The ultimate cash practice income generator

Many DCs are pivoting toward cash practice as insurance collections are getting harder and harder to manage.

But what many DCs don’t know is there are cash services paid by entities other than patients. And many of these services are mandated by the federal government.  

Through the Department  of Transportation (DOT), the federal government has allowed DCs to administer DOT physical exams equal to those of MDs since 1979. But what’s important to note is that less than .01% of DCs in the US are aware of this service, and I actually didn’t learn about it until 1990. However, since then, I found out there are 13 additional services the government mandates for companies to buy and 15 others that are not mandated but highly used. This amounts to $33 billion in cash being spent every year that DCs can tap into.  

Let me put this in perspective. $33 billion is more money than all the money paid to DCs in America added together, including Medicare, Medicaid, personal injury cases, worker’s compensation, regular insurance, weight loss, cash services, etc. $33 billion divided among all 80,000 practicing DCs would be $412,500 paid to every single DC in the US. That’s a lot of money in a system that could be potential income for DCs. In fact, the system needs more providers to handle this. Many MDs and NPs are no longer offering these services because of the shortage of providers for sick people. And because it is mandated by the federal government that each business must do this or their business will be shut down, businesses are coming to DCs to provide this with open arms. 

I serve as a company doctor and with that designation, everything comes to me, including mandated testing, work injuries, wellness programs and in-house chiropractic care. This type of cash practice has been in my experience the best way to practice chiropractic because:  

• Employees are required to take these tests (and come to you for these services) 

• You receive all cash payments paid by the company 

• You incur no advertising expenses 

• Your patients have zero out-of-pocket costs 

Cash services paid for by companies

Remember: This is all cash, paid by companies, school districts, cities, counties and state and federal agencies, such as ICE, the FBI, Homeland Security, the Transportation Safety Administration and others, for services such as drug and alcohol tests, hearing tests, pulmonary function testing, respirator mask fit testing and many more simple, fast, easy tests. A trained assistant can do almost everything except the part of the physical exam required to be completed by the doctor.  

Real-life cash practice case study

I had a company call me and say they were hiring 20 new employees who each needed a physical exam, drug test, alcohol test, hearing test, pulmonary function test, respiratory mask fit test, blood draw for heavy metals (which I ordered down the street at the local lab) and a physical performance test of lifting, sit-ups, squats and step climbing. Overall, each person needed $1,000 worth of testing. I completed it in one day with the help of my staff, while seeing my normal 40 patients, and got a check for $20,000 the next week.  

Companies routinely send hundreds of employees (with jobs and money and insurance) to my office for exams and tests. Many of these people would never go to a DC on their own; however, they are mandated to go when the company sends them. And furthermore, after the initial exam, you may also get requests from these individuals for spinal screenings. This generates cash practice  income from companies, then additional income from patient care (either coming from cash or insurance at this point).  

Where can I do this work?

This work is available in every town throughout the US as it impacts truck, train, plane, bus, ship and pipeline workers. It also impacts school bus drivers, police, firefighters, factory workers, and employees of grocery stores, big box stores and delivery services such as Walmart, Target, Lowe’s, FedEx and UPS. It involves just about every company. I even drug-screen MDs and nurses who work in clinics and EMTs who work for ambulance crews.  

How much does it cost and how difficult is it to do?

It costs almost nothing to start doing this work.  

For physical exams, you need an otoscope, stethoscope, weight scale, Snellen eye chart and a reflex hammer. You take an online course in order to sit for the federal DOT test. The course usually takes about eight hours and costs around $250, and the federal test is given through computerized testing centers all over the US.  

For drug testing, the labs give you the kits free. There is a certification course that takes about two hours to complete online to be able to do DOT drug testing at a cost of $200-400.  

For alcohol testing, there is a four-hour online course to become certified to do DOT alcohol testing which costs about $200-400. DNA lab kits are free, and there is just a PowerPoint slide presentation to learn how to do the collections.  

For DNA testing, there is no certification needed. You make money from the very first person who pays you for a test.  

For hearing testing, there is an eight-hour online course costing about $800. 

For pulmonary function testing, there is a two-day course, costing about $800, taught many times in major cities all over the US.  

Certification requirements

The DOT medical examiner certification is good for 10 years before you need to renew it. It is also good in all 50 states; however, you have to also have a chiropractic license in the state you are doing the exams. But if you have more than one state license and travel or move to another state, the DOT medical examiner certification is already good for you in that state. 

The four other certifications (drug, alcohol, hearing, pulmonary function testing) are good for five years, then you do a smaller recertification class every five years. These four certifications are also layperson certifications and federal certifications, meaning they are good in all 50 states. You can travel across state lines to do the services or move to another state and still be able to do this work with no problems.  

Do I need to purchase special equipment? There is no expensive outlay of money for equipment to do the basic test services, except for maybe $2,500 for an audiometer to do hearing tests or a breathalyzer to do alcohol tests. The rest of the testing requires either free kits from the labs or very inexpensive ones, such as $100 to buy the respirator mask fit testing kit.  

Final thoughts

The appeal of integrating testing into your cash practice offerings is it is easy to learn and you can become certified in just a few days. With these services being mandated by the government for most businesses, there is an abundance of work, it’s easy to conduct, most can be performed by an assistant, and it is all paid in cash.  

Now ask yourself this question: Do I want to work with companies required by the federal government to purchase healthcare services and pay in cash? I think I know your answer.  

JAMES RAKER, DC, FADP, started the OccMed for DCs training program in 2015 and is currently the CEO. He has 30 years of private practice experience, including in occupational health, and has been doing DOT work for more than 25 years. Raker was one of the first DCs in the US to pass the DOT certification and become a certified DOT medical examiner. He can be reached at jraker@arklatexhealthclinic.com.