Palmer Coronavirus/COVID-19 Updates 
Companies are making space for on-site chiropractors

Companies are making space for on-site chiropractors

Spring 2013

cover story

Chiropractors are a perfect fit for on-site clinics

aerial view of reserved parking space for D.C.

As businesses innovate to combat rising health care costs, chiropractors are finding a new niche: providing care for employees in on-site clinics. Chiropractors, with their expertise in treating musculoskeletal conditions that often afflict workers, as well as their focus on overall wellbeing, are ideal health care providers for employees where it is most convenient for them to seek care—the workplace.

"On-site clinics are booming," says William Updyke, D.C., who has been caring for employees at Cisco Systems' LifeConnections Health Center in San Jose, Calif., since 2008. "Last year a survey by Towers Watson found that over 40 percent of employers (small, medium and large-sized) either had an on-site clinic or were planning one or considering one. Chiropractic just happens to be the perfect service because for many companies musculoskeletal complaints are the number one reason for going to a health care provider. And with the growing wellness trend, we are a perfect fit for employers wanting to help their employees stay healthy."

Dr. Updyke's experience at Cisco has been positive and rewarding. It started with a tip from a former student at Palmer's West Campus who saw the opportunity posted on Craigslist. "Cisco wanted to provide what the employees wanted, and when they polled them, chiropractic was very high on the list of providers the employees wanted on-site," he says. "I started in October of 2008 and the clinic opened in November. When I started I was only working 20 hours a week, but I was full-time in about nine months as the practice grew rapidly. We added a second chiropractor, Dr. Morgan Young (West '07, profiled on page 17) a few years later. Cisco's administration has remained extremely supportive of the services and I now manage the chiropractic, physical therapy and acupuncture providers in the practice."

Curt Krause, D.C. (Davenport '99), has been working as a clinic chiropractor in the Healthe Clinic at Cerner Corporation's worldwide headquarters in Kansas City, Mo., since 2009. (See profile on page 14.) He also participated in a research project at Cerner to demonstrate improved overall quality of health of the company's employees, while at the same time providing a cost benefit to the company. The results of this project were published in the August 2012 issue of the Journal of Occupational and Environmental Medicine .

The study, a retrospective claims analysis and clinical evaluation to assess the influence of on-site chiropractic services on health care utilization and outcomes, found that patients treated off-site were significantly more likely to have physical therapy and outpatient visits. In addition, the average total number of health care visits, radiology procedures and musculoskeletal medication use per patient with each event were significantly higher for the off-site group. Last, headache, neck pain and low back pain functional status improved significantly among patients treated at the on-site health clinic. These results, the paper concluded, suggest that chiropractic services offered at on-site health centers may promote lower utilization of certain health care services, while improving musculoskeletal function.

Chiropractors choosing to care for patients at on-site business clinics, as well as their employers, need to consider a number of factors before the chiropractor begins on-site care of employees. "No matter how a doctor chooses to practice, whether a full- or part-time employee of a corporation, visiting a few times a week to provide care, or any other method of delivering chiropractic services to a business, the professional liability issues remain the same," says Mike Whitmer, assistant vice president of corporate relations for NCMIC Group, Inc. "The doctor needs to have a malpractice policy in place, maintain an active license for their state of practice and practice within the state's scope for chiropractic."

Liability issues need to be addressed whether the chiropractor is employed by the business or not, Mr. Whitmer adds. "Regardless of whether the doctor is an employee or an independent contractor, the employer will have liability issues they will want to address with their insurance carrier and legal counsel," he says. "If the chiropractor is not an employee, rather an independent contractor visiting the business occasionally, they will need to structure their practice like any other practitioner running their own practice, whether an LLC or other corporate structure allowed in the doctor's state of practice. As always when structuring a practice, seeking legal counsel is a sound investment for the protection of the doctor and practice."

Additionally, the chiropractor must consider any type of on-site care they provide at a business just as they would if they were operating their own practice. "It is essential the chiropractor realize they will be developing doctor-patient relationships and will have the same responsibility to those patients as if they had their own stand-alone clinic facility," Mr. Whitmer adds. "Records must be kept, informed consent obtained, examinations and histories completed, and practice standards met."

For those chiropractors interested in providing care in this type of setting, Dr. Updyke has this advice: "Learn how to build a practice and be a good care provider; work with medical providers and build relationships with them; network in your community; understand the research and keep up with health policy. That is what worked for me."

