How to Get an On-site Treatment Practice Started

Chiropractors are strategically poised to take advantage of one of the biggest problems facing industries in America: employees with musculoskeletal pain.

Companies pay for the health insurance and workers' compensation insurance that cover this healthcare expense. Whether injuries occur at work or at home, the company pays for treatment of musculoskeletal pain. In addition, the company suffers from lack of production, decreased morale and many other direct and indirect costs that result from employees' pain and absenteeism. We need to be there to fill this need.

Employees all over the U.S. have repetitive motion jobs that cause accumulated trauma injuries. In the past, these were mostly grouped as upper extremity conditions like carpal tunnel syndrome, tennis elbow and rotator cuff. This definition has expanded over the years. Presently, in some states, low back injuries have been defined as accumulated trauma. Numerous programs that have been implemented to prevent these injuries have been successful in reducing the frequency. Unfortunately, these programs will never succeed in totally eliminating the problem. Whatever conditions we don't accumulate at work, we accumulate outside of work. Both cause pain and dysfunction. Both affect a company's bottom line.

The chiropractic profession is the most appropriately licensed and trained profession to deliver services to positively affect the change that corporate America desires. We are able to rapidly and effectively make people feel better and keep them working. They can't make money with injured people who are sitting home or on light duty. If we pay attention and become flexible, we can profit in this challenging and constantly evolving healthcare marketplace.

On-Site Treatment

Over the last two decades, I have seen changes in the workers' compensation system. More and more states are limiting or making access to injured workers difficult for chiropractors. I see the worker-related injury treatment window slowly closing for our profession; however, the window that is opening is on-site treatment.

This type of service is expanding nationwide as companies look for ways to prevent the accumulation of work and home stressors in their employees. Companies want to prevent recordable workplace injuries and light duty. They also want the employee at work, not laid-up with an injury that occurred at home.

An article recently published in the Journal of Occupational & Environmental Medicine showed the cost savings of chiropractic care onsite. This is our expanding niche market.

State and federal laws are constantly changing. Corporate management, company policy and personnel are in frequent turmoil. So, keep in mind that you will have to be prepared to adapt to changing landscapes if you want to enter this field.

Getting Started

I would like to share the evolution of the marketing model that I now use to create more opportunity.

I sat one day and looked at the fact that Blue Cross Blue Shield (BCBS) is more than 75% of my office income. Recent changes in the workers' compensation law in the state of Illinois have made it even more difficult to see patients, much less treat work-related injuries.

This year, BCBS is requiring require pre-certification for all services performed in a chiropractic office in Illinois. Add to that the lack of a yearly cost of living increase, and you have the perfect storm. Adaptation is imperative.

Shortly after I reviewed my office income, a company I periodically worked with called me. They asked if I had a massage therapist who could do seated chair massage at their company two hours per week. They were interested in addressing some of the discomfort expressed by their employees. I furnished the company with one of my massage therapists. I billed for the service hourly at a reasonable fee.

After my therapist had been there for six months, she noted that many of the employees had recurrent complaints that she was not able to help. I called the safety manager and asked to meet with her to help with this problem. I briefly discussed on-site treatment to address these conditions.

It is important to understand the motivations a company has for having on-site treatment: they are only partially based on the prevention of work-related injuries. Companies have rules set up by the Occupational Safety and Health Administration (OSHA) to document work-related injuries. Industry is interested in keeping the number of recordable injuries low to keep under OSHA's radar, as well as for other financial reasons.

I prepared for the meeting by putting together some statistics and a plan for how my proposal would positively impact the company. The financial realities were compelling and I started the next week.