Further, many doctors of chiropractic have been engulfed by the HMO/PPO insurance trap. Those that haven't still fall pray to insurance carriers and limited-care packages. Years ago, many took out school loans, purchased equipment, and bought homes and cars with the idea that being a "doctor" was going to make them financially independent. Sound familiar? For many years the majority of chiropractors have been treated as second-class practitioners. Doctors say that they are not being paid what they are worth. Fear sets in and the "survival at any cost" mentality takes over at the front desk and billing department.
I offer you some new hope. Some of you will take my advice and retrain yourselves and your staff. After a lesson or two at weekend classes, you may never have to worry about CPT codes or insurance companies again.
My entire way of practice changed one day while treating a California Highway Patrol officer. "Why aren't you doing breath alcohol testing?" he asked.
That was two years ago. Little did I know how that conversation would bring me into the world of occupational health care and testing. After 20 years in practice, there I was training as a breath alcohol technician (BAT). I learned that seven million United States DOT (Department of Transportation) class "A" and "B" truck drivers were "mandated" for drug and alcohol tests. Every year a percentage of these truckers must be tested. I also discovered that there were very few BATs in my area. After two days of training, I could be seeing a few of these "mandated" patients in my office.
I purchased an evidentiary breath-testing device. The EBT was ultimately the key to all of my future occupational health care business. Without an EBT, I could not get the attention of employers or trucking firms. I needed to be service-oriented and as good, if not better equipped, than my competition. I was determined to provide better service than the local hospital. What a concept: mandated patients in my office - no insurance billing; no CPT codes; and payment at the time of service. No wonder the hospitals were surviving. No one ever told chiropractors they could perform these kinds of tests.
Before long, and with the help of a mailer to local businesses, I was seeing results. I had beaten the local establishment at their own game. My business juices were flowing. I asked about drug testing. What a natural thing for a drugless practitioner to be doing in his community. I then started a collection site for mandated federal drug testing. I read a few pamphlets and was ready to follow the federal protocols for urine collection. This is serious business, as silly as it might seem to you right now. Thousands of truckers are busted every year for drug abuse. You could be the first step in getting an abuser off the street.
The CDL trucker arrives at my office by appointment, urinates into a plastic lab cup, then signs a few papers. I get paid to send the urine off to a lab. Still no CPT codes, no insurance companies no expense for the shipping or tests kits. My staff was doing all the tests, while I was busy manipulating patients. There was another curious phenomenon occurring. Some of these truckers wanted my chiropractic services after the testing. I guess you could say they came directly from the mandates.
This led to yet another source of federally mandated testing. In California, at least for the last four years, and in many states across the nation, the same truck drivers need CDL (commercial driver's license) physicals. What a concept: federally-mandated physicals in my office - still no CPT codes, no insurance paper work, and payment at the time of service.
You can't imagine what mandates were to follow as I began to investigate all the mandates available for chiropractors to perform. I was angry for not doing this work sooner in my practice. The world of occupational health testing was opening up even more. I took a course in spirometry that lasted two and a half days. I invested in OSHA/NIOSH- certified spirometry equipment. I began testing employees of companies that wanted this service. I trained my staff to use the equipment. Spirometry is mandated for firefighters, welders, and anyone in dusty work-related industries. How many employers needed my services? I called OSHA for a list - still no CPT codes or insurance companies. The companies were paying me directly.
I still wasn't finished adding mandated tests to my once "muscle-bound" office. My staff was becoming more valuable to me. I was providing faster service than the hospitals. The hospitals were beginning to send me work. I trained for five hours with advanced ergonomics and was certified in that protocol. I learned dynamic lifting tests for repetitive lifting. This is not yet mandated during a pre-employment physical. I'm currently performing these lifting tests for eight stores of a large supermarket chain as part of their new employee physicals. I began audiometry class the first week in February 2001. I have my hearing test equipment already picked out for employment baseline testing. You would be surprised at the number of mandated employees that must be tested each year for hearing.
I think you can see that I have placed no limits on my practice. You can still practice chiropractic and meet new expanded challenges in your offices. I believe that traditional roles for our scope of practice must change if we are going to garner more respect. We are being held back to some extent by an uneducated public and the traditional medical community.
Most of all, we have been held back by our own traditional thinking. I believe that chiropractors are better trained for occupational health testing and the eventual rewards that come from meeting that new patient. You either change your way of thinking, or rely on that RN or LVN at the hospital to do all the testing for you. You decide for yourself!
W. Trent Saxton,DC