Offering electrotherapy as an adjunct service can boost your patient base and profitability. Chiropractic Products asks five experts for practical advice.

Perhaps you are among the chiropractors who have done their research on electrotherapy. You have heard about how it can benefit your acute and/or chronic pain patients and what the profit margins are for adding the service to your practice. Maybe you have come this far and the only thing preventing you from incorporating electrotherapy into your practice is advice from experts in the field. Five representatives of electrotherapy products offer their counsel on which devices can help you best, what costs to expect, and how to market the therapy to your patients.

Greg Dorholt is the director of new business development at Rich-Mar Corp, located in Inola, Okla. He has been with Rich-Mar for more than 12 years, serving as marketing manager and director of sales and marketing prior to his current role.

Sheila Hurtt is the director of sales for Clinical Health Services Inc. She has been in the chiropractic and medical industry for 11 years.

Matt Karns is the national sales director of The Synaptic Corp, located in Denver.

Jim Lane is CEO and founder of LSI International Inc, Overland Park, Kan. He is also a guest lecturer for chiropractic events and conducts physiotherapy reviews at chiropractic colleges. LSI has been serving the health care industry since April 1987.

Mark Mettler is vice president of Mettler Electronics Corp. He is in charge of sales and marketing and new product development. Mettler has 15 years’ experience in clinical electrophysiology and electrotherapy equipment and has lectured extensively on this topic.

What type of electrotherapy device is used the most in chiropractic offices? For which complaint is it most effective for?

Dorholt: Probably the most common electrotherapy device in chiropractic would be a stimulator, specifically one that offers interferential current. Interferential is a great tool because the high frequency translates into more comfort for patients suffering from acute pain.

Hurtt: Electric muscle stimulation and interferential are our most requested electrotherapy modalities for office equipment. They are effective for neck and low back pain.

Karns: The transcutaneous electrical nerve stimulation (TENS) is exclusively for pain relief and commonly come as small, box-like units, referred to as belt-TENS, and worn by patients for hours each day. The microcurrent electrical neuromuscular stimulation (MENS) uses subsensory currents, which means patients have no sensation of the treatment. The neuromuscular electrical stimulators (NMES), also known as EMS, are devices used for relaxation of muscle spasms and other muscle function. They are not approved for pain control by the FDA since this claim is limited to the TENS category.

Lane: The most used electrotherapy device in chiropractic offices is interferential therapy. These units are popular due to the wide range of indications they can effectively treat, such as acute pain, chronic pain, and edema. Many interferential units also provide Russian stimulation, which is used for muscle spasm reduction, muscle strengthening, and re-education.

Mettler: Combination ultrasound and electrical stimulation devices are the most common units in chiropractic offices. The advantage of these devices is that they allow chiropractors to relieve pain and spasm with interferential stimulation while increasing local circulation with pain relief using ultrasound.

Which device do you recommend for those just starting electrotherapy? For those wanting to expand their services?

Dorholt: I recommend a combination ultrasound/stimulation device as it will provide the most tools at the best price. If you are just starting out, you can get a basic two-channel combo that provides the IFC currents and the 1- and 3-MHz ultrasound for the best flexibility. For chiropractors who want to expand their practice, a combo device has the ability to increase treatment options and patients—something similar to a four-channel combo that allows you to treat more patients or sites at once.

Hurtt: For a start-up clinic, I usually recommend an EMS machine because they are relatively inexpensive and effective for treatment of neck and low back conditions. An office wanting to expand its services may consider a combo unit, which gives the user a selection of EMS, IFC, etc, along with ultrasound.

Karns: We recommend starting with a high-quality device in order to get measurable, positive results. If the therapy works, patients will tell their friends. When business builds, the expansion is about adding more devices to the practice.

Lane: Whether you are a new or experienced doctor, interferential therapy devices should be your first choice. Most units are easy to use and can easily be incorporated into the office. Since they are unattended devices, additions to staff are normally not required. The devices can be treating some patients while the doctor is adjusting others.

Mettler: If a chiropractor wishes to expand services, a shortwave diathermy would add to the practice and offer patients the soothing warmth and pain relief of this modality. Shortwave diathermy is also advantageous since it is an unattended modality.

What is the average cost that chiropractors can expect to spend on the most popular electrotherapy devices?

Dorholt: Chiropractors can expect to spend anywhere from $500 for a stimulator to $4,500 for a top-of-the-line four-channel combo. I would spend a little more for quality products with true flexibility and a local sales rep for additional support. There are also lease-to-own programs, which allows the modality to pay for itself and generate positive cash flow.

Hurtt: The average cost for the electrotherapy devices range from around $500 to $3,500, depending on the features and brand. However, a few clinics have started a successful electrotherapy addition with just a portable, battery operated EMS unit, which is about $55.

Karns: Clinical electroceutical devices range from $20,000 on the high end to $1,000 on the low end. There is no question that you get what you pay for in this market. A midrange device is usually the most effective option therapeutically and financially.

Lane: Interferential devices are available at very attractive prices, especially compared to pricing of 10 to 15 years ago. Two-channel units are now less than $1,500. Four-channel units, capable of treating two patients at a time, are less than $2,000. Good therapy tables are less than $300 each. Make certain you check out warranties when shopping for equipment.

