Category: Chiropractic Practice

Coronavirus Chiropractic Contingency and Exposure Plan

By Harry Engel

If you have employees or patients, it is prudent to create a set of action and contingency plans to protect the staff, your patients and your practice from the Coronavirus.  Even though we’re exposed to viruses every day as patients come in and out of our offices, and yet we don’t get sick, this Coronavirus seems to be different from the flu.  Hopefully it is more benign.  As doctors, we have our philosophies of health.  As business owners, we need to be prudent about managing risks and protecting the business.  The following is an actual plan developed for a multi doctor clinic in California: 

Our plan of action has 3 separate elements:  A plan to protect our staff. A plan to protect our patients.  A plan to protect the practice. 

Inherently, we understand that there is a scientific and emotional component to managing the effects of the Coronavirus outbreak.  Making sure your employees and patients FEEL safe is just as important as making sure they are safe.

face down on chiropractic table

We identified the following key points:

  • There is a very good chance that the virus will impact our community.
  • Data on this virus is not reliable.  There are a number of indicators.  Governments slant the data.  Media uses it to increase their traffic.  We are liking independent sources like Virology Down Under.
  • Even though the mortality rate will most likely be substantially lower here than it is in other countries, just one fatality from our clinic would impact us in a horrid way.
  • It seems like the most vulnerable are the elderly, very young and those with weak or compromised immune systems.
  • The hysteria will most likely be worse than the virus, comparatively speaking, particularly when you look at deaths from other sources.
  • As the virus hit pandemic levels in communities in other parts of the world, we have seen complete shutdown of industry, education and travel.  People have chosen not to be in spaces where there are other people.
    • If this occurred in our community we could see a substantial drop in patients venturing out in public.
  • Symptoms mimic the flu: fever, cough and difficulty breathing.
  • Cal-Osha (California Worker Safety Board) has decreed we need a plan
    • Written Exposure Control Plan and Procedures.
  • As business owners we need a plan.  As Doctors we need to know how to make sure our patients are properly cared for.  If the virus fails to cause us issues, we have been prudent, and perhaps helped a few people avoid the flu.

Protecting the staff:

  1. Identify staff that have weak immune systems.
    1. These employees should not show up to work.  
    2. We need to better understand if they can collect unemployment, disability or if we need to keep them on payroll.
  2. Be vigilant to patients that may carry the virus.  Notify management/Doctor immediately.
  3. Identify potential exposures, evaluating the cause, determine who was exposed, provide care as needed, improve procedures as we learn.
  4. Educate the staff:
    1. Signs and symptoms
    2. Protection process
    3. Protection equipment, proper use, handling, disposal, limitations
    4. Activities that may cause exposure
  5. Physical protection.
    1. Monitor staff temperatures – if they have a fever they go home.
    2. Masks.  
      1. The CDC and others seem to indicate that masks do not offer significant protection
      2. Masks may actually increase risk.
      3. Masks will provide some protection against spreading the virus if the person wearing the mask has the virus
      4. Masks will show the public that we are doing something, so they offer emotional support.
      5. We will make them available to the staff who desire to wear them.
    3. Antimicrobial wipes.
      1. We’ve ordered wipes for patients to use, to minimize the spreading of the virus by touch.
      2. Wipes can also be used by staff to sanitize as necessary.
    4. Hand sanitizer stations.
      1. Front Desk
      2. Doctors area
      3. Therapy
    5. Anti-Microbial Spray
      1. Spray bottles in all staff areas.
    6. Provide the doctors with stylus so that they don’t need to touch the touch screens.
    7. Ultraviolet lighting
      1. Still in the research stage, but seems to be prudent, and cost effective.
        1. Installed in the AC system
        2. Installed in the patient bathroom with a timer/photo sensor so that they turn for a period of time on every time the light goes out, and turn off when the light is turned back on.
    8. Essential oils
      1. We know we’ll get flack for this, but it’s been on our list for a while to have a scent for the office.
      2. Thieves oil has a reputation for killing viruses as do other oils.
  6. Prevention:
    1. Build the immune system.
      1. No Sugar!  No honey, corn syrup or any other sugar.  That means read the labels, because there’s tons of sugar in processed foods.  And that means no alcohol.
      2. 1,000 units vit C daily
      3. 5,000 units Vit D daily.  If they haven’t been taking it, start with a heavy dose for the first week to kick start.
      4. Get adjusted.
      5. Keep taking other immune supports like chlorella, probiotics.
    2. Educate staff on how to avoid contact and spreading of the virus.
      1. Wash
      2. Sanitize
      3. Elbow sneeze
      4. Do not touch the face
      5. Be cognizant of what you are touching.
    3. Make sure their household is prepared with adequate supplies of food, water, medicines/supplements and hygiene tools.  
    4. Educate their children and others living in their homes.
  7. What to do if you start feeling like crap.
    1. Notify manager
    2. Go home
    3. Stay home until the office manager agrees that you can come back.
    4. Take oil of oregano
    5. Consider Oscillococcinum homeopathic remedy
    6. High doses of vitamin C, follow the protocol on the handout.
    7. Colloidal silver
    8. Lauricidin
    9. Follow medical advice.
    10. Be aware that going to the ER or Urgent care might expose you to the virus, which could be a problem if your symptoms are perhaps related to the flu or other condition.

