Learn from four experts how to increase your patient base and expand your practice with rehabilitation products

Many chiropractors are advocating approaches to strengthen overall fitness and offering products or techniques in their practice. Rehabilitation centers are sprouting up in chiropractic offices nationwide.

Starting a rehab center in your office can be an easy way to grow your business. While there are more complicated variations of exercises and products, for the most part, rehabilitation is simple and easy to incorporate into your practice. Exercise balls and cervical pillows are examples of products that can bring additional profits and support the rehabilitation programs you recommend to your patients.

To discuss the benefits of incorporating rehabilitation into your practice and what you will need to do, Chiropractic Products spoke with four experts in the field.

Kim D. Christensen, DC, CCSP, DACRB, CSCS, is part of the Rehab and Wellness Services Team at PeaceHealth, Longview, Wash. He is currently a postgraduate faculty member of numerous chiropractic colleges and is the past-president of the American Chiropractic Association (ACA) Rehab Council. Christensen is the author of numerous publications about musculoskeletal rehabilitation and has 25 years of experience in the field.

Kurt Graebe is the cofounder and president of Sleepmatters Inc based in Belleville, Ill. Sleepmatters manufactures patented air technology mattresses and pillows. Prior to starting the company 5 years ago, Graebe worked in the medical rehab market for 17 years. Graebe is a member of the International Sleep Products Association.

Kent S. Greenawalt is president and CEO of Foot Levelers Inc, Roanoke, Va. He is also editor of Success Express, a quarterly journal for the chiropractic profession. Greenawalt is the recipient of several awards from the Chiropractic profession, including the American Chiropractic Association’s (ACA) Humanitarian of the Year award, the highest honor the ACA can award to a nonchiropractor.

John Turner, DC, has been in practice for 18 years outside of Atlanta, Ga, at the 6,000-square-foot Roswell West Medical Center, which is an integrated health center with chiropractors, medical doctors, physical therapists, acupuncturists, and massage therapists on staff. He has always kept abreast and embraced the latest technology and advances to improve efficiency within the office.

What do you recommend for chiropractors who wish to include a rehabilitation area within their practice?

Christensen: I encourage all chiropractors to include rehabilitation in their daily practice. Most practices do well with low-tech equipment, which generally includes stretching mats, exercise balls and tubing, balance boards, etc. It is helpful to have space to demonstrate active/passive stretching, PNF procedures, and active spinal and extremity exercises. Sports practices generally benefit from some additional high-tech equipment, focusing on dynamic resistive and performance exercise.

Graebe: Just as each practice attracts different types of patients, each practice’s rehabilitation area should be designed to provide the specific types of products those patients need. For example, if you have a practice of primarily women with LBP, then products such as back rests, lumbar supports, or orthotics would be appropriate.

Greenawalt: Start out simply. Research shows that results obtained from small, inexpensive rehab equipment is the same as a large, expensive one. Look for low-tech equipment that can be set up in a small space. Often, wall-mounted equipment that can enhance the stability and performance of the spine, pelvis, and extremities is best. The goal is to enhance your care, but not wreck your routine.

Turner: Generally there has to be enough available space in the practice. I would recommend a minimum of 400 square feet of open space. Also, there has to be supervision of the patients while they are participating in the exercise programs. If your practice can support the salary, a physical therapist would be best. Easier ways would be to hire or create alliances with personal trainers who are willing to learn about administering rehabilitation.

What equipment, product, or services should doctors have in their practices?

Graebe: It really depends on the nature of the practice. However, the number one health complaint in America is headaches, so a product that helps reduce the causes would meet the needs of a very high percentage of patients. When a chiropractor resets a patient’s nervous system by putting the vertebra back into alignment, a cervical pillow can help those adjustments remain effective.

Greenawalt: Besides the adjusting table, the most important adjunct for rehabilitation, in my opinion, would be the custom-made spinal pelvic stabilizer. Rehab can be much more than doing muscle strengthening. I define rehab as improving a structure and its function. In-shoe stabilizers improve the structure and function of the feet—the foundation of the body. Without pedal stability, rehabilitation of most load-bearing joints and surrounding tissues will be less than satisfactory.

Turner: To keep the costs down, simple products can be just as effective as expensive ones, such as bands, cords, and balls. Exercise computer software can demonstrate how to perform the exercises through printed directions for patients.

What patient education tools or products should chiropractors include in their rehab program?

Christensen: Patient exercise diagrams, booklets, posters, and video demonstrations are helpful.

Greenawalt: Every low-tech rehab station should include a mirror, posters and/or videos for reference. Also, patients should have a brochure or flyer with pictures depicting any at-home rehab. All instructions and photos should clearly explain the purpose, duration, and procedure for the rehabilitation demonstrated in the office.

