In industries where safety is paramount—whether it’s trucking, construction, or manufacturing—implementing robust health and safety programs is not just a legal requirement but a moral imperative. Two critical components of these programs are Department of Transportation (DOT) physicals and workplace drug testing. These programs help maintain a safe, productive workforce, mitigate risks, and ensure compliance with federal and state regulations. By focusing on regular DOT physicals and comprehensive drug testing, employers safeguard their operations and ensure that workers can perform their duties without compromising their health, safety, or that of others.

What is a DOT Physical?

A DOT physical is a mandatory health examination for commercial vehicle drivers. Administered by a licensed medical examiner, the DOT physical is designed to assess whether a driver is physically and mentally capable of safely operating a commercial motor vehicle (CMV). This includes a thorough check of the driver’s vision, hearing, blood pressure, cardiovascular health, and other factors that can impact their ability to perform their job safely.

The DOT physical is required by the Federal Motor Carrier Safety Administration (FMCSA) for anyone operating a commercial motor vehicle that is involved in interstate commerce. The purpose is clear: to ensure that drivers are fit for duty and free from conditions that might impair their ability to drive safely.

Why Are DOT Physicals Crucial?

1. Identifying Hidden Health Issues
   Many serious health conditions, such as hypertension, diabetes, and heart disease, can go unnoticed by employees until it’s too late. Regular DOT physicals catch these conditions early, allowing for timely treatment. A DOT exam doesn’t just ensure that drivers meet specific physical standards—it helps uncover any underlying health issues that could affect their performance on the road. Conditions such as uncontrolled high blood pressure or undiagnosed diabetes can result in medical emergencies while driving, endangering not only the driver but also others on the road.
2. Preventing Medical Emergencies
   Certain medical conditions, if left unchecked, can lead to sudden incapacitation, which is a significant risk for commercial drivers. A well-timed DOT physical ensures that conditions like cardiovascular disease, seizure disorders, or impaired vision are identified early, reducing the risk of health-related emergencies during operation. This, in turn, lowers the likelihood of accidents caused by sudden medical issues while driving, contributing to overall road safety.
3. Promoting Long-Term Health
   DOT physicals don’t only focus on short-term fitness for duty; they are also an opportunity for drivers to get a baseline assessment of their health. With regular check-ups, drivers can be guided on lifestyle changes, preventive care, and health goals. This proactive approach can lead to better long-term health outcomes and fewer instances of chronic illness.
4. Ensuring Compliance
   FMCSA regulations require that all commercial drivers undergo a DOT physical at least once every two years. Employers who fail to ensure their drivers meet this requirement risk facing significant fines and legal repercussions. Compliance with DOT physical standards isn’t just an obligation—it’s an essential part of protecting the business from liability and maintaining a good standing with regulatory bodies.

What is Workplace Drug Testing?

Workplace drug testing involves screening employees for the presence of illegal drugs or alcohol to ensure they are not impaired while performing job duties. In the context of industries with safety-sensitive jobs, such as trucking, construction, and manufacturing, drug testing is especially critical. Drug tests are typically administered in one of several forms, including urine, saliva, hair follicle, or blood tests, depending on the type of testing program and the substances being tested for.

Workplace drug testing programs can be either random, scheduled, or conducted in response to a specific event or suspicion. These programs not only help maintain workplace safety but also foster a culture of accountability, ensuring that employees are fit to perform their jobs to the best of their ability.

Why Is Workplace Drug Testing Important?