Mettler: Combination devices begin as low as $2,500 from most distributors. They are small enough to fit into existing treatment rooms or can be put on a cart to move from room to room.

Where in the office should DCs keep the equipment?

Dorholt: Doctors should have the electrotherapy equipment wherever it makes most sense for their particular office. There is nothing wrong with having it in the adjustment rooms as you can use electrotherapy pre-adjustment or post-adjustment. If your patient flow dictates that you cannot tie up your adjustment rooms, then having separate or open therapy rooms works well, too. An open therapy area allows you to treat multiple patients at one time if you have a combination device, especially with four-channels of stimulation.

Hurtt: Most chiropractors use the same rooms for adjustments and therapy; therefore, I believe the equipment should be set up in that same room. This way everything is easily accessible, and patients do not have to switch from room to room.

Karns: We think it is best for the equipment to be in a therapy room where the patient can relax during treatment but still be close to an assistant if there are questions about the treatment. It’s very easy to teach a patient how the devices work, so very little intervention is required. That way the patient can get in a little relaxation time.

Lane: Patients prefer private rooms. If you do use a therapy bay, curtains provide some privacy. Patients are much more likely to convey personal medical information in private to the doctor or CA, which can be vital to their condition.

Mettler: Most of the modalities are used prior to adjustment, so the devices should be kept in close proximity to where the adjusting takes place. Some smaller stimulation devices can be wall-mounted to save space in the adjustment or therapy rooms.

What patient education materials do you provide or recommend for DCs to increase retention and referrals?

Dorholt: I think the best patient educational tools are the doctors and staff. They can explain how the modalities will enhance the total chiropractic experience by reducing pain and increasing rehabilitation. Also, each patient is different and some may be more electrically sensitive than others, so really working with the patient to get the electrodes placed correctly and setting the intensity level correctly will add to the patient’s experience.

Hurtt: Some electrotherapy manufacturers supply basic materials, which we pass along to the purchasing doctors. I believe that adding these additional modalities to your office may help expand your clinic’s ability to treat more conditions and thus increase your referrals potential.

Karns: We recommend that doctors tell patients about the benefits of electrotherapy, but the best way to increase retention and referrals is for patients to use the device and realize the benefits. This keeps them coming back, and they tell their friends as well.

Lane: A simple explanation of what the therapy is going to feel like and what it will accomplish seems to work best. Literature from manufactures may come across as propaganda, whereas a short story about how other patients have benefited in your office is more accepted.

Mettler: We offer ultrasound treatment charts and motor and trigger point charts that chiropractors can use for patient education.

What type of promotion or marketing do you recommend to attract new patients?

Dorholt: After adding electrotherapy, ultrasound and light therapy chiropractors should position themselves as providing a full spectrum of therapy, with the ability to treat a full range of conditions.

Hurtt: Clinics need to develop a marketing strategy to attract the type of patients they desire, such as auto, workers’ comp, or cash. I recommend contacting a consulting firm and see what it can offer you.

Karns: We recommend that chiropractors promote themselves as a broad solution to helping patients manage their pain and symptoms. By providing additional therapies, patients feel they are receiving a total package of care that has long-term health benefits.

Lane: Make yourself visible in the community, join organizations, spend Saturdays at functions such as 10K runs, health shows, bridal shows, anything to be visible. Give back seminars and treat every patient professionally with compassion and caring.

Mettler: Many chiropractors participate in local health fairs to attract new patients. Most newspapers have a day devoted to health care where individual practitioners can advertise or place advertorials.

Tell us a success story about one of your clients.

Dorholt: We have a customer who added the hands-free ultrasound combo to the practice and has had great results as well as drastically increasing practice efficiency and patient base. He no longer has to dedicate valuable staff time to a manual ultrasound/combo application that probably was not applied as well.

Hurtt: I’ve been working with a client for about 18 months, and he has what I would consider a successful practice. Two years ago, he came to the United States from Cuba—and in just 2 years, he has accomplished the American dream!

Karns: One of our clients has a patient with paralysis from the West Nile Virus. He began treatments, and in the DC’s own words, “Through these treatments the patient has gone from little or no hope to the hope of being able to play golf this spring.”

Lane: We are seeing both new and experienced doctors thriving in their practices. These are smart individuals who work hard, offer complete care to their patients, and treat everyone professionally and honestly. They stay in tune with what is current in their profession, support their state and national organizations, and are involved in chiropractic. They also keep up to date with their equipment and utilize modern therapy devices.

Is there any new technology or equipment that will be available in the near future?

Dorholt: The newest advances for us are the patented AutoSound products that allow the application of ultrasound or combo in a hands-free manner. The AutoSound still moves the ultrasonic field but the applicator remains stationary, which eliminates virtually all human application errors. Plus, it also allows longer treatments.

Karns: We plan to offer a redesigned product this year. We have listened to our customers and are incorporating their suggestions into the new products.

Lane: Combination units, which incorporate multiple wave forms and ultrasound offer flexibility by having everything in one unit. The downside is that you lose all therapies when the unit is being serviced.

Mettler: Shortwave diathermy is making a comeback in the field since newer units also offer pulsed diathermy, which can be used for acute conditions.

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