T oday, it is hard to believe that anyone with a practice that has been around for a while does not have a big injury practice. That’s right. Let’s say you have 2000 patient files of patients over the age of 16. Do you realize that, by general statistics in the U.S.A., you should have 100 patients who were in a motor vehicle accident of some kind; and you should have 120 patients who have a work related injury, just out of your 2000 files? This is from your old files, mind you; this is not from new patients!
Perhaps these numbers surprise you? Perhaps you are thinking, “No way!”
Well, I am thinking, “Yes, way.” And I am also thinking, “Are you capturing this for care; and, if not, why not?”
Okay, let’s verify the numbers. The national average for work related injuries is 6.1 cases per 100 fulltime workers; hence, the 120 work related injuries to the 2000 files above. In Wisconsin, in 2004, there were 213,415 vehicle accidents of some kind and there were 3,933,348 licensed drivers, which means 5% of the drivers that year were in some sort of accident, or your 100 people above. (This is a State Statistic that will translate into the same percentage nationally.) This does not mean that they all were injured; it just means that they were in a crash of some kind and they should be checked.
Here are some more statistics for those of you who were not moved by the earlier ones. These numbers would be the same in any state in the country; I live in Wisconsin, so
used Wisconsin’s statistics for auto crashes:
• One injury or fatal crash every 13.5 minutes
• One traffic crash every 4.1 minutes
• One property damage crash every 5.9 minutes
• One person killed every 11.2 hours
• One person injured every 9.5 minutes
• One alcohol related crash every 80.5 minutes
• One bicyclist injured or killed every 7.8 hours
• One pedestrian injured or killed every 6.3 hours
• One school bus occupant injured or killed every 34.3 hours
Okay, enough on the statistics; I think you get the point. Everyday or every week, I am talking to practitioners about their practices and, of course, spinal ligament work-ups for severity of injury through our services at National Injury Diagnostics, Inc. (X-Ray Digitization) It is amazing to me how many of you have really high numbers of patient files and really low injury practices. I mean, some of you have 5000-20,000 old patient files! Run the numbers at 10,000 patient files, and you would have around 1100 potential injury patients to treat each year, just from within!!
But, let’s make it smaller. Let’s say that you have 1000 patient files; this would be 110 potential injury patients to treat this year, from within. 500 files would yield around 55 injury patients, and I think you get the point.
Okay, so are you getting these kinds of numbers from your already existing patient files? I would say that you probably are not; however, that is what is there! So, if that is what is there, why aren’t you getting this? Could you use, say, 18 re-activated PI or Work Comp cases a month out of your already existing patient base? What would that do to your practice this year? What would that really do to your income this year?
Let’s say, you had 200 injury patients this year at say a very low $3000 case average. That is $600,000 in revenue to your clinic. Now, put the case average to $6000 and have some fun: $1,200,000 in services rendered.
That is your potential in injury work and more, and I do not care if you have a total wellness clinic, if you have files of adults that you have treated over the age of 16, then run the numbers, because the numbers will tell you what you have in potential injury work, period.
Now, let’s say, you are not getting the numbers of people that you have already seen at one time or another for some problem, coming back to your clinic for injury assessment when they are in a vehicle crash or have a work related injury? What do you do? What can you do?
The first thing to know is that is that you must understand and become more of a professional at handling the injured patient—a real pro at diagnosis, treatment and management. The patient is in an auto accident, torn up pretty badly and you handle them the same way you handled them when they came in three years ago because their neck was sore from sleeping on a couch. Wrong: same consultation style, same exam procedures, same X-rays, same report of findings…wrong perception. Do this and you will not get the patients out of your database who are injured and those numbers will be low. I guarantee it!
When you are going to change and grow, you must understand where you are weak and where you are strong so that you can strengthen your weaknesses. The spine has four tissues: bone, nerve, muscle and ligament. Think for a minute and I know you will see that you have a strong assessment procedure for the bone (misalignment on X-ray), muscle (muscle testing and palpation), and nerve (neurological exam)—but what about the spinal ligaments? How do you assess what has happened to the spinal ligaments? A positive break in Georges’ line is what a lot of us use to indicate spinal ligament trauma, but is it a mild break, moderate break, severe break—how do you quantify it? X-ray digitization completely and accurately quantifies this, and compares the normal to the AMA Guides to the Evaluation of Permanent Impairment established numbers for spinal instability. This is the most powerful diagnostic tool in trauma practice today, and it turns your current weakness into a powerful strength.
Patient’s who have injured their spines are different from patients who have regular misalignment problems. Do not treat them the same, as it completely minimizes their significance and minimizes your professionalism, since they are not the same. Test your trauma patient’s for ligament instability, which shows up as “alteration of motion segment integrity.” This is not only a serious ligament condition; it is also a ratable ligament condition listed in the AMA Guide to the Evaluation of Permanent Impairment. Utilize and understand how to accurately determine what is right in front of you on your patients’ X-rays.
X-ray digitization is an appropriate diagnostic procedure to incorporate and, if you do not understand why or how, you need to spend some time and study it more closely. If you need other tests, learn about them and use them. If you need an MRI to rule out the disc, have the patient get it under your direction. Know what electro-diagnostic testing with a neurologist can provide, as well as the many other testing procedures. Develop special exercises specific to injuries of the spine. Develop nutritional guidelines for the injured patient.
Learn about ligaments and how to diagnose, and treat them. X-ray digitization is the most powerful clinical tool in trauma practice today, because it provides you with a way to diagnose spinal ligament trauma. Incorporate its usage of X-ray by utilizing an outside service or buy an X-ray digitization system and do the diagnostic testing internally.
Become an injury specialist, perhaps not overnight, but little by little, one or two steps at a time. As a matter of fact, look at those statistics again and then figure again, in your own patient base, what you are missing?
Incorporate spinal ligament testing in your practice today and let your patients know that you are and injury specialist! Communicate to them in newsletters and keep yourself on the top of their minds as the place to go to when they are injured. When you use an X-Ray Digitization service, let them know that they have a baseline now set up and that, in the future, when (not if) they are injured to return to you for an assessment. Take responsibility for the patients that have been treated in your clinic; and part of that responsibility is to help them when they are injured, as they are going to get injured!
Dr. Cronk currently owns and operates National Injury Diagnostics and can be contacted at