Two chiropractors have achieved better access to advanced imaging services by being on staff at a local hospital

Dan Spencer, DC, and his brother, Jim Spencer, Jr, DC, have been on staff at Hillsdale Community Health Center (HCHC), Hillsdale, Mich, since February 2001. To the Spencers, the process and the benefits—particularly in terms of patient care and professional acceptance—shows that being a part of the larger continuum of care is a goal worth pursuing.

It was simply a question of being at the right place at the right time for the Spencers, who have offices in rural Hudson and Reading, Mich.

Getting on Staff
Dan and Jim Spencer take no credit for influencing Hillsdale Community Health Center to invite them to join the medical staff. The credit goes to Erv Malcheff, DC, of Hillsdale, who spoke with administrators about adding chiropractors to the staff. The facility is classified as an osteopathic hospital, so Dan Spencer says that it is not surprising that administrators would be willing to invite chiropractors to join the staff.

But when the call came, Jim Spencer was a bit skeptical. “I was apprehensive because they called us,” he says.

This time was different, and the brothers, who Dan believes were the first chiropractors accepted to join the physician staff, decided to fill out the necessary paperwork. When the time came for the physician staff to vote on the issue of accepting DCs on staff, they found that they were not going have to do any convincing. “It was up to us; [the physician staff] had already voted to approve us,” Jim Spencer says.

With the approval came changes to the hospital bylaws, which spells out the chiropractors’ privileges and is the de facto contract with the hospital. Credentials are renewable every year and can be revoked by the hospital if a violation of the bylaws occurs. The Spencers can also resign from the staff or have their privileges curtailed at their choosing as well. Renewal involves a much less rigorous process.

As soon as the Spencers joined the staff, they were assigned to the Family Practice and Outpatient Services Committees. The Spencers attend the quarterly meetings of these committees. In addition to the Spencers, the Outpatient Services Committee includes the radiologists on staff as well as representatives from the pathology department and the hospital satellite clinics. Also included are individuals from emergency services, laboratory, radiology, outpatient clinics, physical therapy, and medical records. This committee is important for the Spencers, who can voice any concerns they have over the outpatient services the center offers.

For example, the Spencers were recently having some problems in scheduling MRI and CT scans. “We voiced our concerns in the committee, and we had a resolution about 10 minutes after the meeting,” Dan Spencer says. “We can clarify hospital procedures by asking questions in this committee or offer our suggestions for improvement. This has helped ensure a hassle-free experience for our patients when they visit HCHC for various tests.”

A Two-Office Practice
Currently, the Spencers do not provide any inpatient care, but that could change in the future, Dan Spencer says. Instead, the brothers operate a two-office, two-DC practice—Contact for Health Chiropractic Center—with a staff of four, which includes both of the men’s wives. The practice has two freestanding buildings that include treatment rooms and x-ray equipment. Contact for Health Chiropractic Center, PC, was formed in 1992 when Jim Spencer joined his father, James Spencer Sr, in practice. Dan joined the practice after graduating from college in 1995.

Under Michigan law, chiropractors are limited to performing only a few services, including spinal adjustments, which is fine with Jim Spencer, who is president of the partnership. “It makes you a really good adjustor,” he says. “As a patient, you’re basically going to just get adjusted.”

The Spencers offer aqua thermassage, the diversified technique, the Gonstead technique, nutritional support, orthotic therapy, the flexion-distraction technique, and personal-injury care.

Joining the HCHC staff has helped the Spencers overcome the limitations on their practice.

For instance, being members of the hospital committees will likely help them to overcome recommendations by physical therapists affiliated with the hospital that their patients not seek chiropractic treatment during rehab. Whether or not the physical therapists are overruled, Dan Spencer sees it as one of the big benefits of being on staff.“At least we have a voice,” he says.

A Working Relationship
Though Contact for Health Chiropractic gets few referrals from the hospital, Dan sees another big benefit in the relationships he and his brother have been able to forge with local physicians while serving on the committees and going to other staff meetings.