1. Preventing Impairment on the Job
   The dangers of working while impaired cannot be overstated. In certain industries, a moment of impaired judgment or delayed reaction time can lead to catastrophic accidents. For example, in the transportation industry, a driver under the influence of drugs or alcohol is more likely to make dangerous decisions, such as running a red light, failing to yield, or making a poor lane change. Drug testing ensures that employees are not working under the influence of substances that could impair their judgment or abilities, reducing the risk of accidents.
2. Ensuring a Safe Work Environment
   Workplace drug testing fosters a safer environment for all employees. When workers are aware that their colleagues are subject to drug testing, they are less likely to engage in substance abuse. This not only enhances individual safety but contributes to a healthier, more productive workforce overall. A safe work environment boosts morale and reduces the number of workplace injuries, which is beneficial for both employees and employers.
3. Reducing Employer Liability
   Employers are legally responsible for providing a safe work environment for their employees. When substance abuse is a factor in an accident or injury, the employer can be held liable for negligence, particularly if they failed to implement proper drug testing procedures. Having a drug testing program in place helps demonstrate due diligence, reducing the likelihood of costly legal disputes and liability claims.
4. Promoting Workplace Productivity
   Employees who are under the influence of drugs or alcohol are far less productive. They may struggle with focus, coordination, and decision-making, all of which affect overall performance. A workplace drug testing program discourages substance abuse, ensuring that employees are alert, productive, and engaged in their tasks. This leads to higher overall efficiency and output, benefiting the bottom line of the company.
5. Supporting Employee Wellness
   Workplace drug testing programs also offer employees a level of support. By addressing substance abuse head-on, employers can create an environment where employees feel safe to seek help if they are struggling with addiction or substance use disorders. Many drug testing programs come with educational components or access to rehabilitation services, helping employees regain their health and return to work in a more stable condition.

How DOT Physicals and Drug Testing Work Together

The synergy between DOT physicals and drug testing programs cannot be overstated. Both are integral to ensuring a safe, healthy, and compliant workforce. While DOT physicals focus on assessing a driver’s physical and mental capacity to perform their duties, drug testing ensures that employees are not impaired by substances that could undermine their performance. Together, these programs create a comprehensive safety net that protects not only employees but also the public, clients, and the company’s reputation.

By implementing regular DOT physicals and workplace drug testing, employers are not only adhering to legal standards but are also fostering a culture of safety and well-being within the workplace. A healthy, drug-free workforce is not only more productive but also far less likely to be involved in accidents or legal disputes.

Conclusion

Regular DOT physicals and workplace drug testing are critical to maintaining a safe, compliant, and efficient workplace, particularly in industries where safety is of the utmost concern. These programs help prevent medical emergencies, ensure employees are fit for their roles, reduce liability, and promote long-term employee health and productivity. Employers who invest in regular health checks and robust drug testing protocols are not only protecting their workforce but are also ensuring the continued success and growth of their business. In industries where human lives are often on the line, these preventive measures are more than just regulations—they are essential components of a responsible and forward-thinking business strategy.

Not everything in the office goes according to plan. In your mind, things should go from one to the next without much of a hiccup.  This past week was a reminder of that.  Thousands of adjustments are performed in the office on a yearly basis and hundreds of physicals and drug collections and if I told you that there is no risk in performing this job, I’d be lying to you.

There are numerous stories that are constantly circulating on the internet of how dangerous chiropractors can be, while these stories do not necessarily concern me, the statistics just don’t pull enough weight that a lot of mental energy should go into it, but we do get asked about it.  The things that concern me in the office when it comes to chiropractic care are ribs that either stress or strain during P to A adjustments, this does happen 2-3 times per year, it’s painful to the patient and I feel about two feet tall when it happens because normally it happens to some of my favorite patients.  I feel it on my end and the patient feels it right away.

There is not a lot of “treatment” to fix this in the short term; it’s just a complication that we see in the profession a few times a year.  Time and rest is normally the best thing to do and within a week or two, you will be back to feeling normal but the entire purpose of coming to the office is to feel better but when a patient leaves feeling worse, that’s a terrible feeling as a provider.

I’m constantly weighing risk/reward when it comes to treatment.  An older individual comes in with hip pain, it can be complicated, I want to mobilize the joint but I also need progress and not pain.  So sometimes the best things to do are minimal treatment that day and follow up a few more times than being so aggressive they are miserable and essentially cussing you out when they leave.

The number of DOT physicals we perform in the office is constantly rising.  When paperwork gets filled out, people aren’t necessarily truthful the entire time.  Health scares happen to people all the time without then telling me the entire story.  We can request records and get all of the information we can get our hands on and it can just be a judgment call.  99% of the time, the correct judgment is made but you always remember the 1% you question yourself on.

