least your malpractice carrier should know someone else is treating your patients other than you.  In most states, having an employee put an ice pack on a patient is far different than someone performing a massage, assisting with rehab or (especially) sticking tiny needles in a patient’s back.

Make sure your tail is covered or the needle that comes to extract your license and your money will be the most painful blood draw you’ve ever experienced.

How to Protect Yourself from Other Providers in Your Office

In the absence of donning a shield and suit of squirrel armor, here are a few suggestions…

If you are in a state that requires licensure for massage therapists…

  • Look up their license status online to make sure there are no disciplinary actions or sanctions against them BEFORE you hire them (call your state licensure board if they do not provide online verification)
  • Get physical evidence (a copy) of their current license upon hiring. Make a copy of that license and put it in their file.  You should also have it on display in your office, just like your own license.
  • Note the expiration date of their license. Most massage licenses are cheap.  Offer to pay it for the therapist once they have been successfully employed for 90 days or more. This presumes that they are worth keeping and it also makes sure you don’t leave it up to them.
  • Get physical evidence (a copy) of their malpractice upon hiring. Make a copy of that policy and put it in their file.
  • Note the expiration date of their malpractice coverage. Most malpractice policies for massage are also inexpensive. Comparison shop what they are paying with what your own malpractice carrier may offer as an additional “rider” for covering these therapist. (It may be cheaper that way because you are already insured)
  • Offer to pay malpractice for the therapist as an additional form of compensation. Again, if they have proven themselves a stable employee… When they ask for a raise, this is a good thing to contribute to their overall pay package.  If they don’t believe they are being paid enough, they will often drop the coverage and you will be the one endangered.

If you are in a state that does NOT require licensure for massage therapists…

  • You can obviously skip the license issue steps above, but malpractice is still a good idea since the therapists are working on your patients
  • Check with your malpractice carrier to see if it is necessary to put the therapist on your policy as it is doubtful that the therapist will have their own

If you have Independent Contractors working in your clinic…

  • You are probably killing your profitability on massage — sorry, couldn’t resist 🙂
  • You still need them to demonstrate evidence of a license and/or malpractice coverage
  • I would not pay for either but be vigilant in making sure that they are current

If you have other Associates / Independent Contractors (Chiropractors or Other Providers)

  • The same rules apply, except they definitely need to be licensed!
  • Malpractice coverage should be demonstrated as well!

I hope that this is just an unnecessary reminder for all of you – but it’s better to be pestering you about these things than listening to chiropractors cry on my voice mail.