Offering service-dependent ancillary products benefits your patients by increasing satisfaction and compliance

The science, art, and philosophy of the adjustment are continually debated in the halls of academic institutions and columns of chiropractic journals. The role of the chiropractor as a health care advisor and educator is less contentious. DCs are one of the best resources regarding exercise, nutrition, sleeping, and general health. And they leverage this knowledge by incorporating complementary products into their practices.

Wal-Mart® may offer lower prices, but chiropractors provide an unmatched level of instruction for products that patients cannot get anywhere else. Chiropractors can expand their patient care services beyond the adjustment through special examinations, consultations, training, and treatments that are coordinated with health care products.

A Double Act
There are essentially two types of products that most DCs sell in their offices: stand-alone and service-dependent products. Stand-alone products, such as cold packs and sports gels, are items that may improve patient compliance and response to care, but do not require more from the chiropractor than a brief explanation. They are simple to promote and complement chiropractic without special services or visits. Offering such products may be a convenience for patients, but the money earned on these products does not necessarily merit the doctor’s time that it takes to sell them (Figure 1, page 32).

Figure 1. Average profits earned on popular stand-alone
products, based on prices from several chiropractic
supply companies and manufacturer’s suggested
retail prices.

Alternately, service-dependent products, like orthotics, mattresses, nutrition, and rehabilitation equipment, require chiropractors to provide additional patient instruction and care. They necessitate specific examinations, consultations, and follow-up visits. By incorporating additional services for the patient, DCs can exact a premium fee on the product, including a higher level procedure code and extra office visits worth several hundred to more than $1,000 dollars, depending on the product (Figure 2, page 32).

Figure 2. Profits earned on service-dependent ancillary
products, which can easily be integrated into a
chiropractic practice.

Though selling products can be profitable, as stewards of the public’s health care needs, the decision to recommend products should be determined more by the product’s effect on patient care than on the doctor’s bottom line. Most products offered can be purchased in a store, from a catalog, or online, but with proper selection and training, DCs can make service-dependent products more effective for patients than off-the-shelf items. The result is improved quality of care and better outcomes.

And Then There Were Four
There are four common service-dependent products that are best purchased from a chiropractor because optimum fit and use can only be achieved with the instruction and guidance by a trained health care professional. Though the protocols vary, understanding the assessment and instruction processes for custom orthotics, mattresses, nutritional products, and home rehabilitation exercise products is the key to properly incorporating them into practice.

Custom orthotics. When DCs cast a patient for custom orthotics, they examine the patients’ gait and feet, as this is a necessary step to fit patients correctly. Patients should be then instructed in the proper use and care, have certain exercise recommendations, and given an extremity adjustment along with their spinal adjustment. Orthotics should also be evaluated periodically for proper fit and even wearing to ensure they are still providing the necessary support. This entire procedure requires three or more separate visits.

The combined value of the examination, casting, fitting, instruction, follow-up, and extremity adjusting is often two to three times the cost of the orthotic itself. Patients appreciate the premium quality of the custom orthotic versus the off-the-shelf brand and the informed recommendation that far exceeds that of the store clerk.

Mattresses. Fitting a patient to the right mattress uses similar protocols. Patients should be consulted on medical and sleep histories to identify health and sleep disorders and mattress history to determine sleep preferences. If they share a bed, the spouses or partners have to be consulted and examined as well. Both the patients and spouses’ postures and body frames must be examined in standing and recumbent positions. Based on these collective findings, DCs can then explain the specific features of the mattress that they require. Before the mattress is delivered, review how to create a healthy sleep environment and develop a pre-sleep ritual. Subluxation analysis and spinal adjustments can be provided pre- and post-delivery for comparison and evaluation. Additional problems, such as muscle weakness patterns, may also be identified with the mattress-fitting examination that would necessitate a rehabilitation exercise program or other chiropractic service.

The money earned on selling the mattress alone is usually several hundred dollars, or even more by the mattress retailers who mark-up prices by 100% to 125% of their cost. However, DCs can provide a special mattress fitting service by instructing patients on better sleep habits and discounting the mattress, thereby earning more than $1,000. Built into this mattress process is also a new patient system because the spouse or sleeping partner must be examined as well.

Nutritional supplements. Compare the difference between buying a bottle of vitamins from a store shelf with buying a bottle of vitamins recommended after a nutritional consultation. By impulsively buying a bottle of vitamins in a store, patients are likely supplementing based on the latest fad in the media, but failing to address the real culprit, a poor diet. In this hit or miss strategy, it is unlikely that patients receive much benefit from the vitamins.

Chiropractors add value with a nutritional consultation and dietary evaluation that teaches patients about better eating habits. The value and quality of care are increased with greater personal attention and dietary instruction, and instead of earning only a few dollars, DCs now earn an office consultation fee for the time spent with patients. Used properly, the vitamin bottle can serve a better purpose than a quick sale with education about related health topics. Vitamin sales can also retain patients because they will need to come in to purchase their professional brand supplements not available to the general public.

Exercise rehabilitation. Products can include tubing and band exercise kits, Swiss exercise balls, light home equipment or weights, stretching equipment, balance boards, or other similar home rehabilitative products. Often, patients have already been examined to determine the need for exercise rehab, but they still require specific assessments for the right type of equipment and resistance strength. Chiropractors also have to instruct the patient in proper technique and review the set-up and use of the equipment and also adjust the spine and injured extremity to insure optimal biomechanics when performing the exercise. Patients should return for checkup visits after 1 or 2 weeks to evaluate performance of the exercises, and then again a few weeks later to evaluate the program results. Even though the rehab equipment is inexpensive, the additional services provided improves results, increases compliance, and yields additional visits.

Improving the quality of patient care by incorporating health care product sales can be an ethical and profitable means of practice building for chiropractors. It is important to select products based on the individual chiropractor’s principles and practice styles as well as profitability. Many manufacturers offer billing instructions and promotional materials, and seminars can provide additional training about specific products and protocols. In this competitive world of health care, it pays to be attentive to both the individual needs of the patient and to your own bottom line. CP

Mark Mandell, DC, MBA, is the cofounder and managing partner of Chiropractic Mattress Education. He is also a third generation chiropractor practicing in Metuchen, NJ. He also provides health care consulting to chiropractic-related businesses. Mandell can be reached via email: mmandell dc3@comcast.net.