Drug tests are a different animal, the people that come into a drug test and have nothing to hide look at it more as a inconvenience but you do run into situations when people are going to do everything possible to pass a test including, devices and fake urine, in order to keep or get a job. Most of the time, I’m just the collector and don’t have a lot of skin in the game but there are times when people try to pull a fast one on you, it does happen but as long as protocols are followed the people that try to game the system will eventually get caught.

I wanted to write this as a reminder that things do happen, but mentally you have to just keep pressing on.  It takes a lot of mental energy when things don’t go according to plan.  We strive to do the best we can with all patients that walk in the door.  We do feel bad when adjustments go wrong and never forget the DOT’s that press the envelope or the “judgment” call but we do the best we can and have to keep moving forward.

I think I would be preaching to the choir to say that every job has its ups and downs.  If you say that you love your job 100% of the time, I think you’re either the extreme rarity or you’re lying to yourself. Genuinely, I do like what I do but there are days and patients that drive you up the wall.

The anti-thesis chiropractor, I do see a lot of value in the work that I do. But some of these offices get a little carried away, in my opinion, with the treatment plan aspect. I come from the school of thought that we will treat you a time or two, get you back on your feet and allow the body to heal.  Going for a walk, get moving or some simple stretches are most of the time significantly better for you then more treatment in the office. A lot of the passive therapies that are performed in the office are short term, they feel good in the moment but a couple hours after the therapeutic benefit has worn off, so walking and proper exercise are more conducive for long term health and recovery. So if you want to spend your hard earned money on a long term treatment plan, feel free, but personally I don’t feel that it’s necessary.

Simple things go a long way, as I just stated, doing simple things outside of the office can be more beneficial than anything. Divert to DOT physicals and drug testing, if you call to schedule a drug test, please don’t pee 5 minutes before you come into the office.  Have your medications and proper paperwork filled out or available before coming into the office for your appointment.  Not only does it make your life easier but I am able to get you in and out of the office in a much more efficient and timely manner.

I’ve said this from day one.  The services that I provide and the way I practice allow me to sleep well at night.  Things are done on the up and up, we follow the rules and don’t abuse them.  There are some grey areas in regards to DOT physicals, but drug and alcohol testing is very black and white.  Chiropractic treatments are subjective, people tolerate things differently, but we get you in the office and back on your feet as fast as possible and you let us know when you need anything else.

Needing to be able to be comfortable in your own skin as you are fighting an uphill battle is never ending.  Insurance is becoming less and less sustainable from an office stand point. Reimbursements are falling WAY behind the cost of operating a business.  If you think that my office is expensive, boy do I have news for you.  Go into a clinic or hospital and see what the cost is just to be seen. I try to keep things reasonable and at prices that I would feel comfortable paying for the services that are offered.

I like my ancillary services and I feel that they are a benefit to society and provide value to the people seeking them. Drug and alcohol testing are mandated by the federal government.  DOT Physicals are required in order to keep a CDL active.  These are keeping drivers and the general public safe on the roads.  People are always going to try and skirt the rules, whether it’s lying about medications or trying to “pass” a drug test.  It is my responsibility to get to the truth and keep them on or off the road if necessary.

Do I think that chiropractors come with a poverty complex, not necessarily. We are getting to a point where prices are going to have to increase on our end in order to keep things operating as smooth as they should be in my opinion. I feel that charging a fair price and giving great service is the basis of a successful business. Are we the cheapest, no but we are far from the most expensive. There are a lot of chiropractors in the area and only so many patients to go around.  Offering services that people utilize and value is where I’m at in this ever evolving healthcare circle.

I don’t plan on drastically changing anything but just know that running an office and surviving in the current healthcare environment while living a comfortable life is an uphill battle. I’m willing to fight that fight at this time, I RARELY turn anyone away but with the ever growing accounts receivable in an office and the ever growing cost of running a business, patience runs thin at time.