The Palmer alumni working in corporate chiropractic settings credit their education with their success in this new arena for providing patient care. "It's always exciting to see fellow graduates doing well and working in new and emerging settings," says Blake Howard, D.C., West '04, (profiled on page 14). "Having been out of school for almost a decade now, you get a sense of what type of doctors graduate from each type of school, and there is always pride when you see someone from your school excelling. I think it speaks volumes to the type of education we receive at Palmer's West Campus when you see graduates in these types of positions."

Doug Endel, D.C. : Taking care of employees and their families at Modern Medical, Inc.

Dr. Doug Endel

A pitch to the CEO of Modern Medical, Inc., in Lewis Center, Ohio, who is also his patient, led Doug Endel, D.C., to providing care to the company's employees and their family members in October 2011. Since graduating from Palmer's Davenport Campus in 2008, Dr. Endel has wanted to provide chiropractic care in a corporate setting. "I really believe that the way health care will be delivered is going to drastically change in the next five to 10 years, and on-site corporate chiropractic clinics will emerge as a solution to decrease employer costs while giving employees an added benefit," he says.

Modern Medical's CEO was very receptive to his proposal to provide on-site employee care. "He said he was tired of his employees having to take sick days because their kids were sick, so he wanted to offer a program to allow family members to also receive care, knowing that if the kids were to get adjusted, they wouldn't get sick as often."

Dr. Endel launched the program with a presentation at the business to give people a better understanding of chiropractic and what was being offered to them. "There are about 115 employees currently, and I'm seeing about 40% of them as well as their families on-site. I come in to the business two half days each week and all of the scheduling is done online."

Several employee satisfaction surveys Dr. Endel has conducted demonstrate that employees are satisfied with their care, have seen health benefits from it and would recommend it to their coworkers. Here are the latest employee satisfaction results:

  • 90% are very or extremely satisfied with their chiropractic experience
  • 64% report that their job performance has improved significantly
  • 83% say their overall health has improved dramatically
  • 18% have seen a direct decrease in their out-of-pocket health expenses
  • 100% would recommend it to their co-workers

Dr. Endel encourages chiropractors to pursue practicing in an on-site corporate clinic. "It is a great way to make a difference in the community, get out of the office and is going to drastically change the way health care is delivered in the United States," he says. "I have started a company called Buckeye Wellness Solutions, with the vision of setting up chiropractors in on-site corporate centers like this in the future. My goal is to see 500 chiropractors changing the culture in 500 companies across the U.S."

Blake Howard, D.C. : Making the transition from private practice to corporate chiropractic

Dr. Blake Howard

Following his graduation from Palmer's West Campus in 2004, Blake Howard, D.C., ventured out on his own and maintained a traditional private practice in Idaho for nearly eight years. However, over time, the business challenges of managing a practice began to outweigh the exhilarating joy of caring for his patients.

"I've been a good practitioner and have had good success at getting my patients better and out of pain," says Dr. Howard, a Casper, Wyo., native who was introduced to chiropractic care while serving a two-year mission for the Church of Jesus Christ of Latter-day Saints near Davenport, Iowa. "However, maintaining my own office was always a struggle for me—in particular due to the challenge of getting patients to understand the importance of regular chiropractic care, which led to a constant turnover."

Last spring, Dr. Howard's frustration with "revolving door" patients led him to pursue a position at the Take Care Health Center, based at the Boise campus of a prominent technology company. He now provides chiropractic care as a member of a multidisciplinary team—which also includes M.D.s, a physician assistant, physical therapist and naturopathic practitioner— serving more than 5,000 employees.

During his years of private practice, Dr. Howard developed referral relationships with some of the M.D.s in the Boise area. The lack of formal work experience in a multidisciplinary setting was not a dealbreaker when he applied for the chiropractic position at the Take Care Health Center. "I think the primary skill that clinics such as this are looking for in all the providers they hire, not just the chiropractor, is an ability to work as a team and to understand your role as part of that team," he says.

Much like the company at which he's providing care, Dr. Howard says that Take Care Health Services (owned by Walgreen's) measures the Center's success by the achievement of bottom-line goals. And the bottom-line results are rather impressive: In 2011, the company reported On-site Visit Savings and Clinic Oversight of Workers' Compensation Claims were 64% below Official Disability Guidelines (ODG).

