One DC keeps a New Haven multidisciplinary practice busy by working to make chiropractic care an employee benefit

The second most important lesson learned by Stephen C. Piserchia, DC, CCRD, ACSM, is that corporate employers are eager to offer chiropractic care into the workplace. The first important lesson is that few major firms know how to actually go about making chiropractic part of those benefit plans.

Accordingly, Piserchia devotes quite a few hours each week explaining to attentive employers in his market area the ins and outs of accessing chiropractic, especially when it comes to treating job-related injuries. The result is that Piserchia, along with the New Haven, Conn, multidisciplinary group to which he belongs, generates big business from Big Business.

“Right now we’re working with close to a dozen Fortune 500 companies,” says Piserchia, an employee of New Haven Medical, Sports, and Occupational Health. “A lot of it involves giving presentations that show how we can reduce an employer’s worker’s compensation (WC) claims and employee absenteeism, as well as increase productivity.”

Piserchia delivers presentations as often as twice a week, but seldom less than 2 or 3 times a month. “We’re branching out to the corporate world and providing pre-employment services because we don’t want to be a purely CPT-driven practice,” he says. “If you’re a CPT-drive practice, you face the problem of reimbursements getting smaller and smaller you spend less time with patients, and that compromises the quality of care.”

No Business Like Big Business
Services provided to corporations vary. In some instances, the group simply is a company’s preferred provider of treatments. In others, New Haven Medical, Sports, and Occupational Health functions as a manager of health services. For one company, a well-known maker of razors, Piserchia acts as an onsite consultant about 5 hours a week. “I’m there to look at the reasons the company is having certain kinds of injuries,” he says. “The goal is to reduce the OSHA-reportable incidence of those injuries. The company correctly believes that reducing those injuries will increase profitability by reducing claims and supporting productivity.”

During his visits to that plant, Piserchia reviews injury reports to develop insights as to the possible causes. “Of the cases I look at over a year,” he reveals, “I’ll find that maybe 30% of them were personal-protection issues—workers wearing the wrong type of gloves, or not wearing protective eyewear—and 5% were housekeeping issues, such as workers who didn’t keep their areas clean, didn’t store materials and tools in their proper places, left things laying around where people could trip over them. Meanwhile, the rest of the cases involve ergonomics issues and improper training issues.”

After identifying the causes of injury, Piserchia puts together workshops for employees to impart methods of avoiding harm. “For example, toolmakers tend to have a high incidence of carpal tunnel syndrome,” he says. “One reason is that some of them have a habit of overtightening screws and nuts. We recommended that the toolmakers do their tightening with torque wrenches, a type of wrench that lets you know when a nut is tight enough.”

When New Haven Medical, Sports and Occupational Health’s role involves itself as the go-to place for evaluation and treatment of job-related injuries, among the first things the group does is ascertain a company’s return-to-work policy.

Piserchia discusses strengthening exercises with patient. Piserchia made contacts by lecturing at the New Haven Police Academy.

“We go in and take a look at the individual positions ahead of time so that, when an injured employee comes to us with a work-related back injury, we already know if there’s a temporary, partial disability program available for that person,” says Piserchia. “Or, if there are some ergonomic modifications we can do to his worksite to prevent a recurrence of the injury.”

Piserchia contends that employer interests often suffer at the hands of WC providers who are either too rigid or lenient with cases sent to them: “At one extreme is the doctor who insists that everyone goes back to work, no matter how serious the condition. ‘You lost your arm? That’s no excuse. You can still operate the equipment with your other one,’ is what such a doctor might say. On the other extreme is the doctor who says, ‘Oh, you bumped your toe? Obviously you can’t work.’ Employers don’t like either one of these extremes. The doctor who says there’s nothing wrong with the injured person only causes the employer’s costs to go up because then an attorney is going to get involved. The doctor at the other extreme also drives up the employers’ costs because lost time becomes extremely expensive and reduces production time.

“We try to find that middle ground, where the patient receives the exact care he needs.”

Another service offered is pre-employment physicals. In Connecticut, chiropractors are permitted to perform physicals and drug testing for individuals seeking employment as drivers of trucks, buses, and other vehicles governed by Department of Transportation rules.

“We do about 70 pre-employment physicals for many different industries,” Piserchia says. “As part of the physical, I look at the employment candidate’s musculoskeletal condition to see if there are any indications of increased risk for injury once the person is hired and performing the tasks associated with his or her particular job along with the medical component. This is especially valuable to employers who are looking to hire the person into a job that’s very physically oriented, such as construction, loading dock, and police work.”

On the Competitive Edge
There is plenty of competition in the local market among providers of pre-employment physicals, meaning that New Haven Medical, Sports, and Occupational Health must work hard at keeping its name in front of the continually changing pool of human-resource executives, as well as the more stable ranks of occupational nurses and case managers who refer the job applicants.

“Our strongest selling point is service,” Piserchia asserts. “That’s what we emphasize and that’s what the referrers remember. We treat every person who comes through the door like they’re the only patient we have. We never look at people who come in for a drug test as a number that no one cares about.”

But an even stronger selling point is the group composition. Says Piserchia, “We’re unique because we utilize medicine, chiropractic, physical therapy, and rehabilitation, all in one location. We’re a true multidisciplinary organization, and that makes us a standout in the market.

“When a patient comes in, we look at them not only from a chiropractic, but also from a physical therapy and medical standpoint. Taking a team approach, we’re able to design a better program of treatment and offer the patient a much higher probability of a positive prognosis, which makes employers and nurse case managers extremely satisfied.

