Two DCs take a gamble with a multidisciplinary approach in Las Vegas

Integrated Health Care (IHC) is coming up as a winner in the Las Vegas market’s increasingly high-stakes business of chiropractic. The young venture is betting that taking a multidisciplinary approach, which teams its two chiropractors with a primary care physician, a psychotherapist, and a massage therapist under one, 3,000-square-foot clinic roof, will pay off in a big way. “We’re providing tremendous convenience to busy patients with this one-stop environment,” says Eric G. Easton, DC, CCSP. “They can come to a single location and receive the health services they need—all in the same day’s visit.”

It is also advantageous for the IHC team because it allows them to reduce their individual overhead by sharing major expenses, such as rent. “Overhead is a real killer. In the average chiropractic office, it eats up 60 cents of every dollar of income,” says Easton. “With our arrangement, overhead for each doctor is well below that. And our goal is to bring overhead down to no more than 30 cents on the dollar.”

Even Money
Although Easton, his fellow IHC chiropractor Joseph R. Nicola, DC, and the others parcel expenses evenly among themselves, they each operate separate practices. This greatly pares their individual exposure to liability while it increases their incentive to work hard. “Revenues aren’t placed in a common pot from which we draw equal portions; we each keep what we make,” says Easton. “This avoids the problem of one doctor feeling like he’s carrying the other, who, for whatever reason, isn’t as busy or productive.”

Unless a new patient specifically requests Easton or Nicola, first-timers are assigned to the chiropractors on an alternating basis. Nicola explains that there are two other exceptions to this rule: the first is when the newcomer has been referred by someone who is already a patient of one particular IHC chiropractor; the second is when a nonreferred new patient requests an appointment at a time of day when the doctor whose turn it would be will not be in the office.

The Integrated Health Care of Nevada staff: (front row L–R) Joseph R. Nicola, DC; Glen Alex, massage therpist; Eric G. Easton, DC, CCSP; (back row L–R) Alison A. Conner, office manager; and John Procaccino, massage therapist.

Three-pronged Operation
The revenue stream at IHC is fed by three tributaries: cash, insurance, and personal-injury awards. No workers’ compensation (WC) cases are seen by either chiropractor because that Nevada significantly limits the number of providers who can accept WC patients, and neither Easton nor Nicola has been able yet to gain admission to that rarified club.

Because many patients rely on insurance, the two doctors employ various clinical strategies for achieving desired outcomes inside of the visit limits imposed by third-party payors. “We try to quickly transition patients from acute care to rehabilitation,” says Nicola. “This way, at the end of the 12 or 15 visits allowed by their health plan, they’re much improved, and they don’t walk away feeling like chiropractic didn’t help them.

“We’ve tried to break out of the familiar mold where patients come in, receive passive modalities and adjustment, and that’s the end of it., “ Nicola adds. “Instead, we offer what we like to call progressive care. In the early stages of treating an acute problem, we do give passive modalities, such as ice packs, e-stem, and ultrasound. But once the acute pain is addressed, we then introduce a rehab component. The intent is to get the patient back to a level of functionality and health as good as, if not better than, what he or she experienced, pre-injury.

“The key aspect of the rehab component as we’ve structured it is, however, that it ultimately becomes the patient’s responsibility to get well again. In other words, we want the patient to rehabilitate himself, to start doing things for himself, so that he can take care of his own injury and advance himself.”

Easton contends that IHC’s multidisciplinary approach also contributes to putting patients on the road to good health before their insurance benefit for chiropractic is used up. “Over the years,” he begins, “I’ve had people ask me why chiropractors and medical doctors can’t work together. Well, the answer is they can. And the environment we’ve created with IHC proves it.”

Credit for the idea of a one-stop shop belongs to IHC’s primary care practitioner, Khossrow Hakimpour, MD. Easton and Nicola were nearing completion of the building that now houses their separate practices when Hakimpour approached them and asked to rent some space. Once word got out that a medical doctor was part of the enterprise, other types of practitioners soon sought to base their practices there as well.

Serendipity At Work
Nicola and Easton themselves teamed up not that long ago. In fact, it was only in 2001 that Nicola finished his training at Los Angeles College of Chiropractic. Having worked a few months in a chiropractic clinic in Las Vegas, his hometown, Nicola decided the time was right to purchase a practice and go solo. He contacted a practice sales broker to help him shop for local offices. The broker happened to be Easton. “As we drove around together to look at the various practices, we talked a lot and got to know one another,” Nicola says. “A relationship formed, and we realized that we had a lot of ideas and ambitions in common.”

Nicola works with patient James Haas during a rehabilitation session.

It eventually became clear to Nicola during the course of shopping that only by starting a practice from scratch would he be able to achieve his expectations. “Of the practices I considered buying, none was doing things the way I wanted to,” he reveals. “And if I had gone ahead and acquired an established practice, it would have meant making a lot of changes, which very likely would cause quite a few of the long-time patients to become uncomfortable, perhaps enough so to pick up and leave. That being the case, I figured there was no point in buying a practice, that I would be better off creating a new one.”

In reaching this conclusion, Nicola also began thinking about how great it would be to practice with Easton, since the two held such similar views about chiropractic and because Easton possessed a decade of experience in the operation of two practices. The offices Easton formerly owned were located in Pennsylvania. He sold them in 1998 and 2000 after suffering from practice burnout. “I needed a respite and a change of scenery,” Easton shares.

He and his wife chose to relocate in Las Vegas. The draw was a massively growing city set in a desert clime where, in the winter, “people shovel sunshine instead of snow,” he jibes. Easton studied for a license in real estate, and then was recruited by a brokerage to handle health care practice sales.