Through on-site visit savings and clinic oversight of workers' compensation claims, costs for 2012 were 72% below ODG. Health center reports attributed the improved ODG figures to the health clinic's addition of physical therapy and chiropractic care.

"Patients are looking to get fixed and get back to work, so you have to use all your skills and tools to help your patients quickly," Dr. Howard adds. Chiropractic care is referred by one of the M.D.s, and Dr. Howard says he treats approximately 45% of the patients who present with a musculoskeletal complaint.

He enjoys the health center position for the patient-care benefits, including a regular flow of new patients and challenging cases, along with no weekend hours, as well as the personal benefits such as a 401k plan, health insurance and paid vacation time. However, he also acknowledges that before any D.C. pursues a similar position in a corporatebased health center, the doctor must be prepared to make a few concessions.

"I miss out on seeing some acute cases, where I could really make a difference, because they have to see their primary-care provider to receive a referral for chiropractic care" says Dr. Howard. "You definitely give up control over the case—but the other providers also understand that just giving medicine isn't what patients need."

Curt Krause, D.C. : Chiropractor for Cerner Corporation's health care innovators

Dr. Curt Krause

An ad for a clinic chiropractor at Cerner Corporation's worldwide headquarters in Kansas City, Mo., caught Dr. Curt Krause's eye in 2009. He got the job and began providing care to Cerner employees, which Cerner calls "associates," in an on-site, multi-disciplinary medical clinic, called the Healthe Clinic. The Healthe Clinic staff also includes board-certified family medical doctors, nurse practitioners, licensed clinical social workers, nutritionists and health coaches.

"Our leadership was very receptive to on-site chiropractic care," Dr. Krause says. "Cerner as a company is very innovative and on the forefront of health care. We have multiple health and wellness initiatives to motivate and encourage our associates and their families to live well and lead healthy lifestyles, even providing incentives like insurance plan premium reductions for their participation. By doing so, Cerner has been recognized locally in the Kansas City area in 2011 and 2012 as one of the 'Healthiest Employers' by the Kansas City Business Journal, as well as recognized nationally by the National Business Group on Health as one of the 'Best Employers for Healthy Lifestyles.' "

But research is needed to demonstrate effectiveness of any new health initiative, and Dr. Krause and several colleagues at Cerner conducted the research project detailed in the introduction. (Their article about the project titled "Value of Chiropractic Services at an On-Site Health Center" was published by Krause, CA D.C.; Kaspin, Lisa Ph.D.; Gorman, Kathleen M. M.P.H.; Miller, Ross M. M.D., M.P.H., in the August 2012, Volume 54, Issue 8, pp. 917-921, of the Journal of Occupational & Environmental Medicine .)

In addition to this research, Cerner associates treated by Dr. Krause and his colleagues at the Healthe Clinic have an opportunity to complete a satisfaction survey after each visit. "My care and the care of the clinic has consistently been rated 4.8-4.9/5," he says. "They enjoy the convenience of the facility being on site."

Dr. Krause is optimistic about the on-site corporate chiropractor trend and how it is already benefitting the profession and will continue to do so as more and more businesses add on-site clinics and include chiropractors. "I believe that as the cost of health care increases every year, particularly expenditures for musculoskeletal conditions, and as research demonstrates the benefits not only in overall health, but also for cost benefits to the company, having on-site chiropractors will only increase. I believe this will benefit the profession immensely. First, it opens doors for chiropractors that were not open before and provides them with another option for employment besides owning a practice or becoming an associate. Second, it brings chiropractors in collaboration with other practitioners and provides them with a voice. Third, it gives greater and easier access to potential patients who have not used chiropractic care previously."

His advice to aspiring on-site corporate chiropractors is to focus on cooperation, patient education and outcomes. "Understand that we don't have to be all doctors to all patients, but should be willing to work cooperatively with other providers," he says. "Be educators and teachers and not salesmen, and allow the outcome of care to speak the loudest."

Daniel Lord, D.C. : Helping Facebook employees stay healthy and productive

Dr. Daniel Lord

Daniel Lord, D.C. (West '08), really "likes" providing patient care as the director of chiropractic services at the health care center located at Facebook's corporate headquarters in Menlo Park, Calif. And judging by the number of employees that Dr. Lord has already served, it appears they "like" his quality of care.