Protecting Patients:

  1. Educate patients that they are responsible for their own health.  Teach them how to protect themselves, their families and friends.  Use our Staff plan as the basis for their education.
    1. Dry erase boards
    2. Handouts
    3. Workshops
    4. Social media
  2. Provide antimicrobial wipes for them to use to wipe the face section of the table and any other sections of the table they desire to wipe, as well as any electronics they may touch.
  3. Leave the front door open if weather permits so patients don’t have to touch the handles (and improve air cirulation).
  4. Regularly spray sections of the office that patients come in contact with.
  5. Explain our plan so they understand we are taking action to protect them.

Protecting the Practice.  

  1. The practice needs to survive the following scenarios:
    1. Substantial drop in patient visits
    2. Substantial decrease in staffing (Doctors and staff)
    3. Unknown length of time for the practice to recover
  2. As patient volume drops
    1. Overhead must drop congruently and immediately.
      1. Temporary Layoffs, doctors and staff
      2. Cutting expenses 
      3. Negotiate overhead wherever possible
    2. This will be dynamic


This posted document is a work in action.  We’ve shared it with our staff.  We have ordered supplies.  We are educating our patients.

Do This Ten Minute Simple Exercise Daily

By Michael Dorausch, D.C.

I am extremely grateful to mentors that have helped guide me along my path. This 10 minute simple exercise in mindfulness comes from the entity known as SETH aka Jane Roberts. I am posting it here for those that are seeking it.

Chuckwalla Mountains Moonrise

Pretend that you are on a lighted stage, the stage being the room in which you now sit. Close your eyes and pretend that the lights have gone out, the setting has disappeared and you are alone.

Everything is dark. Be quite. Imagine as vividly as you can the existence of inner senses. For now pretend that they correspond to your physical ones.

Clear from your mind all thoughts and worries. Be receptive. Very gently listen, not to physical sounds but to sounds that come through the inner senses. Images may begin to appear. Accept them as sights quite valid as those you see physically.

Pretend that there is an inner world and that it will be revealed to you as you learn to perceive it with these inner senses.

Pretend that you have been blind to this world all your life and are now slowly gaining sight within it.

Do not judge the whole inner world by the disjointed images that you may at first perceive or by the sounds that you may at first hear, for you will still be using your inner senses quite imperfectly. Do this simple exercise for a few moments before sleep or in the resting state.

It may also be done even in the midst of an ordinary task that does not take all of your attention. You will simply be learning to focus in a new dimension of awareness, taking quick snapshots, as it were, in a strange environment.

Remember that you will only be perceiving snatches. Simply accept them, but do not attempt to make any overall judgments or interpretations at this stage. Ten minutes a day to begin with is quite sufficient.

Michael’s Notes: I have found that this and similar practices can well be incorporated into daily tasks (as suggested), I will leave it to you to decide when is best to add this simple practice to your day.

Chiropractic Associate Opportunities Spring 2019

By Michael Dorausch, D.C.

One of the top reasons chiropractors visit the Planet Chiropractic Classifieds is the search for employment opportunity. Chiropractors are posting positions available for associates, and recent grads (and those seeking alternatives to current practice) are seeking to fill those positions.

practice chiropractic

Back in October, Harry Engel highlighted several amazing associate opportunities in a post that featured ads posted at that time. While those positions have likely been filled, I selected a few recently posted associate ads to share this month. While there’s plenty of US positions to fill, I chose a few locations from across the planet.

Tasmania, Australia

Tasmania, an isolated island state off Australia’s south coast, is known for its vast, rugged wilderness areas, largely protected within parks and reserves.

The ad is from Outback Chiropractic, and they are looking for good quality adjusting chiropractors to join their team in Australia. The clinic has multiple adjusting rooms, digital X Ray and well trained CA’s. They practice mostly manual adjusting techniques, Gonstead and Diversified.

Kolkata, India

Kolkata (formerly Calcutta) is the capital of India’s West Bengal state. Founded as an East India Company trading post, it was India’s capital under the British Raj from 1773–1911. Today it’s known for its grand colonial architecture, art galleries and cultural festivals. It’s also home to Mother House, headquarters of the Missionaries of Charity, founded by Mother Teresa, whose tomb is on site.

Dr. Kevin Mernissi (of 3C Chiropractic) is seeking 2 motivated chiropractors to start the first chiropractic clinic in Kolkata. You will have the chance to work in a friendly environment in the fastest growing country in the world. This is a great opportunity for talented DC to enjoy the beauty of India while earning money. Great career opportunity. Newly graduated Doctor are welcome to apply.

Lima, Peru

Lima, the capital of Peru, lies on the country’s arid Pacific coast. Though its colonial center is preserved, it’s a bustling metropolis and one of South America’s largest cities.

Dr. Adam Heying is advertising a once in a lifetime chiropractic opportunity to live along the Pacific coast for FREE, eat daily in one of the culinary capitals of the world (also for FREE), learn and grow alongside up and coming chiropractic superstars in your OWN office, along with making great money and being able to save most of what you earn in the gorgeous South American city of Lima, Peru. The office at Centro Quiropractico McLellan is seeking two full-time long-term associates, that preferably speak Spanish.

I noticed recent associate wanted ads for the Philippines and Vietnam as well. You can browse all the current employment related ads here and hit up the main classifieds on this page.

Have an awesome day!


My Dog Died Chiropractic Visit

By Michael Dorausch, D.C.

