Health & Medicine

December 2, 2012

Chiropractor chain could roil treatment market

Construction started last month on a string of centers in the Sacramento area that will specialize in drop-in, cut-rate, hands-on therapeutic care.

Construction started last month on a string of centers in the Sacramento area that will specialize in drop-in, cut-rate, hands-on therapeutic care.

If the story sounds like the recent trend in massage chains, it should. An Arizona-based franchiser called The Jointthe chiropractic place is opening the first of up to 16 clinics in the Sacramento region. The company's CEO is John Leonesio, who founded Massage Envy a decade ago and turned it into a $300 million operation with more than 800 franchises.

Reno businessman Sean O'Neal and his sons Chris and Rory have been allotted 36 licenses to open up chiropractic spots, the highest number sold in The Joint's 13-year history. The family plans to open most in the Sacramento and San Jose areas, as well as a few in Nevada.

Several sites are being readied for spring openings, including locations at Sacramento's Loehmann's Plaza, Lake Crest Village in the Greenhaven area and the Elk Grove Commons shopping center.

"We're not changing what the doctors do. We're just making it more convenient," said Leonesio, CEO of The Joint since 2010. The Joint advertises chiropractic adjustments, also known as spinal manipulation, for $49 a month for four visits – and even cheaper on the family plan. Most clinics are open seven days a week and all are staffed by licensed chiropractors.

The Joint does not take insurance. The company's chiropractors are compensated on an hourly or salaried basis.

Many Sacramento-area chiropractors are watching warily as The Joint prepares to open here.

"It will kind of cheapen chiropractic medicine and bring it down to a down-dirty, massage therapy in-and-out kind of place," said Dr. Mark Pedroncelli, an east Sacramento chiropractor. "Are you really functioning as a doctor? Are you really functioning in the person's best interest if they're just popping in for an adjustment?"

Leonesio contends that his franchise approach, which includes proprietary software, is more convenient for the chiropractors themselves, as well as their patients.

He said most chiropractors spend too much time "chasing their money," often waiting several months for insurance reimbursements and other payments. "This eliminates that hassle and gives the doctors a lot more time to do what they were originally trained to do: treat people," he said.

Under Leonesio, The Joint has grown to 323 clinics open or in development in 24 states, and was recently ranked No. 94 in Inc. Magazine's list of the fastest-growing companies. The fee per franchise is $29,000, though the total investment including software, uniforms, training and a host of other requisites runs as high as $167,000. About one-fourth of The Joint clinics are licensed to chiropractors. The rest are franchised to business people such as the O'Neals, who signed off on their 36 licenses earlier this year.

The O'Neal family has had some experience with health care, and with franchising. Patriarch Sean O'Neal, a former hospital CEO, co-founded SurgCenter, a string of more than 100 physician-owned and -operated ambulatory surgical centers, including the Roseville Surgery Center. Sons Chris and Rory own franchise licenses for a Famous Dave's BBQ in Salinas and Ling & Louie's Asian Bar & Grill in Reno.

Chris O'Neal said he and his family were attracted by The Joint's business model, and by Leonesio's Massage Envy success.

"The territories are going fast," he said. "We wanted to have a good amount of territory to keep us busy for a few years."

O'Neal said he thinks the chiropractic clinics will fare well because they are affordable and keep longer hours than conventional practices. "Most of your insurance-based chiropractors are closed for lunch, leave at 4 and are not open on Saturdays. We're there at all those times," he said.

Pedroncelli, for his part, begs to differ. He starts his days at 7 a.m. a couple of times a week and takes late lunches most days to accommodate his working patients. And when they have chiropractic emergencies, he said, he readily comes in on the weekend. Many of his colleagues keep Saturday hours, too.

As The Joint readies its Sacramento offices, industry professionals are watching closely. Executive Officer Robert Puleo of the California Board of Chiropractic Examiners, which regulates the state's 13,000 licensed chiropractors, said the commercial approach is permissible as long as the treatment provided is consistent with the board's rules and regulations.

"The chiropractor is still going to have to do a thorough exam, diagnosis and determine a treatment plan," Puleo said. "If you have patients treating it like massage, going back all the time, there could be allegations of excessive treatment."

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