At the end of the day, you have to choose to be happy with the road you have chosen and overall I would say that when I lock the doors are the end of the day, I’m content with the life I have chosen.  Are there things that I could do to make significantly more money with fewer headaches, sure but at this stage I don’t have to answer to anyone on a daily basis.  I can go to kid’s events and not have to ask anyone and the ability to have a life outside of the office, while sometimes difficult, is one of the best perks about the profession.

I completely understand that this is more of a rant but writing these thoughts down and letting even a few people have access to my thoughts is not only therapeutic for me but it allows you get an insight as to what the struggles are from time to time.

Occupational Medicine is a pretty broad term but I’m going to approach this from a DOT Physical and a drug/alcohol testing aspect.  We hear from people all the time that Medical doctors, nurse practitioners and physicians assistants have said that chiropractors have no business performing DOT physicals.  I would like to rebuttal that argument: while chiropractors don’t have to ability to manage medications or order many medical procedures, we most definitely can perform the type of exam necessary to qualify (or disqualify) drivers to safely drive.

Roughly 12 years ago, the FMCSA developed guidelines that all medical examiners needed to be certified to perform these physicals.  I was one of the first 10 people in the state, across all profession to get certified and I haven’t looked back since.  I have since taken the course again and past the test, again. I say all of this because it doesn’t matter what profession you are, we all take the same certification process and take the exact same test. So while I may not be able to take people on and off medications, I am able to review a medical history, medication list, previous surgeries and send you out for sleep apnea testing and other testing that may be necessary to safely pass the test.

As for are we able to identify things, yes and quite honestly we have seen most if not all of the items we are tested over: monocular vision, insulin use for diabetes, amputated limbs or the basic high blood pressure have all come through the office in some shape or form. The process has changed over the years and we have had our hiccups with getting the correct forms filled out, but we eventually get there.

I find a lot of enjoyment performing these exams, they are normally pretty straight forward, quick and we are able to get people in and out of our office in a timely manner.  We are discovering that most medical clinics are not getting recertified, I’m not sure if the paperwork is a headache or if it’s just not something they want to do anymore, but fewer and fewer people are doing them.

The drug/alcohol testing is a little bit different animal.  Whether you are part of our consortium that we run in house or just use us as a collection site, just know that I have gone through the training and certification to perform this service.  It’s always a little interesting as you don’t have to be a healthcare professional to perform these collections, just pass the certification.

At this point, I plan on keeping it run and collected by healthcare professionals, whether that is me personally or have a nurse or two that come in and do collections, I would like to keep it that way. The process is fairly quick and painless unless you have a “ding” on your collection history, then it’s a little more invasive, but not crazy.  We are finally starting to hit our stride with this service and are looking to potentially going mobile at times for companies that don’t like to send their drivers away from the day’s work in order to get to a clinic to perform a collection.

While it was never my intention to get into DOT Physicals and urine collection, I’m fully committed at this point and I would love to discuss you or your companies needs in regards to any or all of these services. If you have any questions or comments please direct them to spracklindotservices@gmail.com and we can discuss how we can make your life a little easier.

As the year turns over and people start to present into offices with different insurance cards, I wanted to do a brief write up on Medicare Advantage Plans, why patients love them and offices/physicians loath them.

When you turn 65 you get the option as to what kind of Medicare you can sign up for, Traditional Medicare in which you have a deductible of around $250 and then pay 20% of the allowed amount unless you take out a supplemental plan, which most people do.  This is the bulk of your cost is the cost of the premiums on a month to month basis but not a lot of questions are asked about treatment, you get the care that needs to be done.

Medicare Advantage plans are when the patient essentially gives up their traditional Medicare rights and allows a private insurance control the plan. It is much more like what we see in our office as a traditional insurance.  The premium is typically lower, the coverage normally included prescription, dental & vision but the initial burden falls on the patients. A deductible needs to be met, co-pays are normally required at office visits and we have begun to see a trend towards pre-authorization for care.

From a chiropractic perspective, this can be a nightmare for certain plans. As with traditional Medicare, only the adjustment is covered.  Medicare does not cover therapies and exams in a chiropractic office, we can bill for them but the responsibility falls to the patient. The fee schedule for Medicare is stagnant if not declining. So, when someone says you should just raise your price to come in, it doesn’t necessarily work like that, when we agree to accept Medicare patients we are agreeing to a fee schedule and the rules that Medicare sets out, we can’t just “charge more.”