It happened again this week. Phone call made to office so a family can come get adjusted. It’s not their regularly scheduled day. The reason for the visit wasn’t due to low back pain, a car accident, neck pain, or a contagious event of sciatica. It was something else.

yellow labrador venice canals 90291

They enter the adjusting room, like they have many times before. The oldest daughter begins the conversation with a socially accepted (something I’ll cover here later) reason for the visit. Mom follows up and mentions they put the family dog down earlier in the day. The room fills with tears.

They don’t teach this in chiropractic school.

Although I didn’t consciously know it when I agreed to travel this path, this IS why I am a chiropractor.

I’ve lost count of how many times this scenario has taken place in the office. Dogs, cats, parents, children, spouses, and other loved ones.

It’s not always mentioned when someone gets on the table, but if I listen (listen with my heart and hands) while palpating, the information comes out. I have words to describe what happens to me energetically when their words are spoken, perhaps I’ll share another day.

What I do know is that I’ve been permitted to enter a realm of sacred trust, and I have a greater responsibility to serving that, than anything I can comprehend in this manifest world.

Creating a safe place, a sanctuary, a place of love and healing, has long been an intention for my practice. Yet it was only a few years ago that the realization set in. The office isn’t located anywhere special, it’s simply a collectively perceived physical location where people gather to re-tune and re-balance.

The creation of a safe space, a sanctuary of balanced tone and healing, manifests from within.  As healers, we commit ourselves to being well tuned, energetically balanced vessels.

Thank you for being in my field of vibration.


The $500 Signing Bonus Ultimate Hiring Guide

By Dr. Steven Visentin, D.C.

Everyone is replaceable. If someone wants to quit or needs to be replaced, let them go! Holding on to the wrong employee because you hate the process of hiring and retraining is a terrible idea. Read this article carefully to learn how to hire quickly and well.

job hiring resume

Post An Ad That Pulls

Every minute your chiropractic center is understaffed you’re losing money. Don’t hesitate to post an ad in a popular online site, like Below is a sample ad that has drawn lots of applicants.

Will Train, Receptionist For Doctor’s Office $500 Signing Bonus

Compensation: $16.00 per hour to start


Will Train!

  • Natural health care setting
  • Team approach to drugless healing
  • Fun family environment
  • No knives (surgery), no blood, and no drugs
  • Great hours
  • Free chiropractic care for you and your family
  • Good pay
  • Great career opportunity
  • Terrific management team
  • Work at a place where your opinion counts


Why Offer a $500 Bonus?

The $500 Signing Bonus appeals to many applicants, even in competitive markets. When they start, have them sign an agreement that reads as follows:

Conditions of Signing Bonus

After 90 days of employment, you are entitled to a $500 bonus if the following conditions are met:

  • You have been in full compliance with all office policies,
  • You have not been late or missed work for any reason, and
  • You did not have to leave work early.

Nothing in this agreement guarantees employment for any length of time.

Even the best employees find it difficult to be on time for the first 3 months. The stress of a new job may cause them to “get sick” and be late or absent. If they are late, confront them about this “unacceptable” behavior. Ask them whether they would like to look for work elsewhere, or be on time. Be tough from the start. When they’ve proven themselves, you can be more generous.

If they do complete the first 90 days on time and meet your expectations, you’ve hired a winner. Celebrate by giving them the $500 bonus they deserve.


Initial Screening

Accept resumes online and have your current staff contact the best ones during less busy hours by phone. Have them choose applicants who are within a 20-minute driving distance of your center. Employees who drive over 20 minutes may burn out quickly or arrive late due to traffic or inclement weather.

Select bilingual applicants to broaden the market niches your clinic can serve. Of course, their primary language should be English in the United States. Also, ask if they can work the hours you need filled.

Give your staff authority to quickly eliminate candidates who can’t communicate clearly.

Once they select a potential hire, have them set an appointment for an interview and testing.

Staff will help screen applicants by noting who’s late for their appointment, impolite, or can’t follow directions. Have your current staff administer a simple filing test and any other skills you might need. These can be found online.


Outstanding People Stand Out

You will have lots of perspective employees coming and you’ll be able to compare them easily. Looking for work is stressful. Make sure each applicant is comfortable before you begin an interview. Listen carefully and wait for the right one.

The best questions for job interviews are open ended and start with phrases like; “Tell me about a time when…” or “Give me an example of…” or “What has been your experience with…”. Of course, your questions should be prepared in advance. Let them do most of the talking. A potential receptionist might be asked, “What experience have you had in talking to clients?” Other questions can be found on the internet.

One of the best questions I’ve heard is, “We always test for drugs and perform a thorough background check before hiring. Can you tell me what we’re going to find when we do?”



Most interviewees can give names and numbers of coworkers who will supply glowing reviews of their work experience; this is not helpful. Have the person you’re interviewing call their former boss during the interview and introduce you over their cellphone. Ask their employer to confirm details of their previous employment and then say, “I’m seriously considering hiring Mr. or Ms.____________. We have several positions open in our office. Is there any type of job they would NOT be suitable for?”

Asking the question in this way may reveal more about the candidate than a simple, “Would you re-hire them?”

Of course, if their former boss refuses to say anything about the candidate other than “Yes, he (or she) worked here,” don’t hire them. There may be a problem, about which they can’t or won’t tell you.