Turner: Simple and less expensive equipment is better to start out with. I also use exercises generated from my computer program to give to my patients.

How can chiropractors build a successful secondary profit center with rehabilitation products?

Christensen: Rehabilitation services add a dimension in practice that allows patients to demonstrate function. This generally involves concentrating on structural rehab products that ultimately improve patient function.

Graebe: Just because we are talking about rehabilitation as a profit center doesn’t mean it has to look like a retail center. Doctors can display rehabilitation products at convenient locations throughout the office. For example, back rests (still in the packaging) can be displayed on all the chairs in the waiting room. Pillows and more personal products may be more appropriate for the examination room.

Greenawalt: Demonstrating a rehab procedure is a very simple process and can easily be done by a trained chiropractic assistant. Space is minimal, and the cost/benefit ratio is huge. It’s a very small cost for the effect on a patient’s health, postural stability, and practice income. Once patients experience the positive effects of low-tech rehab, they will want to purchase at-home models. Simply display these items so patients know they are available.

Turner: I believe that a comprehensive approach is better at helping my patients. Patients want to have an exercise program to help improve their spinal problems. Also if you add patient education to a patient’s total health care package, it is easier to coach them back into a healthy lifestyle.

What marketing or promotion should chiropractors do for their rehab services?

Christensen: Rehab services are sought after by athletes and active patients who already recognize the value of rehabilitation. Pointing out that you offer these additional services directs these patients to your office.

Graebe: Doctors can market products by brand or by category on the back of their appointment cards. They can also display free literature in the waiting area, so patients can learn about the available products. If the doctor has an hold message on the phone line, their rehab services or products should be mentioned. A newsletter is an excellent place to market ancillary items and services. If the doctor has a Web site, this is also an ideal place to educate patients and market rehab products and services.

Greenawalt: Do the level and type of marketing that fits into your comfort zone. There are effective ways—internally and externally—to promote rehab services to patients. Some internal examples would be staff education and health care classes. External methods that advertise your rehab expertise might include patient newsletters, lay lectures, business cards, and Yellow Page ads.

Turner: The best marketing is internal marketing. Announcing a new program through your newsletter or sending educational information to my best patients (who would then share the information with others) was how I got started.

Tell us a success story about one of your clients or colleagues with their rehab services/products.

Graebe: We gave two of our pillows as a gift to a graduating chiropractor. She and her fiancé both used them and even took them on their honeymoon. Today, the doctor always sleeps with the pillow and has firsthand knowledge of how effective they are. She has no trouble recommending the pillows—even to friends and family who are not bothered by neck pain, headache, or sleepless nights. At work, she is not only able to increase patient satisfaction with the practice, but increase ROI as well.

Greenawalt: Doctors constantly tell me that therapeutic adjuncts that directly support the adjustment improve patient results, generate enthusiastic referrals, and make their practices more rewarding. It can be very frustrating to treat the same patients who continually return with the same complaints. Rehab and supports are often necessary items to remove the underlying causes of repetitive subluxation patterns and poor posture.

Turner: In offering a more comprehensive care plan to your patients, success is common. Patients enjoy being active with their treatment, and response to treatment is quicker and referrals increase. Eighty percent of my new clients are from patient referrals. I have also been able to expand the scope of my practice and work with post surgical cases and market myself to the medical community.

Are there any new products/services or advances in technology that chiropractors can use for their practices in the future?

Christensen: Computer analysis of posture, function, and performance is the current and future rehab technology to consider.

Graebe: Our company is working on rolling out a new sleep product that provides either hot or cold treatment as well as exceptional cervical support.

Greenawalt: What is new is specificity—doing a better job in a smaller area. For example, doctors can now obtain for their patients a custom-made support pillow to help individually rehabilitate a cervical curve. This is a major therapeutic breakthrough. Another advancement would be the level of sophistication now available to electronically scan patients for postural distortions, which can lead to more specific rehabilitative care.

Any last words of advice?

Greenawalt: Some of the most profitable reimbursable codes are for active-patient care. Third-party payors know that when the patient is actively involved in their treatment, outcomes improve and have greater permanency. Since the cost is so reasonable, the protocols are simple and logical, and if you have a wall you have the space. Every chiropractor should add a low-tech profit center to their practice.

Turner: First, determine whether or not you have the space to start a rehabilitation center. Then start with basic equipment and expand as patient load increases. Equipment will be necessary as the clinic grows, but don’t get caught up in all the new gadgets. Investigate the possibility of using other professionals to administer the exercise and rehabilitation programs. Market to your existing patient base, and open the possibility of offering your new patients a more comprehensive program. CP

Julie Z. Lee is a contributing writer for Chiropractic Products.