While escorting Nicola around Las Vegas to show available practices, Easton began thinking that, if he were to return to clinical work, it would have to be as part of a team and with someone possessing Nicola’s qualities—seemingly boundless energy, enthusiasm, and optimism. The more time he spent with Nicola, the more he found himself toying with the notion of practicing chiropractic again. He asked Nicola to consider joining him in some kind of paired venture. Nicola needed little convincing before saying yes.

“It was a very attractive offer,” says Nicola. “I had no business experience, and I knew that I’d likely spend the next several years spinning my wheels until I figured out how to be a good businessman. But here was Dr Easton, who had already been there and done that. I felt I could achieve success much more rapidly by getting on board with him.”

The Right Connections
Since opening IHC in July, Easton and Nicola have focused on generating referrals. “You can spend a lot of money on formal marketing, but the bottom line is people will go to whomever it is that friends and relatives say they’re getting results from,” says Easton.

The two attracted their first patients by capitalizing on Nicola’s lifelong Vegas connections. “I knew a lot of people here, so that was a big plus,” Nicola offers.

Easton discusses treatment options and compliance with his patient.

They also relied on pavement-pounding to drum up business. “In real estate, they teach you to get belly to belly with 20 to 75 people each and every day,” says Easton. “That’s what we did when we started IHC. We looked for every opportunity to meet with people, introduce ourselves, and hand them our business cards. I gave cards to all my former colleagues in the real estate business. I passed out cards while standing in line at the grocery store. I ate in restaurants and gave them to the waiters and waitresses. Basically, anybody I encountered anywhere during the course of the day received one from me.”

Understandably, Easton and Nicola see lecture engagements as a good investment of their time. “We try to do as much public speaking as possible,” says Nicola. “It’s one way that people can get to know us personally.”

Easton adds, “It’s a mistake to think that just because you’ve hung your shingle, patients will come flooding in through your doors. Chiropractic is a sales-dependent business. It is a service and must be sold to people.”

On the advice of Nicola’s public relations consultant wife, Marina, the doctors have made it known to editors and reporters at broadcast and print media outlets in the Las Vegas market that they are available to serve as expert sources on stories pertaining to health-related issues, not just chiropractic.

“Getting positive exposure from the press can be invaluable,” says Nicola. “But that means being available to reporters when they call. You also need to be able to present yourself well and be knowledgeable. It helps to have good contacts. We were lucky in that regard because my wife knew most of the press people in town and had a strong working relationship with them.”

Upping the Ante
Currently, the IHC chiropractors have only one facility, but it will may not remain that way. “We’d like to expand and have additional offices that replicate our IHC formula of various types of practitioners working under the same roof and sharing overhead expenses to keep their costs down, their profitability high,” says Nicola.

The doctors are noncommittal about when they might begin opening those other facilities or how far out into the Las Vegas market they might deploy them (their current office is located in the center of the city). However, they know they need to proceed with caution.

“From experience, I can tell you that multiple offices are either multiple success stories or multiple headaches,” says Easton. “We want to make sure we have only the former and none of the latter. That means making sure we’re on track at one site before adding another.”

Experience and Youth: A Profitable Combination Integrated Health Care (IHC) in Las Vegas offers a spectrum of family-oriented chiropractic care. Sports-related services represent a sizable piece of that. No surprise there, since athletics have a played a big part in the life of IHC practitioner Joseph Nicola, DC. “In college, I traveled to a number of Iron Man events and helped provide care for the competitors,” Nicola recounts. “I’ve also worked with a number of athletes at charity events, such as ‘Turning the Tide on Multiple Sclerosis’—a 40-mile swim from Catalina Island [off the coast of California] to the city of Long Beach, 27 miles across the bay. Recently, I traveled to the Bahamas and spent a week working with the national Bahamian Olympic team before their qualifying finals.” Nicola landed the Bahamian assignment after that team’s sports therapist put out the word through his network of friends that he was looking for a chiropractor to help him keep the athletes in top condition. One of those friends was living in Las Vegas and was acquainted with Nicola, whom he contacted to tell about the Bahamians’ need. “I’m still a young chiropractor,” he acknowledges. “Participating in these kinds of activities provides me with tremendous opportunities to see a lot of very different patients and gain more confidence as a doctor.” Nicola, who has an undergraduate degree in kineseology, started in health care as a physical therapy (PT) aide. “I provided PT services as a technician in inpatient and outpatient settings at St Luke’s hospitals in Tempe and Phoenix, Arizona,” he says. “I did just about everything there was to do when it came to orthopedic PT, neurological reeducation, cardiac rehab, outpatient care, and aquatic therapy, but I was frustrated by the scope of PT practice. I wanted to be able to do more, and I felt chiropractic was the way to go because it would allow me to deal with the body in a much more comprehensive, yet natural way.” For his part, IHC’s other chiropractor, Eric Easton, DC, CCSP, brings to the table the necessary expertise in running a practice, some of it gained from his training (beginning with college, where he majored in business administration), and continuing on through attending to his 9 years of practice in Pennsylvania. Easton opted for a career in chiropractic near the end of his final year of college. A business major, Easton had sought a chiropractor’s help for healing an injury and was so impressed by the care he received that he decided to return to school the following fall, accumulate the necessary science credits, and enroll in Chicago’s National College of Chiropractic, graduating in 1991. Next, Easton obtained an associate’s position with a practice near his hometown of Monongahela, Pa. He and another doctor a short time later jointly purchased that practice. Easton later bought out his partner and operated the practice by himself until the end of 2000, at which time he sold it and headed west to Las Vegas.

Rich Smith is a contributing writer for Chiropractic Products.