In the scramble to get new patients, increase visits, broaden the scope of services offered and improve overall revenues, rehab is one area you seriously need to consider building into your chiropractic business model. Prevention and wellness are the buzzwords of the day in medicine and just got a major cash injection from health reform plan dollars. If you want a piece of the pie, start looking for “exercise prescription” referrals.
Exercise prescriptions are orders from a physician requesting exercise for a patient who needs a professional’s expertise to create an exercise program that will account for their medical condition. As chiropractors, we know that many MD’s are simply not willing to spend the time and effort to treat many patients with back pain. And most are even less willing to instruct their patients in exercises that they may need to improve their condition, overall fitness level or for preventative measures.
Get the Word Out!
Unfortunately, many chiropractors are viewed as passive therapy specialists by many of the Medical Doctors in their community who view Physical Therapists as the providers of choice for rehab. But for those of you who are already receiving MD referrals for chiropractic care, you are missing a golden opportunity to offer these patients the convenience of guided exercise instruction in your clinic, improve your status in the eyes of the MD’s and boost your own revenues simultaneously. DC’s looking to increase the number of MD referrals and new patient sources would do well to develop this niche and, of course, make it known to your medical community.
Setting up an exercise program for patients with musculoskeletal injuries or chronic problems requires specific training on these types of conditions, as well as expertise on tailoring exercise that is safe for deconditioned or injured patients. Because chiropractors see these types of patients each and every day, are familiar with treating car accidents or work injuries, who better positioned to do this than a DC?
Feel wary about “filling” an exercise prescription and billing insurance for it? You don’t need to be with the proper codes and documentation. In this respect, since most rehab codes are timed services, it is important for you to indicate the amount of time spent during your exercise instruction in your documentation.
Your biggest threat and the biggest mistake DC’s make…
In my experience, most chiropractors who have seen poor results with integrating rehab into their clinic have also failed to assess their target market and their competition. Unfortunately, I have seen clinics with $50,000 of the latest exercise and fitness equipment gathering dust because the chiropractor couldn’t get his rehab program off the ground.
The first steps toward success are to define who you target patient is and what needs they have that you can meet. Once you have this defined, you will notice that some of these patients are already be in your practice, so start marketing your services to them.
For MD’s, if you don’t market yourself to physicians as the most qualified providers, they’ll send their patients to a gym where the patients will have either no guidance or be working under the non-medically trained eye of a personal trainer.
What’s worse is many DC’s attempt to market themselves without considering their target market and they mistakenly brand themselves in the same vein as a fitness center or gym. Unfortunately, in this battle, you are likely going up against a bigger entity who can outspend you. And you have missed your niche.
Patients will come to you and MD’s will refer to you because you are a physician who can offer the guided, experienced, professional and safe instruction that many personal trainers cannot.
The Future is Bright
The American Medical Association put forth an “exercise is medicine” initiative in 2008. Following this initiative, physicians may be required to prescribe “exercise” to their patients (they are getting hit with the same emphasis on active care as we are). The reality of the situation is that MD’s really need partners to do that. So think about ways you can educate referral sources about what you can do for them. Physicians don’t know as well as you do what you can do with exercise prescriptions. The future is bright and the time to act is now, when MD’s are pushed towards becoming more active care oriented.
Can you put together information on exercise instruction or rehab offered in your clinic that could encourage physicians to refer to you? Then do it! Don’t automatically assume the referrals always go to physical therapists. And don’t pre-judge that your patients are not interested or willing to pay for such a service. With proper planning, you can set up a rehab department that creates significant revenue for your practice AND increased satisfaction for your patients.
A Real Life Lesson
Several years ago, I can recall a conversation with an MD in my town who mentioned the largest physical therapy chain in our area with disgust. “They get all the new grads fresh out of school who don’t know how to manage a case. Then they pay them peanuts, so there’s no consistency or retention” he complained.
His solution? He (and the other 8 docs in his clinic) refused to send patients to the large PT chain even though they were conveniently located just about everywhere. Instead, he referred all their patients to two solo practitioner PT’s in the area who were skilled and consistent. It just so happened that one of these PT’s decided to head into early retirement, leaving the other swamped.
After our conversation, I decided to follow up with a letter to this MD and I explained to him how we also perform rehab and exercise instruction in our clinic. Several weeks later, when the MD was frustrated at the waiting list to get into the “good” solo practitioner’s clinic, he decided to give my office a try and he sent over a car accident patient as a referral. His prescription? “Chiropractic care, to include exercise instruction/physical therapy for treatment of MVA injuries.”
We did an excellent job assisting this patient recover from his injuries (but probably did nothing much different than any of you would do) and the rest, as they say, is history. We gained the confidence of this one MD – actually 9 MD’s, because he mentioned our clinic to his colleagues as well – and scored many referrals over the years.
Had I assumed that MD’s only refer to Physical Therapists, I would have missed out on the one referral that generated thousands of dollars of business over the years. Had I been unwilling to teach my patient exercises, I would have shared some of this revenue with the PT down the street and probably frustrated the patient and the MD in the process because this PT was so busy.
The Bottom Line
Obviously, I have no way of knowing if a similar situation exists in your practice area, but probably neither do you — unless you begin to try. The bottom line is that most successful ventures that I have seen start small (and inexpensively). They introduce the program to their patient because, bottom line (again) is that patients need the service. And, finally, yes, a well run rehab department is good for your bottom line (again, I know — do you get the point?).
Spend some time this week thinking about how many of your patients could benefit from such a service, how you could integrate it into your practice and what kind of revenues you can generate. I think when you consider the bottom line (last time, I promise!), you will see that this is a niche worth incorporating into your practice.