This has led to a shift in practice for the Spencers. “We have a working relationship with the family practitioners, so they send patients to us with confidence and vice versa, and include us in consults,” Jim Spencer says. “In the old days, if we found something outside of our area of care, we would say, ‘I think you need to call your doctor.’ Now, we can sometimes get that patient a same-day appointment with one of our colleagues.”

But there are little, immeasurable things that have helped the Spencers as well. Like the rest of the medical staff, Dan and Jim Spencer’s photographs are hanging in the hospital lobby. This has been a boon to the practice.

“The photographs are trust-building,” Jim Spencer says.

“New patients tend to be more confident in your abilities when they know you’re on the staff of the hospital.”

The hospital has also provided marketing services to the Spencers, and they have used their affiliation with the hospital in their own marketing efforts, including the fact on their Web site and in press releases.

Another big benefit to the Spencers has been the availability of advanced digital imaging services at the hospital.

MRI
Prior to joining the staff of HCHC, Jim Spencer says that he and his brother typically sent patients to Toledo, Ohio, for advanced imaging services.
“Now, the money stays in the county, and that’s a big boost to the hospital,” he says.

Getting more patients through its imaging services was one of the big motivations for administrators to invite the Spencers and other chiropractors to join the staff, Dan Spencer says. HCHC currently has one of the only open-MRI units in the state, and will soon offer a 64-slice CT scanner. The DCs on staff have full ordering privileges for these advanced imaging techniques.

Because Medicare requires an MD or DO order to reimburse for such services, the Spencers can co-order MRI studies with an MD on staff, meaning the patient can get the needed imaging without having to pay out of pocket.

This has also made capturing the image much more efficient.

Jim Spencer, Jr, DC, reviews the results of a lumbar MRI with the assistance of MRI technologist Lee Adamski.

In many cases, the patient can be imaged the same day of the order and the Spencers get the results back almost immediately. “A lot of the time, I get the images before I get the report,” Dan Spencer says.

The use of MRI also means that the Spencers are providing better service to their patients, since, unlike x-ray, MRI can also give details about damage to and disease of the soft tissues. Dan says that he has found more serious problems, and quickly referred them to the patient’s physician.

A patient is assisted into the open-MRI unit by Dan Spencer, DC.

Even with more routine x-ray studies, being on staff gives the Spencers access to an expert second set of eyes in the event that there is a question about the image. “We don’t do this often, but it’s nice to have that access,” says Jim.

Though being on staff has benefited the Spencers in numerous ways, the practice was already providing patients with state-of-the-art care in their offices.

Flexion Distraction
Dan and Jim Spencer use flexion distraction regularly to provide relief to patients suffering from disc bulges, low back pain, and other low back conditions. It can also be used to alleviate cervical spine pain.

The technique involves placing the patient face-down on a specialized table, with his or her ankles strapped to the table. The bottom half of table is then lowered, so the patient’s legs are aiming toward the floor. By doing this, the disc space is opened up, the nerve roots are decompressed, and the muscles are stretched.

Dan Spencer discovered the technique in a class he took while attending Palmer College, Davenport, Iowa. He later took a certification course at National College, Lombard, Ill, which involved a practical and written test.

Even with the tremendous benefits of such chiropractic techniques, the Spencers have found even greater benefits from being a part of Hillsdale Community Health Center’s staff.

More Hospital Benefits
The primary benefits of being on Hillsdale Community Health Center’s staff have been access to digital imaging and greater respect from medical colleagues. “We want to be more of a part of the health care system,” Dan Spencer says.

And this feeling is reflected at the national level. Dan recommends a 44-page booklet published by the American Chiropractic Association titled, Doctors of Chiropractic: Part of the Hospital System. The publication gives details about joining a hospital staff and is a resource not only to read, but to present to administrators as an argument to include DCs on staff. “I think if there were more DCs on staff at hospitals, chiropractors would have more prestige within the healthcare community,” Dan Spencer says.

Jim Spencer has seen how this can work firsthand. Prior to joining the hospital staff, he was rarely at the facility. Now, he is at the hospital once per week, where, in addition to attending to staff business, such as committee meetings, he makes it a point to visit his patients when they are in the hospital.

“When a patient sees you at the hospital [doing business] they know you are on staff,” he says. CP

C.A. Wolski is a contributing writer for Chiropractic Products.