Thirteen Mistakes You May Be Making with Decompression Therapy Patients
DECOMPRESSION
TRACTION
David A. Bohn
DC
"Effective and profitable Decompression in my practice is due to my procedures that I have refined over years of practice."
According to the 2015 National Board of Chiropractic Examiners practice analysis survey, 48.3% of respondents utilized mechanical traction/spinal decompression in their practices. Spinal decompression has been around about 20 years now, and many doctors have integrated decompression treatment into their practices with patient outcomes ranging from poor to excellent. I have successfully utilized spinal decompression in my practice since 2003 and currently have four KDT decompression tables in my office. Effective and profitable decompression in my practice is due to my procedures that I have refined over years of practice.
The Table
Let’s talk first about the table because it really isn’t about the table. There are many good tables on the market as long as you get one that provides effective distraction while making the patient comfortable. Patients simply do not care about the name of the table, how much you paid for it, or what it looks like. They are only concerned about pain relief. Now, with that said, I recommend getting a KDT Neural Flex table, which allows you to set your patient up in positions that decreases pain. Not every table will allow you to put your patient in prone, supine, semi-seated, reclined, reverse-hammock, or side-lying positions. Pain-free positioning is critical to success.
The Intake
Perhaps the most important part of your decompression protocol is the new patient intake process. The first impression you and your office make is critical to establishing whether this patient will accept your recommendations and elect to begin treatment. This means your staff must be friendly, your office impeccably clean and modern, and your appearance professional. Make your patient feel comfortable, offer bottled water or coffee, keep wait times to less than 10 minutes, and eliminate anything not critical from your intake paperwork.
History/Exam
In my office, a CA first records a personal history of the patient before I enter the room. I then go over the history and get additional details. I prefer to jot notes onto a clipboard so I can maintain eye contact and be knee to knee with my patient—not clicking a keyboard or looking at a computer screen. After the history, I ask the patient if he or she has any questions or concerns and then explain that I will do some palpation and tests followed by positional preference, form closure, range of motion, posture, gait, and X-ray. If they pay with cash, I explain the cost of these tests and get their permission to proceed. At this point, the patient has been in the office less than 30 minutes, and I have personally been with the patient for less than 10 minutes.
Mini-Report
People today are conditioned to receive immediate resolution to their problems. They go to walk-in medical clinics and leave with a prescription. They go to a dentist and get immediate relief for a toothache. They can even get eyeglasses within an hour of an exam, yet chiropractors still insist that patients schedule a follow-up appointment so they can look over their exam and X-ray findings to formulate a treatment plan. This gives the impression you do not know what to do and must “look it up.”
Recommended Action Plan (RAP)
My high acceptance rate of treatment recommendation is due to my RAP. This is a full-color printed and comb-bound copy of their posture analysis, range of motion, spinal listings, X-ray mensuration analysis, gait, treatment plan, financial plan, and their first visit note. I show patients a copy of a sample recommended action plan (RAP) and let them know I will provide this for them to take home on their next visit. I then proceed to explain any important exam findings and X-rays, give them my diagnosis and care suggestions, and ask them if they would like to begin treatment today. The answer is yes 95% of the time. The patient is then treated appropriately and scheduled to return for their second visit.
Satisfaction Guaranteed
There are 8.5” x 11” framed signs on the wall in my reception area, my checkout desk, and in my exam and consultations rooms that says to let us know before you leave if this visit did not meet your expectations and you will not be charged. This is my promise to every patient and, to date, not one has asked for this to be honored. This is a great way to avoid negative social media posts and let your patients know you really care about their satisfaction.
Creating The Take Home Report
When software wasn’t available to make this process quick and easy, I made it so I could generate a take-home report in less than 10 minutes for every patient. My next step was to hire a licensed radiologic technologist as a CA to take my X-rays and free up my time. Always think about what you are doing in your office. If it is keeping you from adjusting patients, it is costing you money, and you must find a way to delegate it to someone else. My care plan consists of a list of what is causing their problem followed by a list of what we need to do to correct it. At the bottom is the time involved in visits per week. This is all selected from my software. I then have my office manager use the software to generate a financial plan with treatment options. It may be a 100% cash plan or it may be for the coinsurance only, but it still lists time-of-service discount, monthly payment, or even things like Care Credit if patients choose to use these services. The point is that you must have options to make care affordable.