Let The Staff Have The Final Say

Your staff must be able to work with the new employee. Make sure everyone’s on board with the hiring decision before you offer the job formerly.


How To Present The Opportunity

When you’ve found the right person, present the job enthusiastically and outline the benefits of working for your clinic. You might mention how many applications you considered, so that they prize the job. Ideally, your welcome should be honest, disarming and most of all, end their job search.

If they cannot start within 2 weeks, consider your second choice.


Be Careful About Multiple Interviews

If you’re in an area of the country with an extremely low unemployment rate, you may be forced to hire an outstanding candidate and offer them the position immediately or risk losing them to another employer.

Check them out on social media and look at their posts. If their online presence is inappropriate, you can move onto better applicants. At the very least, do a Google search to find out more about their background.


Hiring Family

Your spouse is an obvious first choice in hiring. No one could be more committed to your practice success. There are also tax advantages.

Otherwise, there are good reasons not to hire relatives; it creates feelings of resentment when family is treated differently than the rest of the staff. Relatives might feel they are being used and insufficiently compensated, because they’re related. The family dynamic can be ruined by discussions of business and work-related problems. Finally, it’s embarrassing and nearly impossible to fire a relative who’s underperforming.



On their first day, have them observe a typical day in your office.

Before they leave, be sure to interview them once more. Ask if they are happy or have questions. Listen carefully to what they say and how they say it.

Steve VisentinHire Legally

Never ask questions or make comments that reflect prejudice based on sex, race, color, religion or national origin. Employment laws vary. Get legal help to be sure your hiring practices meet local guidelines.

Be kind to each applicant. Remember how hard it is to look for work. If you can’t offer them a job, tell them, “I will hire the most qualified person for the position. I’m not sure who that is yet. Thanks for applying.”


Don’t Wimp Out

Put maximum energy into this process; it’s important. Your clinic is only as good as the weakest staff member. Work hard to create the best center for care. Hire, train, re-train, motivate, and never be satisfied until you have the very best team for your patients.

Steven Visentin is a Denver chiropractor at Care Chiropractic serving “The World’s Best Patients” for over 30 years. Dr. Visentin is also an accomplished public speaker and author of an e-book on practice growth.

What it's like to be a chiropractor in Los Angeles

By Los Angeles Chiropractor, Michael Dorausch, D.C.

Chiropractic is practiced throughout the United States and every city, town and community offers a unique chiropractors story. Being a chiropractor in Los Angeles is no exception, and many stories could be told about being a DC in LA. With Los Angeles being a major metropolitan area, we sometimes experience a different sense of community than someone practicing in a small-town community setting. This article focuses primarily on the Los Angeles beach communities of Venice, Marina del Rey, Playa Vista and Santa Monica and the local practice of chiropractor, Michael Dorausch.

Even though a greater amount of celebrities come to our office (and other LA offices) than the typical chiropractic office in America, there’s a lot more to practicing chiropractic in Los Angeles than just taking care of movie stars. Actors make up only a small portion of those working in the film industry. For many of us, it’s the writers, producers, set builders, property master’s, stunt people, editors, assistants, and a tremendous number of other hard working people in the industry that continue to support chiropractic.

Overall, it’s not all celebrities and Hollywood as some people may think. I’ve heard of chiropractors claiming to be DCs to the stars but how many top film people are there anyway? I believe there are more chiropractors in Los Angeles than there are major film personalities so most offices will typically see only a few celebrity type clients. Trust me, you get over the thrill pretty early, especially if they want to come in only when the office is closed. However, by the nature of the area, I’d figure LA chiropractors are seeing more than the rest of the nation when it comes to Hollywood screen types. Only other place I can figure would be in New York City, or even maybe in Las Vegas.

ADIO Chiropractic Gold Card(Photo: ADIO Chiropractic – Gold Card)
Here in LA, the same goes for athletes. While there are some professional sports teams in the Los Angeles area (Dodgers, Avengers, Kings, Lakers, Clippers and Sparks) we don’t have many Los Angeles team athletes that are coming to our office on any regular basis. Again, just as in the film industry, there are a lot more people involved in sports than just the pro athletes. A few years ago I was reminded of this when we began seeing more spouses, girlfriends and children of professional athletes coming to the office. The reality is they are the ones at home. Most pro athletes are often on the road, and have team chiropractors as well as other health care professionals, that come to them or travel with the organization.

Dogtown Athletes
Living in the Santa Monica and Venice Beach areas, the great majority of athletes (we’ll call them that) coming to our office are locals. Skateboarding and surfing are super popular in the area. Venice is a skateboarding Mecca. It’s not uncommon to see a guy or girl in their 40’s or 50’s cruising around on a skateboard when you’re in Venice. (The dog you see to the right will power any skateboard, just watch out for squirrels.) The same goes for surfing. It’s not just kids that are getting into the water. In fact, many of the surfers coming to see us are in their 30’s and 40’s and are coming in from either Venice, Dockweiler, or El Porto Beach before heading to work.Beach dog Jasmine

Other local athletes include those on rowing teams in Marina del Rey, they get up before 5am and row in the Marina channel. I keep telling the coaches I’ll come and visit but even in the summer, it’s chilly at 5am and I require my chirosleep. Biking/cycling up and down the coast from Manhattan Beach to the canyon in Pacific Palisades is popular (sometimes too popular). The bike path runs for miles along the coast and a branch of the path is only a few blocks from our office. Biking is naturally one of those sports or activities that many people in our practice community participate in since it’s so convenient.

