The Combined Care Practice:
A Curse or a Blessing?

So what exactly is a combined care practice? There is no absolutely universal definition, but generally, the term refers to a medical or complementary medical group run by a doctor, physical therapist or chiropractor who employs multiple independent contractor caregivers from various healing arts, all within the same facility. That is a mouthful! To put it simply, a combined care facility offers many different treatment options which are used in combination and are regulated by a single head of services or governing board of practitioners.

So, what are the benefits of combined care for back pain patients?

When set up correctly, a combined care practice will offer suffering patients a world of options for treating their diagnosed conditions and/or managing their pain. More options are often an advantage, particularly for patients whose pain has not responded to the usual traditional approach to back care. A few patients may actually find true cures using combined care, while many more will be able to diversify their pain management goals, often reducing their dependency on potentially hazardous and addictive pharmaceutical products. These are all very good things to be sure.

This sounds wonderful! What could possibly be the downside?

Many combined care practices are known in some circles as personal injury mills. These practices go to great lengths to acquire new patients and keep them in longterm care for the sake of financial profit. Now, there is nothing wrong with making money treating patients. In fact, this is the goal of most medical professionals. However, when money becomes the priority over the wellbeing of the patient and the regulations set forth by the law, then there is a real problem.

Many combined care facilities start out with lofty and commendable goals to help as many people as possible. However, with time, most lose their way and wind up as exploitive insurance fraud scams operating on borrowed time. Is this a cynical view? I guess, but I must mention it is based on fact and statistics… not speculation. A great number of successful combined care practices are eventually closed down and criminal charges filed against their operators for insurance fraud and often fabrication of false injury for support of litigation purposes. There are the words that change everything… BACK INJURY LITIGATION. When lawyers get involved with doctors, no good can come of it. The doctor is often molded into a puppet who is at the beck and call of the personal injury attorney. This is a partnership destined for disaster in most cases.

Without going into my usual tirade about medicine and the law, I will instead focus myself on how this partnership affects the patient.

Back pain sufferers in combined care rarely find a cure. More often they are transferred from provider to provider with a “try a little of everything and let’s see what works” philosophy. This seems great, since it offers options and makes the patient feel like they are being proactive. In reality, the only thing they are helping to do is make lots of money for the various doctors in the practice, at the expense of their health and functionality. Usually, none of the care modalities offered demonstrate ANY HOPE for providing a cure. Instead symptomatic treatment is the rule of thumb in a combined care practice. It comes down to managing the pain versus curing it. This is almost NEVER discussed with patients prior to them beginning therapy at the facility. I have been treated by several of these multicare practices myself and have seen 2 of them closed out from under me for insurance fraud and falsifying documents. I have also considered myself lucky enough to have been there when many were closed in the course of my job as an investigator, for a variety of criminal offenses. It seems that the lure of easy money is simply too much for these “knowledgeable” health professionals to resist… such as shame!

So, without turning this into a book… here is my advice concerning combined care practices:

* As a patient, stay focused on achieving an accurate diagnosis and then pursuing a real cure. Symptomatic treatment will get you nowhere in the long run.

* If you see obvious signs of insurance fraud, leave. This may include bussing in patients from other areas, a lawyer on site, or actually being approached about how you can “benefit from your pain”.

* If you are being passed around like a snack tray at a party without finding back pain relief from a variety of care providers, you might want to consider that these doctors are simply spreading the wealth and are not really focused on helping you as much as helping themselves and one another.