Let me paint you a little picture: a patient presents at the first of the year and gives us a new insurance card; it’s a Medicare Advantage Plan. We bring you back and treat you like you were before the patient selected this particular insurance. When the patient leaves, is when the work actually starts. I, the doctor, sits down at a computer, logs into a website and requests care from a third party conglomerate, which requires constant oversight as we have numerous patients we are watching how much care is allowed and when certain authorizations expire. We may get 10 visits over the first 2 months.  The patient will get a bill for their co-pay amount for each visit. A phone call comes in, it’s the patient saying, why do I owe this amount, it’s the plan you signed up for.

On a side note, this is actually one of the worst parts of the entire process, is that we (the office) have to explain benefits to people (not our job).  The agents that are signing people up for these plans don’t do a good job explaining what is and isn’t covered and what the expectation level will be on the patient end when they present the card to an office.

The first authorization is not normally an issue, it’s the second and third….the “incidents” are not taken into account individually. Let’s say you come in 4 months later, they may only authorize 4 visits over 8 weeks. The year is looked at as a whole, not on an incident by incident explanation.  They are trying to manage cost, for every visit they can “not allow” the more money they save and adds to the bottom line. The more times you try to get pre-authorization, the fewer visits that will be allowed if not flat out denied in some cases.

The plan that you sign up for has a trade off for the cheap premium, which is why most patients love them.  You are responsible for more out-of-pocket expenses, while the doctor and office has to do more background work and paperwork with 3^rd party companies that are going to dictate how much care you are “allowed.” I’m not saying that insurance is perfect, all of them have their quirks and intricacies but the Medicare Advantage plans are crazy in our office because most of the time we are doing paperwork and notes to collect somewhere between $6-15.

While it’s not necessarily in our game plan, don’t be surprised when clinics, hospitals and doctors stop accepting certain plans. We have seen certain hospitals having to hire additional staff just to “babysit” the pre-authorization process while not getting reimbursed more. So try running an office or a business, where you are required to perform more work, can’t raise your prices and your cost of operating a business continues to rise. The math doesn’t math in most offices. There is no perfect solution when it comes to healthcare but the current model doesn’t seem to be working for anyone other than the insurance companies.

I normally try to sit down at the end of the year and put together some thoughts about the previous year and reflect on the things that went well, went bad and what we can change in the office to make it more convenient and accessible to everyone that comes in the doors. I’m taking a few days off to gather some sanity and thoughts so I’m going to do some writing.

2024 was largely an unremarkable year; we saw lots of changes in regards to Medicare Advantage plans and some insurance in general. In all honesty, it was a pretty stagnate year which I think if you talk to most business owners, they would largely agree.  There is no real rhyme or reason why it was but it just was. (Think pre-authorization process for the doctor with lots more documentation requests all while taking longer for claims to get paid/processed)

We made a push and will continue to push to grow the DOT side of the business.  Hundreds of DOT physicals were performed this year and we would like to continue to see that number grow.  Drug and alcohol testing is growing as well.  Our consortium continues to add more and more members that trust us to keep everyone in line with FMCSA/DOT drug and alcohol standards.

From a chiropractic perspective, we saw LOTS of patients of all ages and demographics. Different conditions come into the offices regularly.  It’s not uncommon to hit just about every complaint in a day, from a headache, sciatica and elbow pain, sometimes all in one patient. We can handle lots of conditions but we do have our favorites and are comfortable with.

Patients seem to like the laid back atmosphere of our offices and quite honestly, I do too but we go into the new year I’m going to be making a push to see more follow up visits.  While that doesn’t mean that long, drawn out treatment plans are going to be coming in, we are going to try to make a more conscious effort to track patient progress a little closer.