Being that running is my favorite activity, we’ve naturally attracted quite a few runners into the office. Running on the beach here is great. The tides go real low so you get some wide and fairly flat sand to run on. A round trip run on the sand between Marina del Rey and Santa Monica is about 6 miles if you go from pier to pier. It’s great body, mind, spirit exercise.

Volleyball is also a real popular sport in this area. Our office has sponsored several Ocean Park Volleyball (OPV) tournaments and we continue to do so since it’s great fun, great for our community relationships, and the OPV donates funds to the Heal the Bay foundation.

Second most visited place in Southern California
After Disneyland, the Venice Beach, Santa Monica areas are reportedly the most visited by travelers each year. Our chiropractic office is about 6 miles from the Los Angeles airport (LAX) but even still we get quite a few travelers coming into the office. It amazes me how many tourists come into our office every week looking for directions, usually to the beach.

Venice BeachFor our regular folks, it is not uncommon to have someone come in on their way to the airport when leaving on a trip (great time for an adjustment). They also come in on the way back. I smile inside whenever people come in saying… “this is my first stop” when they are on their way home from the airport. I think there should be chiropractic airport attendants so that everyone could get adjusted. It would certainly make for some less stressful travel. I just travel with other chiropractors so I’m usually taken care of.

The Techies are Coming
One industry that we are definitely seeing more and more of are those in the tech industry. Without getting into which companies are using our services I’ll just point out that Electronic Arts (EA), Google, Yahoo, and Activision, all major internet or gaming companies, have opened offices within 5 miles from us in the past few years. The word in the tech world is that more are coming. The Santa Monica area is on its way to becoming a new high-tech digital Hollywood and it won’t be long before we have as many internet companies in the West Los Angeles area as there are in Northern California and Seattle areas. I’m sure lots of other chiropractic offices around West LA are noticing the same growth.

The tech industry has been a great fit for our office. You have young, intelligent, hard-working professionals that spend lots of time at computers. They know they should be exercising more frequently and they come to us already knowing that they will benefit from regular chiropractic care. It really impresses me when a young tech professional comes to our office and already has an understanding as to the benefits of regular chiropractic care. As I always tell them… work hard, play hard, get adjusted!

With tech professionals comes lots and lots of kids. The glass on our front office window does say ADIO Family Chiropractic and people in our community are ensuring that the inside of the office reflects that message. We’ve had kids coming in from the beginning, but during the past year or so I’ve seen an increase in families that come together to get adjusted. Most of those new families are working in tech industries. I don’t know the correlation, that’s just what we are seeing. I don’t have stats as to whether there are more or less kids in the area compared to others. I would actually think there are less kids living by the beaches but again, I have no data.

Chiropractic itself is no different in Los Angeles than it is anywhere else. The chiropractors may be different, but chiropractic itself is not. It’s still a hands-on, getting people well, keeping people well, kind of service mentality that continues to work.

There are a lot of chiropractors here and that could definitely be a factor for someone thinking of opening an office in the West Los Angeles, Santa Monica, Playa Vista or surrounding beach areas. Within 4 miles from my office, I know of 5 chiropractic offices that had closed or relocated in 2003-2004. There was an office on Lincoln Boulevard in Marina del Rey that appeared like they had massage, yoga, acupuncture, psychotherapy, hypnosis, nutritional counseling, as well as chiropractic services. They were at their location for about a year and I just noticed the other day that their office was closed. There was a chiropractor in Marina del Rey that practiced on his houseboat for years and was quite well known in the area. I don’t know the details, but he’s gone and has moved forward. There was a chiropractor that opened up down the street from me on Washington Boulevard. I believe the office opened in August and was closed by February of this year. And just two weeks ago, I got news from one of my patients that told me a local gym called Angel City Fitness was closed down. There was a chiropractor practicing there.

On the upside, I know of at least two offices that have opened on the Westside Los Angeles area since the time that ADIO chiropractic (my office) was opened. They are both doing fantastic so I’m not saying that someone can’t open up in the Los Angeles area and do well. In fact, I believe what we’re seeing in this area is a shift in practice types and styles. Chiropractic offices that run on high overheads and offer kitchen sink services with very little focus on chiropractic are having a difficult time financially with keeping their doors open. The ones I see doing really well are low on overhead (typically under 1500 sq. f), service minded, and have energetic doctors along with fired up staff.

Our office is a traditional chiropractic office. People come to our office primarily for chiropractic adjustments, simple as that. There’s a fantastic health-food (V.P. Discount) store only a few doors away from us and we send all of our people there for their nutritional needs. There is also a massive number of fitness facilities in our area. There is a Curves right next door, and we have a number of people coming in from Gold’s Gym, Spectrum Club, LA Fitness, the Marina Athletic Club, Camp Technique, and others. Rather than try to teach fitness in our office, we prefer to refer out to trainers and other professionals in those fields.

It’s funny because a lot of people may think that if we were to provide a number of added services such as yoga, massage, workouts, private fitness, body fat analysis, nutrition, and any number of things, our office would make more money. While that may be true, it’s not the focus of our office and it’s not the focus of good chiropractic. In our office, all of our time is dedicated to the adjustment and seeing that our people receive the best chiropractic adjustment possible. There are many, and I mean many, very qualified professionals in the Los Angeles area that can take care of every other need that comes to mind.