The RAP Room
We have a room that is devoted to the second day. All of my models and charts are in this room. One of the very important charts is the fatty infiltration of the multifidus that explains how a chronic back pain sufferer has lost muscle mass to fatty infiltration. I ask the patient to flex their biceps and then place my fingertips on their lumbar paraspinals. Then I ask them to “make these muscles tight” when they find they can’t. I explain that these muscles are proprioceptive muscles and not under voluntary control. They must be strengthened and conditioned with postural exercises, and that is why rehab is so very important in correcting their back pain.
Second Visit
Since every patient gets a bound copy of everything we did on day one, I do not have to explain every little detail about the exam. We use a wall-mounted HDMI TV in portrait position attached to a laptop to display their posture, ROM, significant X-ray analysis findings, listings, treatment, and financial plan, and I click through and explain these findings. This works great, and it’s very fast and easy to set up. For years, I used a flipchart on an easel and we wrote everything with colored markers. It worked very well too, and it was extremely personal and patients love that, but it required a lot of time to complete for every patient as volume increased. Now the monitor displays the completed take-home report in PDF format and I love it.
Adjunctive Therapies
The majority of patients will also get an appropriate combination of electrical stimulation, dry needling, microcurrent, therapeutic exercises or PNF, active therapeutic motion ATM2, shockwave therapy, class IV laser therapy, or massage therapy. I have found that including these treatments in a care plan makes patients feel better faster and sets my practice apart from the competition.
Home Supplies and Supplements
I like to provide things that may help the patient progress or feel better faster. I frequently recommend Serola SI Belts, natural anti-inflammatories, or appropriately sized Swiss balls. I made DVDs of exercises for the lower back for the Swiss balls and provided them to my patients for years, but now these exercises are online. This is something you can do in your own office.
Putting the Patient on the Table
This is where many doctors lose the patient. Initially, I tried to setup every patient exactly the same way, but it didn’t work. Using positional preference to select the setup is the most effective method I have found, but it can be difficult to learn. To make things easier, I worked with Dr. Jay Kennedy to create an easy-to-use interface that helps the doctor select the appropriate patient position and pull weights. So all you have to do is explain to the patient what is going to happen, how long it will last, and how to use the safety shut-off if they feel uncomfortable. I have never had a patient use the shut-off, but initially, they like to know they have control.
Rechecks and Progress Exams
After 12 visits, we do a recheck of posture and ROM and share these finding with the patient in printed format. Additional care is based on progress with most of my decompression cases reaching maximum improvement in six to eight weeks (18 to 24 visits). On the rare occasion a patient requires 36 visits, I’ll do a second recheck on visit 24 just to document improvement and be sure the patent wants to continue. Never try to force treatment on a patient. Instead, provide the proper information to allow him or her to decide to continue. Many of my patients ask me about continuing with supportive care at the end of treatment, so I don’t have to sell it.
Primary Care Providers
There is one last thing to consider if you want to have a successful decompression practice. Once you create this take-home report for your patient, get the patient’s permission to send the note, posture, ROM, gait, and significant X-ray analysis findings to their primary care providers. You will find that you’ll start getting referrals when, like your patient, they understand what and why you do what you do.
David A. Bohn, DC, graduated from National University of Health Sciences in 1988 and has since been in continuous practice. Since 2004, Dr. Bohn has pursued development of both documentation and x-ray analysis software. He has extensive experience with developing, marketing, and maintaining a successful practice. Dr. Bohn is a frequent guest speaker for KDT Decompression Seminars and can be reached through his office at 301-777-3710 or through Kdt.
References:
1. Hannah Fell. 2018 Chiropractor Salary Survey. Chiropractic Economics. May 25, 2018
2. Jen Wieczner. 10 things walk-in clinics won’t tell you. www.marketwatch.com. Nov 2, 2012
3. Adriano Pezolato, Everaldo Encide de Vasconcelos, Helton Luiz Aparecido Defino, and Marcello Henrique NogueiraBarbosa. Fat infiltration in the lumbar multifidus and erector spinae muscles in subjects with sway-back posture. Eur Spine J. 2012 Nov; 21(11): 2158-2164
4. ICA. Best Practices & Practice Guidelines. Chapter 7, Outcome Assessment Measures in Chiropractic. 2013