I would also like to make the point, that we are a business that has bills to pay and people to pay, so while we field a lot of comments that I must just be raking it in because I’m a “doctor.” If it only worked like that, raising prices doesn’t work that well because you are beholden to insurance contracts and still need to be competitive in the market. It’s not my favorite topic to broach with patients, sometimes the hard conversation needs to be had about insurance coverage, cost per visit and how we as an office did not select the plan that you selected whether it be on the marketplace or through your employer.

2024 was not a bad year by any means but it was just interesting.  I’m hoping that 2025 continues the trajectory that we have set out on over the past few years and the ups and downs that come along with owning a business, but reflection and fixing certain situations most certainly project that 2025 should be a better year than 2024.

We look forward to seeing everyone in the new year after a few days off to gather some thoughts, rest and sanity.

It all started with what I thought was a stomach bug.  I left work early, didn’t feel all that well, couldn’t make it to work the next morning and ended up in the Emergency Room.  A little while later, I find out I have a ruptured appendix and am septic in the ER. Surgery ensues, which went according to plan, drains are in place and IV antibiotics are my new normal for the 5 days I spend in the hospital.  Peritonitis (infection/inflammation of the abdomen) and organ systems that had started to shut down needed to come back on line. Released from the hospital and spend 7 days recovering at home while trying to not go crazy, get depressed and maintain a normal household with a 6 & 4 year old.

I had no idea what life was going to hand me when I left the office that day thinking I just had a stomach bug but at the end of the day, you have to be able to control what you can control and this situation spun out of my control in a hurry. My wife indicated that she had never seen me more at peace with not being at work, in this situation I had no choice.  I couldn’t get up and leave and miraculously start working again.

Being self employed and essentially having the business rely on you, the doctor, to be present to generate revenue creates a caveat when you are out for an extended period of time. While we are not in jeopardy of going out of business, finances take a hit when no one comes in the door for 2 weeks.  The headache of having other people in the office is not worth it at this time for me, so I end up just taking the hit and moving on.

Follow up appointments have all finished up and we are getting back in the swing of things at this time. This is currently our third week back and while I was hoping to be it would be a little bit of a slower build back into practice, it was not.  The past couple of weeks have been slammed and honestly, my abdomen and health suffered the consequences fairly regularly. At the end of the day, I have been very fatigued, sore and zapped on energy.  The general rule of thumb is for every day in the hospital it takes 4-7 days to recover.

The stress points of running a solo practice came to surface.  While Marty and Carol are seriously my Godsends, they can only do so much.  Phone calls and billing were what kept them busy and I cannot thank them enough. When you are out for an extended period, patients understand the circumstances and are very gracious but there were a few that exposed true colors when complaining about how long I had been out and billing/collection issues that patients can be downright rude about.

I truly appreciate all the thoughts and prayers that came my way over the past few weeks, we are beginning to get back to a normal flow and hope to keep it that way for a while. The end of the year is always a little hectic but this one will be a year to remember, with my own personal health scare.

In ending, just know that sometimes I’m not in the office it could be for professional reasons, health reasons and on the very rare case, personal reasons.  As the calendar turns over, I’m going to try to take few days for my own enjoyment as two week off was not exactly enjoyment.

Always remember, that life does come at you fast and try to enjoy it as it goes because it can go sideways in a hurry.  The situation ended well and I never felt in jeopardy but I was a VERY sick boy and am forever grateful to the doctors and staff at CHI Good Samaritan.

The current state of Chiropractic, in my opinion, is on a cusp. This might just be my observation but it’s what I actually see on a daily basis. The profession is ever evolving and appears to be going more to a rehab/functional medicine model. Outside of prescription rights, there are not a lot of limits on the scope of practice within the chiropractic profession. While I don’t want anyone to limit our scope of practice, it is my thought process that some offices take this to a new level. The comingling of providers skews this practice quite a bit because you as the patient may not even know the what type of provider they are seeing, physical therapist, occupational therapist, nurse practitioner or chiropractor….while all in the same office the flow may never been known by the patient but from a billing and licensing prospective, they are all different.