Thanks to the people I’ve met in the area, I get to refer to swim coaches, rowing coaches, volleyball coaches, yoga instructors, acupuncturists, private fitness trainers, and others. An amazing thing happens as a result. When it comes to getting adjusted, they refer back. It’s true, you cannot out give the giver.

Life is a Beach
I love living at the beach. The weather here on the coast is fantastic. It’s great to be able to leave the office at lunch, go for a run, have time to get back home, shower, eat, and get back to the office to serve more people. One of the things that I’ve discovered about practicing in Los Angeles is that it’s a much tighter community than people might think. Although millions of people are living here, it always amazes me how many people interact daily in our office that know each other from somewhere else in the city. I think sense of community is all a state of mind, in our case a Los Angeles “chiropractic” state of mind.

Chiropractic in Los Angeles Summed Up
Positives: People, Weather, Lifestyle
Negatives: 405 FWY, 10 FWY, Lincoln Blvd., Cost of Living, Finding Parking Places
(everyone should own a skateboard, it would reduce traffic congestion)

If you are a chiropractor visiting the Los Angeles area (you’ll find plenty of free parking on the 405 freeway) you are welcome to get in touch and pay a visit to our office. The number is… 310 301.4448

ADIO Chiropractic – 12740 Culver Blvd. Suite G, Los Angeles, CA 90066
(we are only about 6 miles from LAX and about 2.5 miles inland from Venice and Playa del Rey beaches)

HIPAA & Chiropractic

By Linda Nadeau (Consultant – Practice Management Analyst)

Disclaimer: The information contained here is intended for informational purposes only and should not be construed as legal advice or a substitution for obtaining legal advice from an attorney licensed in your state.

HIPAA — It’s A Law… Are You Ready?

HIPAA was created from the simple concept of protecting patient Privacy and to preserve patient rights in their selection of healthcare, and has concluded with complex legislation and legal jargon difficult to interpret. After years of regulatory turmoil, there are only a few weeks remaining until the April 14, 2003 HIPAA Privacy Compliance Deadline becomes effective. HIPAA is a law, and you must be compliant.

Many providers have procrastinated because of the difficulty in understanding what the requirements of HIPAA are, or they believe that HIPAA does not pertain to them, as patient Privacy has always been addressed in their practice, however; all providers must institute changes to meet the letter of the new Privacy law. Providers must have documented policies and practices clearly stating patient Privacy and protected health information security, even if you are a solo practitioner with no employees. Patients must receive policies from you regarding consent, authorization, disclosure and rights.

No, there will not be a HIPAA Mod Squad storming your clinic on April 14th, however, enforcement will be complaint driven by other healthcare providers, payers, business associates and patients; to the Department of Health and Human Services and the Centers for Medicare and Medicaid Services. Patients and business associates will notice if your processes and services differ from other providers, and you will be reported. There is no escaping HIPAA, it does apply to you.

If you are in HIPAA violation, you will face civil and/or criminal prosecution resulting in excessive monetary penalties and possible imprisonment. Notwithstanding, Privacy advocates are eager to expose delinquent providers with negative publicity that would quickly threaten your reputation, your livelihood, undermine public confidence with your profession, and alter your acceptance in the healthcare marketplace.


Designate a Privacy Officer, and a Security Officer
One person may be designated for both functions. This individual must have authority for decision-making. The quickest, most effective way to achieve Privacy rule compliance at this late date may be to assume that you meet none of the regulatory standards and go from there.

Determine Data Flow
Be aware of how data flows from you system to third parties, (business associates); such as your clearinghouse and payers. Use a clearinghouse that is HIPAA compliant and uses transaction software that is X12 compliant. Ask the clearinghouse if they will be able to transmit the transactions in HIPAA standard format on your behalf, if not, ask what you need to do to ensure you get the transmission capabilities required. Ask similar questions to your billing system vendor. Verify that your identifiers and codes, (ICD-9 CM and CPT-4,) are current with vendors and payers. If the vendor has developed a HIPAA-compliant release, update your system if you have not already done so.

Establishing Disclosure-Tracking
The only way long-term compliance with accounting of disclosure provisions will be possible is if a disclosure of protected health information is recorded from day one. Covering known security vulnerabilities by installing needed measures to protect data confidentiality e.g., firewalls, passwords, logon/logoff procedures, and workforce training in Privacy and security awareness.

Document Policies and Procedures
All requirements must be met by the compliance deadline. Verification of having HIPAA requirements met is to have written documentation of the processes of the HIPAA policies and practices. Some provisions affect patient confidentiality more immediately than others and the absence of some may also create greater legal risks for covered entities. Implement first the policies and practices that are visible to the patient (such as the Notice of Privacy Practices, Patient Rights, Policies on Treatment Records, Record Amendments and Restriction of Access, Account of Disclosures, Staff Conduct and Standards.) Consider jump-starting the policy process by investing in a high-quality set of Privacy policy templates that can be tailored to your practice. The research and development of a comprehensive set of original HIPAA policies and operational manual can take up to a year or more to develop, and cost several thousand dollars. Customization of an authoritative set of templates can be accomplished in less than a month. Once you have everything in place, you will need to audit your practice every 90 days to ensure compliance is maintained.