Nearly one-third of the approximately 4,000 Facebook workers at the Menlo Park campus utilized at least one form of service at the 6,000-square-foot health center in the first six months after its opening in August 2012. The demand for Dr. Lord's services has grown so rapidly that his treatment space, which he shares with the center's physical therapist, was quickly doubled to 1,000 square feet and soon will be doubling again, so he can accommodate his ever-expanding patient load.

In addition to Dr. Lord, Facebook's health center, which is managed by Crossover Health integrated health services, is staffed by two M.D.s, four nurse practitioners, an acupuncturist and a physical therapist, and provides services that compare with a hospital emergency room.

"I think more and more companies recognize that providing campus-based health services for their employees typically results in a healthier and more productive workforce," says Dr. Lord, who joined the Facebook clinic following four years as member of the chiropractic staff at the Chiro-Medical Group in San Francisco.

"An on-site health center helps reduce a big portion of company health costs that result from work-related accidents, production loss from missed work days, or symptoms that typically would result in admitting someone to the local hospital emergency room," says Dr. Lord, who served as co-president of the West Campus Sports Council.

At the Facebook health center, chiropractic is a portal of entry service that employees can seek without first receiving a referral from one of the staff M.D.s. In fact, all health center patients who present any type of musculoskeletal type of condition are directed first to Dr. Lord.

The average Facebook employee falls into the 20-something generation, and the most common conditions for which they seek Dr. Lord's care typically fall into one of three categories: repetitive stress, sports injuries or postural syndromes.

In addition to the convenience of the on-campus health center, Facebook also promotes a healthy environment for its workforce by serving healthy meals prepared by top chefs in its primary cafeteria, and bikes are available for workers to peddle from one part of the spacious campus to another.

"The types of conditions that I see most are what you would expect from a young and athletic group of people who approach their recreational endeavors with the same degree of passion and energy they do to their work-related projects," says Dr. Lord.

Bryan Muth, D.C. : Wellness and chiropractic are part of the culture for Standard Process

Dr. Bryan Muth

Bryan Muth, D.C., is a 2008 graduate of Palmer College's Florida Campus. Dr. Muth joined Standard Process Inc. in 2009 as part of the team facilitating the company's award-winning health and wellness program. He provides chiropractic treatment, nutritional counseling and personal training for the company's nearly 300 employees.

"There are so many advantages to this approach to wellness, not only for me, but for the employees and the company," Dr. Muth says. "I make a difference by giving adjustments and providing nutritional counseling. I then get the chance to physically walk into my patients' work environment and make modifications on site! And of course I am experiencing what every chiropractor wants to see … better health due to greater compliance."

Standard Process, headquartered in Palmyra, Wis., has been providing health care professionals with nutritional whole food supplements for more than 80 years. "I am fortunate to work for a company that truly does put their employees number one," Dr. Muth says. "Standard Process realized long ago that a happy employee is a productive employee. By putting wellness initiatives in place to help employees enjoy a better work/life balance, the company has experienced happier, better- focused employees. Additionally, convenience equals compliance. The convenience of being right on location keeps patient compliance relatively high. Compliance means patients get better faster and are able to return to work and continue being productive for the company."

There are three chiropractors on staff at Standard Process. In addition to Dr. Muth, Paul Frank, D.C., and Georgia Nab, D.C., are also employed full-time with the company. "I think we've been very well received," says Dr. Muth. All three of us have great relationships with the employees. We all have very different personalities and different areas of expertise. Also, our hours vary, allowing for all first-, second- and third-shift employees to take advantage of our services."

In the last year, Dr. Muth had nearly 3,800 visits (chiropractic and nutrition). This year, he expects to have even more visits because Standard Process has extended the benefit of on-site chiropractic, nutritional and fitness services to the employees' spouses. The spouses can also go online and sign up for an appointment at the company's corporate headquarters. "Eventually, I personally would also like to see on-site services extended to the employees' dependents," adds Dr. Muth.

According to Dr. Muth, his education at Palmer's Florida Campus was imperative to his preparation for his current position. "Before attending Palmer I never realized that the four pillars of health included educating the patient, chiropractic care, physical fitness and nutrition. Palmer helped me to understand this idea and laid the groundwork for me to succeed in my current position. Those four pillars are the foundation of our Corporate Wellness Program."