“For example, say the patient has neck pain that radiates into the upper extremity and has a medical history of diabetes,” Piserchia says. “They have some numbness in their hands and have neck pain. Is it a diabetic neuropathy, a nerve irritation or a disc herniation? Or could it be both? Or does thyroid factor into it? So, the medical component would evaluate the patient’s diabetes and any medications that could mimic numbness in the arm. The chiropractic aspect would evaluate the muscles, nerves, and joints.”

The group sees patients of all ages—by and large adults, with a few pediatric cases thrown into the mix. Group medical insurance pays for about half the patients. WC picks up the tab for approximately 35% of the cases; roughly 20% are personal injury and less than 5% are cash self-pay.

Heading the group is Tracey Zhu, MD, an internal medicine specialist. She is the first to see each new patient. “Dr Zhu makes a recommendation for the best course of care, which frequently, but not always, includes chiropractic, either by itself or in concert with medical and/or physical therapy services,” says Piserchia.

New patients referred by Piserchia’s satisfied patients, and wanting only to be seen for chiropractic care, are still examined first by Zhu. “We do this in order to determine whether there might be underlying pathologies causing the problem,” Piserchia explains. “We’ve found that there are a lot of patients with co-existing morbidities, and that’s a reason why patients don’t always respond to the medical approach or chiropractic. However, with the team approach, patients always respond.”

New Haven Medical, Sports, and Occupational Health is located in a high-visibility commercial strip along the main street running through the heart of New Haven’s medical district. With 3,000 square feet of space, the enterprise offers a full rehabilitation center with eight machines, including those for neck, low-back, abdominals, and legs, along with cardiovascular equipment. There is also a physical therapy suite with nerve block equipment, interferential ultrasound, and intersegmental traction tables. Scattered about are examination and treatment rooms, as well as an x-ray unit.

“We can offer diagnostic tests including electrodiagnostics, diagnostic ultrasound, drug testing, and urine analysis,” says Piserchia. “Also, we write orders for about 10 to 15 MRIs a month. From those, we periodically run across pathologies that need the attention of an orthopedic surgeon or a neurologist. We’re able to refer such cases to those specialists.”

Piserchia himself maintains a solid referral relationship with an orthopod, a neurologist, and a physiatrist in outside groups. In fact, so collegial is that relationship, that those specialists have welcomed him to observe their surgeries as a way of enhancing his understanding of their procedures.

“Going into the operating room with them was a privilege I asked to be granted,” Piserchia clarifies. “I felt that the more I knew, the better job I could do referring them patients.” That proposition appealed to the surgeons because “they don’t want me sending them sprains and strains, which are time-wasters where they’re concerned.”

When Piserchia refers to the surgeons, he also sends with the patient an MRI and CT study. The surgeons appreciate this since it shortens the time they need to spend on case workup. It also subtly conveys to the surgeons that New Haven Medical, Sports, and Occupational Health is a conscientious and trustworthy group. In appreciation, the surgeons send referrals to Zhu and Piserchia’s group.

Piserchia explains to the patient the nature of her injuries, while rehabilitation therapist Majidah Mateen observes.

“Most chiropractors don’t like to refer out because they’re afraid they’ll never see the patient again,” says Piserchia. “It was a risk I took, and I learned that’s not necessarily going to happen. If you have a good relationship with the practitioners you’re referring to, you will see that patient again—and more because they appreciate the referral and the confirmation that the care is appropriate and necessary.”

Integral Role Model
Piserchia says he decided to become a chiropractor after realizing that he needed more of a career challenge than that offered by exercise physiology, the field for which he was trained at Springfield College in Springfield, Mass.

“I wanted to be active with my patients,” he tells. “I wanted to play a very integral role in their care, but I couldn’t do that as an exercise physiologist. But still, I enjoy the hands-on approach. That made chiropractic the ideal choice for me.”

He graduated from Logan College of Chiropractic, St Louis, in late 1993. He returned to his native Connecticut where he landed a spot as an associate in a purely chiropractic office. About 3 years ago, Piserchia met Zhu. It happened that the two of them lived in the same neighborhood and kept bumping into one another at various community activities. Eventually, they struck up a friendship.

Zhu was in the process of setting up a practice. Hoping to give it a competitive edge, she decided to form a multidisciplinary group. That’s how New Haven Medical, Sports, and Occupational Health was born.

Piserchia was a strong addition to the group, given his prominence in the community. “At the time, I was already giving lots of lectures on chiropractic,” he recalls. “One of the places where I was lecturing was New Haven’s police academy. I was seeing so many city police department members that they thought it would be good for me to come in and talk to them about work-related injuries, how to prevent them, and what to do when they happen.”

He still lectures there. More recently, he has begun speaking to audiences from Yale New Haven Hospital (YNHH)—his latest talk was to physicians, physician assistants, and registered nurses at the Nathan Smith Clinic of YNHH on the topic of the integrated approach to health care. “The payback to the practice is exposure,” he says. “It’s a way to introduce people to us and set us apart from the other practices in town.”

It’s also a way to increase his own satisfaction as a chiropractor. The same holds true of his involvement with Big Business. “I enjoy providing services to corporations because it gives me an opportunity to broaden my skills sets,” he indicates. “I don’t want to be a doctor who only treats necks and backs.”

Being a more satisfied practitioner—and one who possesses a larger-than-customary set of skills—makes Piserchia a more sought-out chiropractor in the corporate and industrial markets.

“I’m contributing to the building of a well-balanced, recession-proof practice where the patient’s care is never compromised,” he enthuses. “But, since the future is never sure, or even all that clear, the best thing I can do is keep my feet constantly moving and making sure this practice stays on the cutting edge.” CP

Rich Smith is a contributing writer for Chiropractic Products.