There to be a time and place for multidisciplinary offices, it is of my opinion, that patients do not want to be served a platter of services when presenting to a chiropractic office for pain in the lower back or neck, they want to get better as fast as they can and come back when it happens again.  I’m totally aware of the premise of maintenance care and life long treatment, I just don’t prescribe to it. There is still a vast array of people in this world and community that wants to present to a chiropractic office for a quality adjustment, trusted therapies and not spend an hour in the office. There is a time and place for the extensive rehab, but not everyone needs or is looking for that.

One major crux in healthcare is the insurance industry. It may be the greatest curse and biggest blessing to the profession as a whole. It’s absolutely awesome that chiropractic is included in the vast majority of major health insurance plans; the downside is that insurance is essentially sick care. There is no incentive to get a patient better faster and not see them, the provider that essentially abuses the insurance reimbursement and the “system” will make more money, bill for more services, have more headaches and have very little incentive to get patients out of pain as soon as possible.

Different services are covered by different insurances. Physical therapists are reimbursed at a higher rate for certain services while both professions can provide the same service; I’m not saying this is right or wrong. Medicare doesn’t even reimburse for an initial exam but more private insurances do. If you get an injection from a nurse practitioner that works in a chiropractic office, this may be a cash service or a covered service but offices are normally set up in such a way to maximize reimbursement. Read an EOB some time from your insurance company, it doesn’t usually matter what the provider charges, the insurance dictates what is and isn’t covered. Even in our office, there are certain things that certain insurances don’t cover, it’s not our responsibility to know your insurance coverage, we submit the insurance claim and hope for the best with the information that is provided to us by the patient.

Personal research and development can pay huge dividends for offices, while it’s always a learning experience, it also teaches you what things work and what doesn’t. We have tried traction tables and lasers. I’m a terrible sales person and most patients don’t seem to have interest in these types of therapies. I’ve come to learn that the tried and true techniques and therapies are what the vast majority of my patients want and appreciate. Sure, I fell into the DOT realm and like it as a niche part of my practice and having acupuncture available is beneficial but outside of that we keep things VERY simple in our office and feel that most people appreciate that. I’ve said this before and I will continue to say this: our office is not for everyone but we will give it our all for those individuals that find value in our services.

Slightly different tangent, but students are coming out of school with MASSIVE student loans and the traditional model of chiropractic is not conducive to high profit margins that are needed to pay your bills and live a comfortable life. Insurance dictates a lot of things in the healthcare realm and the only solution for reimbursement is to see more people.  If you are not capable of seeing more people you tend to lean towards providing more cash based services and longer treatment plans in order to maximize the insurance and patient dollars. While we may be old school in our treatment techniques, we have positioned ourselves well for the future by delivering a quality product at an affordable price. Are we the cheapest, I’m not sure and are we the most expensive, not by a long shot. But I do try to live by the motto: I’m able to sleep soundly at night with how the practice is run. The profession and my own practice drive me crazy from time to time but ultimately I’m happy with where things are.

While this may just be my personal opinion and not do anything long term but it’s a reminders that we attempt to provide quality, honest care with good people to help you feel better as fast as we can with no long term time or financial commitment. In ending, what is chiropractic anymore, I know what I would like it to look like but I’m starting to think that my type of practice is a dying breed as they are not huge profits driven. I’ll survive and thrive (hopefully) but the profession is ever evolving and there are a lot of factors at play, but the chiropractic profession will look different in 20 years then it does today, I will promise you that.

Over the course of the past 2-3 years, my wife and I have become personal finance gurus. We have paid off student loans and tried to set up ourselves and our family up for many years to come, while this is not an instant results endeavor but small steps can make a big impact. Part of the process of investing is compounding, where your initial money and investments start to make gains on the early work.

One of the major parts that people don’t like about investing is the ability to mentally withstand the ups and downs of the market. Your 12% gain on average is not a smooth path; you could see a 20% loss or gain on any given year. So you have to be able to stomach the volatility.  Most financial advice  indicates that the major index funds are self cleansing, the top 500 companies in the US will be an ever evolving thing, companies will come and go. So you don’t necessarily have to choose individual stocks, you can choose the broad index and catch the majority of the gains that the market puts out, but you have to be able to stomach the roller coaster.