Asked if he sees a trend in companies continuing to offer health care in the workplace, Dr. Muth says, "Standard Process is pretty unique in that way and way ahead of the wellness curve. However, I truly feel more companies will be heading in this direction. Having health care professionals in the workplace environment provides a definite cost savings for the company and its employees. I think both patients and corporations are starting to seek out alternative health care options."

Providing health care in the workplace is different from a private or clinic practice. "The convenience for the patient and patient compliance are the big differences," Dr. Muth says. "If we did not have chiropractic care available here, our employees would have to take time off from work or from their family time. It is so much more convenient for all parties if the employee can walk right in for their appointment, then get right back to work without having to drive anywhere."

A unique benefit of being in the workplace is the ability to influence the employees' work environment. "I can ergonomically assess their workspace," Dr. Muth says. "If they are telling me that a particular job or motion is hurting their shoulder, for example, I can observe them performing their job and recommend ways to modify their movement. I can talk with Standard Process' engineers and determine ways to improve our workspace environments throughout the company."

Standard Process has taken several different approaches to impact the rising costs of health care. One of the most impactful approaches has been an annual, comprehensive Health Risk Assessment (HRA), which is offered at no charge to the employees and also includes a selfassessment. This helps to screen for general health issues. In 2012, 270 employees and spouses participated.

"As the health care staff, we can see what areas could use improvements, and then we gear our patient education programs or 'brown bag' lunchtime talks to address them," Dr. Muth adds. "Education helps lower our employer health care costs by teaching employees and their spouses which choices they could be making to improve their health. There's always a positive attitude here. We use every opportunity to keep everyone involved and educated on health. A happy, enthused, engaged employee is healthier and more productive. Our customers can see it when they visit for company tours. They see the smiling faces of employees who truly care about their job."

Morgan Young, D.C. : Providing care to Cisco Systems employees in a multidisciplinary setting

Dr. Morgan young

In the five years since graduating from Palmer's West Campus in 2007, Dr. Morgan Young has already earned a pair of impressive appointments: at a hospital of the largest managed care organization in the U.S.; and the corporate- based health center for a Silicon Valley company that employs more than 70,000 people worldwide.

Dr. Young's first step into a multidisciplinary setting came in 2008, when he was hired as an independent contractor to provide chiropractic services at Kaiser Permanente's medical center in San Jose. "I learned a lot about working with other health care professionals, sharing patients, how to build relationships with other providers— and I also learned a bit about the politics, and how large organizations function," he says.

In the summer of 2010, Dr. Young joined Dr. Bill Updyke, former West Campus clinician, at Cisco Systems' LifeConnections Health Center, a multidisciplinary health facility based at Cisco's largest campus in San Jose, where growing demand for chiropractic care (a portal of entry service) prompted the need to add a second D.C. "My position with Kaiser helped prepare me for my position at Cisco; without that, I probably wouldn't have been chosen, since I'm a relatively young practitioner," says Dr. Young.

The LifeConnections Health Center opened in 2008, and provides an array of health services to employees and their dependents from a team of providers that includes M.D.s, D.C.s, P.T.s, an acupuncturist, nurse, dietician and mental health counselor. The Center's close proximity to the West Campus is an added bonus for Dr. Young, a member of the faculty since he graduated.

Dr. Bill Updyke, former West Campus clinician, with Dr. Young at Cisco Systems' LifeConnections Health Center in San Jose.
Drs. Bill Updyke and Morgan Young standing in front of wall

In addition to advancing his clinical skills, Dr. Young's experience at Kaiser also provided a valuable lesson on learning about the interprofessional (as well as interpersonal) components that commonly define the dynamic of a multidisciplinary setting, where some patient cases may involve overlap care by multiple practitioners. "You have to be a team player, which means a willingness to provide care within the specified role rather than a 'cure-' em-all-cowboy' attitude," says Dr. Young. "Understanding everyone's scope and specialty means a strong referral system."

More than anything else, Dr. Young feels a great deal of satisfaction in providing his patients with the best possible care, due to the center's collaborative model and the immediate accessibility of multiple health care specialists. "In this sort of setting, you have the ability to provide much more complete and thorough care, because you have multiple providers of various specialties right down the hall," he says.

Choose your program