All health care providers will have at all times, appropriate administrative, technical, and physical safeguards to protect the Privacy of protected health information and comply with The Health Insurance Portability & Accountability Act of 1996, which includes Administrative Simplification, requiring:

  • Improved efficiency in healthcare delivery by standardizing electronic data interchange, and
  • Protection of confidentiality and security of health data through setting and enforcing standards
  • Standardization of electronic patient health, administrative and financial data
  • Unique health identifiers for individuals, employers, health plans and health care providers
  • Security standards protecting the confidentiality and integrity of “individually identifiable health information,” past, present or future.

All health care providers will comply with HIPPA regulations with all healthcare organizations, including healthcare providers, even if it is a 1-physician office; health plans, employers, public health authorities, life insurers, clearinghouses, billing agencies, information systems vendors, service organizations, and universities.

Effective compliance requires all health care providers to implement the following steps prior to April 14, 2003; and maintain all policies, procedures and process for the duration of the practice existence, with periodic review and monitoring of:

  • Staff awareness of HIPAA.
  • Comprehensive assessing and ongoing monitoring of information security systems, technical, and management infrastructure policies and procedures.
  • Develop an ongoing action plan to monitor methodologies of HIPAA compliance.
  • Implementing a comprehensive action plan, including documented policies, processes, and procedures.
  • Building a “chain of trust” agreements with service organization.
  • Redesigning a compliant technical information infrastructure.
  • Purchasing new, or adapting, information systems.
  • Developing new internal communications.
  • Training and enforcement.

All health care providers will comply with the four parts of Administrative Simplification including:

Electronic Health Transactions Standards

  • Electronic Health Transactions includes health claims, health plan eligibility, enrollment and disenrollment, payments for care and health plan premiums, claim status, first injury reports, coordination of benefits, and related transactions.
  • All health care providers will comply with the national standard format, thereby “simplifying” and improving transaction efficiency nationwide. The proposed rule requires use of specific electronic formats developed by ANSI, the American National Standards Institute, for most transactions except claims attachments and first reports of injury. (Proposed regulations for these exceptions are not yet out as of 011803).
  • All health plans must adapt to the national standards, even if a transaction is on paper, phone, or fax.
  • Providers using non-electronic transactions are not required to adopt the standards; although if they don’t, they will have to contract with a clearinghouse to provide translation services.

Unique Identifiers

  • All health care providers must adopt Standard Code Sets to be used in all health transactions (ICD-9CM, CMS Common Procedure Coding System (HCPCS), AMA Current Procedural Terminology (CPT-4), American Dental Codes, and National Drug Codes (NDC) J Codes. For example, coding systems that describe diseases, injuries, and other health problems, as well as their causes, symptoms and actions taken must become uniform. All parties to any transaction will have to use and accept the same coding.

Security & Electronic Signature Standards

  • All health care providers will provide a uniform level of protection of all health information that is housed or transmitted electronically and that pertains to an individual.
  • Electronic signatures, if used, will meet a standard ensuring message integrity, user authentication, and non-repudiation. No transactions adopted under HIPAA currently require an electronic signature, as of 12/05/02.
  • The security standard mandates safeguards for physical storage and maintenance, transmission, and access to individual health information. It applies not only to the transactions adopted under HIPAA, but to all individual health information that is maintained or transmitted. However, the Electronic Signature standard applies only to the transactions adopted under HIPAA.
  • As of 01/18/03, the security standard does not require specific technologies to be used; solutions will vary from business to business, depending on the needs and technologies in place.

Privacy & Confidentially Standards
In general, Privacy is about whom has the right to access personally identifiable health information. The HIPAA rule covers all individually identifiable health information in the hands of covered entities, regardless of whether the information is or has been in electronic form. The current Privacy standards include:

  • Limit the non-consensual use and release of private health information;
  • Give patients new rights to access their medical/treatment records and to know who else has accessed them;
  • Restrict most disclosure of health information to the minimum needed for the intended purpose;
  • Establish new criminal and civil sanctions for improper use or disclosure;
  • Establish new requirements for access to records by researchers and others.

HIPAA regulations enforces the five basic principles more strictly defined as:

  • Consumer Control: The regulation provides consumers with critical new rights to control the release of their medical/treatment information.
  • Boundaries: With few exceptions, an individual’s health care information should be used for health purposes only, including treatment and payment. Under HIPAA, for the first time, there will be specific federal penalties if a patient’s right to Privacy is violated.
  • Public Responsibility: The new standards reflect the need to balance Privacy protections with the public responsibility to support such national priorities as protecting public health, conducting medical research, improving the quality of care, and fighting health care fraud and abuse.
  • Security: It is the responsibility of organizations that are entrusted with health information to protect it against deliberate or inadvertent misuse or disclosure.
  • Review: Each time a patient sees a doctor, is admitted to a hospital, goes to a pharmacist or sends a claim to a health plan, a record is made of their confidential health information. For many years, the confidentiality of those records was maintained by our family doctors, who kept our records sealed away in file cabinets and refused to reveal them to anyone else. Today, the use and disclosure of this information is protected by a patchwork of state laws, leaving large gaps in the protection of patients’ Privacy and confidentiality. There is a pressing need for national standards to control the flow of sensitive patient information and to establish real penalties for the misuse or disclosure of this information.

Covered Entities
As required by HIPAA, the final regulation covers health plans, health care clearinghouses, and those health care providers who conduct certain financial and administrative transactions (e.g., electronic billing and funds transfers) electronically.

