The rising cost of healthcare has propelled the industry into discovering the role of safety, preventive health and wellness programs not only as a hedge against increasing litigation and insurance costs, but also as part of the overall benefits for employees.

By Bruce A. Hansbrough, DC, DACBOH

A small but growing number of chiropractors have taken advantage of this new paradigm by adapting how they earn their income.

In most states, chiropractors are considered primary-care physicians, and consequently are portal-of-entry providers. This status increases the opportunity to provide services not only to industrial clients, but also to requesting entities, such as attorneys, nurse case managers and other physicians as well.

The nice thing about most industrial-medicine services is that that they do not require involvement of insurance claims and the associated labor-intensive management to get paid.
Here is a list of seven industrial-medicine services a typical chiropractor can become involved in within six to 12 months:

1 Post-offer job screenings.
The U.S. Department of Justice enforces employment standards in hiring practices that fall under the Americans with Disabilities Act (ADA). Many businesses seek qualified healthcare practitioners to physically certify an employee’s bona fide disabilities after a job offer.

Chiropractors with knowledge of the physical job demands and the employee capabilities can provide these service.
You can find ADA resources by logging onto www.usdoj.gov/crt/ada.

2 Department of Transportation (DOT) physical exams. Federal regulations require operators of certain classes of commercial motor vehicles (CMVs) to be physically certified.
Most chiropractors can conduct a CMV screening in 15 minutes
or less.

You can find more resources on how to conduct a DOT physical at www.fmcsa.dot.gov.

3 Substance-use testing. A 1998 Congressional study found that 74 percent of employed adults use illegal drugs or alcohol and that 47 percent of workplace accidents involve drugs or alcohol.

Many businesses require drug and alcohol screening for their employees as a condition of employment.

Very little retrofitting and training are required to establish this profit center in a fairly short time. For more information on drug-free workplace programs log on to: www.sbaonline.sba.gov/news/drugfree/.

4 Functional capacity testing. Also known as a functional capacity evaluation (FCE) or “fit for duty” examination, this service assists in determining an impairment rating or a disability claim.

According to Occupational Medicine Secret (Hanley and Belfus Inc.), most workers’ compensation programs utilize the FCE to make an objective assessment of impairment by determining the physical capabilities of a worker. And some employers establish baselines in case of any future disability claims.
Although some of the equipment and training required to perform FCEs can be expensive, other equipment for more specific conditions (such as pulmonary function testing) is affordable.

5 Impairment and disability evaluations. One of the greatest challenges in litigated injury cases is providing accurate and fair impairment ratings.

Impairment ratings are based on objective data and anticipated future risk factors. Too often ratings are based on opinions with little or no objective criteria. But according to R.D. Rondinell in Impairment Rating and Disability Evaluation (W. B. Saunders Co.) correlating an FCE to determine an impairment rating in accordance with accepted standards ties two services into one.

A trained chiropractor can make a credible difference in rendering a rating that results in fair and justifiable compensation for a claimant.

Contact your state workers’ compensation agency for information.

6 First Aid and CPR. One critical area of need in the workplace is the ability of personnel to recognize and respond to emergencies. Knowledge and utilization of first aid and cardiopulmonary resuscitation (CPR) fundamentals by workers in the event of an emergency is essential to controlling workers’ compensation and group health insurance costs. Many employers either are required to have, by regulation or self-mandate, first aid and CPR as core in-service training.

These health and safety programs can be self-administered or farmed out to a vendor for a fee. Either way, these programs alone serve not only the industrial clients but are powerful marketing and public relations tools.

7 Workplace ergonomic and safety analysis and reporting. Comprehensive ergonomics and safety mandates have waned but OSHA retains an active interest in ergonomics.

You will need to conduct research to determine just the market in your community and to sell this service credibly, you’ll need fairly extensive specialized knowledge and training.

To gain a foothold, work with other certified health and safety professionals, since most of them have broad networking arrangements already. And visit the Web site of the American Chiropractic Association's Council on Occupational Health, www.acaoh.com/index.html.

Industrial medicine can be very profitable if implemented and managed carefully. These seven recommendations are only a sample of the services a chiropractor can render. You are not limited in your imagination. Keep in mind that scope of practice varies from state to state. Check with your state board before investing into equip-ment, training or marketing.

Dr. Bruce A. Hansbrough is vice president of the American Chiropractic Association, Council on Occupational Health and is a diplomate of the American Chiropractic Board on Occupational Health. He owns Industrial Health Solutions, a multi-disciplinary clinic and industrial safety consulting company. Dr. Hansbrough may be contacted at 772-286-1799 or through his Web site at www.industrialhealthsolutions.com.