The art of running a business is a lot like investing. Days, weeks, months and even years have their ups and downs but I’m banking on the fact that compounding in business will also be the same.  We have been performing chiropractic care, DOT Physicals and most recently drug/alcohol testing for the last 12 plus years. Financially this has been a weird year, not that it has been bad but just strange on the collection and billing end.

Healthcare is a changing and ever evolving profession, not just for chiropractors. The market will eventually figure itself out, while we as a profession may not like the path we will get to a stable point again. Longevity should be beneficial if you are able to work through the ups and downs. The adage is that time in the market will outweigh timing the market, so you may come into the profession at just the right time and your experience will look entirely different than someone that has been on the job for decades.

The amount of goodwill and benefit of having people through the door for the past decade along with offering a variety of services (I’m hoping) should be beneficial in the long run.  DOT Physicals are a prime example, we have a strong base built and hope to build the drug/alcohol testing along with continued growth of the physical side of things.

There is another saying that comes to mind, “Comparison is the Theft of Joy,” so when a young chiropractor comes out of school and looks into starting into the profession, just know that your experience will look entirely different than your peers, so don’t try to compare yourself to others in the profession or even healthcare in general. The time you come into the profession, the demographic of patients that you see and the state you work in, will all have an impact as to how see the profession and your future.

In short, I’m banking on the fact that business, like investing will go through ebbs and flows that may not be fun or comfortable but the light and path should be worth it. Let your valuable patients and services carry you through the hard times, compounding gains along the way throughout the years. And lastly, do not compare yourself to other people in the profession because based on the time that they came into the profession and length they have been in practice the perception will be completely different.

I wanted to have a little post/discussion of some of the things that happen on a daily basis in the office that most people don’t understand or think about when they come in for a visit. I recently received an email from FMCSA (Federal Motor Carriers Safety Administration) that they will be doing random audits on medical examiners that perform DOT physicals.  We have also seen an increase in insurance audits and preauthorization requests from companies themselves.

This type of screening scares the hell out of providers, even if you feel that you are doing things correctly and ethically. The last thing any business wants to have is to open up their records with the possibility of money claw backs and threats of taking away the ability to perform specific tasks within the office.

The question arises all the time, “how come you only give me a one year or three month card?” Well, I don’t make the rules.  The enforcement arm is always on the back of the mind. Blood pressure medications, CPAP’s, certain types of diabetes and other past history can bump certifications all over the place. Just because you passed the test and have been performing them for 12 years, doesn’t mean that they just let you keep doing them without some oversight.  There is A LOT of wiggle room with these physicals and we feel that we perform them to the best of our ability.

The other issue that we are constantly running into, the ever evolving health insurance model, I’ve always said “I just need to know the rules to play the game but a lot of the new insurances don’t tell you the rules, you just figure them out as you go.” There are new preauthorization requirements for certain insurances and “palliative care” is starting to get cracked down on quite a bit more.

Maintenance care has never been allowed by the majority of carriers, so if you plan on coming in every two weeks on the dot or schedule a month out for your next appointment because you just “like to be adjusted,” insurance has not and will not pay for these services.  You are more than welcome to come in and be adjusted as much or as little as you would like but just know that we, as an office, are starting to look patient by patient of things that would qualify as “maintenance care” and cracking down on it ourselves to limit the possibility of audits.

Some plans allow for a certain number of visits throughout the calendar year or give you a set number of visits over a certain number of weeks, but this doesn’t necessarily mean that this is what your insurance will pay for. We do not set the limits on your plans, we submit and attempt to do the background work, we are not picking on you if you get a bill but you don’t think you should get one because you think your insurance will pay for it.

These plans are starting to be very confusing, not just for you but for our office as well. This blog post is by no means a way of discouraging but more of a reminder that we don’t set the rules for the insurance that you or your employer signs up for. By being an in-network provider, we agree to submit and essentially hope for the best.

In ending, audits within the Federal government and private insurance companies appear to be on the rise, due to overuse and blatant fraud.  We are doing the best we can to work within the guidelines that are laid out for us and we are not necessarily picking on you or your situation. We do the best we can with the rules that are set out for us.