Information Protected
All medical/treatment records and other individually identifiable health information held or disclosed by a covered entity in any form, whether communicated electronically, on paper, or orally, is covered by the final regulation.

Consumer Control over Health Information
Under this final rule, patients have significant new rights to understand and control how their health information is used.

  • Patient education on Privacy protections. Providers and health plans are required to give patients a clear written explanation of how they can use, keep, and disclose their health information.
  • Ensuring patient access to their medical/treatment records. Patients must be able to see and get copies of their records, and request amendments. In addition, a history of most disclosures must be made accessible to patients.
  • Receiving patient consent before information is released. Patient authorization to disclose information must meet specific requirements. Health care providers who see patients are required to obtain patient consent before sharing their information for treatment, payment, and health care operations purposes. In addition, specific patient consent must be sought and granted for non-routine uses and most non-health care purposes, such as releasing information to financial institutions determining mortgages and other loans or selling mailing lists to interested parties such as life insurers.
  • Patients have the right to request restrictions on the uses and disclosures of their information.
  • Ensuring that consent is not coerced. Providers and health plans generally cannot condition treatment on a patient’s agreement to disclose health information for non-routine uses.
  • Providing recourse if Privacy protections are violated. People have the right to complain to a covered provider or health plan, or to the Secretary, about violations of the provisions of this rule or the policies and procedures of the covered entity.

Boundaries on Medical/Treatment Record Use and Release
With few exceptions, an individual’s health information can be used for health purposes only.

  • Ensuring that health information is not used for non-health purposes. Patient information can be used or disclosed by a health plan, provider or clearinghouse only for purposes of health care treatment, payment and operations. Health information cannot be used for purposes not related to health care – such as use by employers to make personnel decisions, or use by financial institutions – without explicit authorization from the individual.
  • Providing the minimum amount of information necessary. Disclosures of information must be limited to the minimum necessary for the purpose of the disclosure. However, this provision does not apply to the transfer of medical/treatment records for purposes of treatment, since physicians, specialists, and other providers need access to the full record to provide best quality care.
  • Ensuring informed and voluntary consent. Non-routine disclosures with patient authorization must meet standards that ensure the authorization is truly informed and voluntary.

Ensure the Security of Personal Health Information
The regulation establishes the Privacy safeguard standards that covered entities must meet, but it leaves detailed policies and procedures for meeting these standards to the discretion of each covered entity. In this way, implementation of the standards will be flexible and scalable, to account for the nature of each entity’s business, and its size and resources. Covered entities must:

  • Adopt written Privacy procedures: These must include who has access to protected information, how it will be used within the entity, and when the information would or would not be disclosed to others. They must also takes steps to ensure that their business associates protect the Privacy of health information. Train employees and designate a Privacy officer. Covered entities must provide sufficient training so that their employees understand the new Privacy protection procedures, and designate an individual to be responsible for ensuring the procedures are followed.
  • Establish grievance processes: Covered entities must provide a means for patients to make inquiries or complaints regarding the Privacy of their records.

Establish Accountability for Medical/Treatment Records Use and Release
Penalties for covered entities that misuse personal health information are provided in HIPAA.

  • Civil penalties: Health plans, providers and clearinghouses that violate these standards would be subject to civil liability. Civil money penalties are $100 per incident, up to $25,000 per person, per year, per standard.
  • Federal criminal penalties: There are federal criminal penalties for health plans, providers and clearinghouses that knowingly and improperly disclose information or obtain information under false pretenses. Penalties would be higher for actions designed to generate monetary gain. Criminal penalties are up to $50,000 and one year in prison for obtaining or disclosing protected health information; up to $100,000 and up to five years in prison for obtaining protected health information under “false pretenses”; and up to $250,000 and up to 10 years in prison for obtaining or disclosing protected health information with the intent to sell, transfer or use it for commercial advantage, personal gain or malicious harm.

Balancing Public Responsibility with Privacy Protections
After balancing Privacy and other social values, HHS is establishing rules that would permit certain existing disclosures of health information without individual authorization for the following national priority activities and for activities that allow the health care system to operate more smoothly. All of these disclosures have been permitted under existing laws and regulations. Within certain guidelines found in the regulation, covered entities may disclose information for:

  • Oversight of the health care system, including quality assurance activities
  • Public health
  • Research, generally limited to when a waiver of authorization is independently approved by a Privacy board or Institutional Review Board
  • Judicial and administrative proceedings
  • Limited law enforcement activities
  • Emergency circumstances
  • For identification of the body of a deceased person, or the cause of death
  • For facility patient directories
  • For activities related to national defense and security

The rule permits, but does not require these types of disclosures. If there is no other law requiring that information be disclosed, providers and hospitals will still have to make judgments about whether to disclose information, in light of their own policies and ethical principles.

Audit your practice every 90 days to ensure compliance is maintained.

Linda Nadeau became a CA in 1982, and has been a consultant and practice management analyst for both the chiropractic and medical industries since 1993. Linda is the author of DRS ADMIN, a HIPAA Compliant Operations Manual, templates of policies and forms designed for chiropractors to maintain HIPAA Compliance while assuming an effective leadership role in the administration of their practice. This work is a collaboration of 22 years of experience in the health care industry; which encompasses the private and public sectors, teaching facilities and political sub-divisions of state institutions.