September 2002

Is On-Site Diagnostic Testing Right for Your Practice?
By Gregory D. Thurston, DC, DIBCN

On-site diagnostic testing has become an increasingly popular way for doctors to become more accurate and effective in treating their patients. How do you ascertain if these services are right for you?

Do your homework. Do the research needed to determine if your practice is capable of providing the patients necessary to benefit from on-site diagnostic testing. Ask other doctors about their experiences. And, don’t be afraid to ask questions of the diagnostic providers you are considering.

Types of Testing Available
There are many types of diagnostic tests available in the on-site diagnostic testing market. Some of the common test types include nerve conduction velocity (NCV), musculoskeletal and spinal ultrasound imaging, somatosensory evoked potential (SSEP), dermatosensory evoked potential (DSEP), visual evoked potential (VER/VEP), brainstem auditory evoked response (BAER), P300, thoracic outlet study (TOS), blink reflex studies, and voltage-actuated sensory nerve conduction threshold (V-sNCT). Determining what types of tests your practice will utilize is dependent on the needs of your patients.

Patients with extremity pain from central canal stenosis, lateral recess stenosis, degenerative or traumatic herniated nucleus pulposus with nerve root entrapment, nerve root irritation, myofascial induced referred pain, and sclerotegenous pain can benefit from NCV, SSEP, DSEP, and V-sNCT musculoskeletal and spinal ultrasound diagnostic tests.

The results from these tests are the main reason you should be testing your patients. Correct interpretation of motor and sensory conduction studies can diagnose muscle weakness, radiating pain, carpal tunnel syndrome, neuropathy, sensory loss of extremities and tarsal tunnel syndrome, to name just a few.

The results help determine what is wrong with your patients so you can better treat them. NCV, SSEP, DSEP and V-sNCT tests help determine neurological damage and nerve threshold. Musculoskeletal and spinal ultrasound tests help determine soft-tissue injury and inflammation in muscles, tendons, ligaments, and facet joint capsules.

Convenience and Control
One of the primary advantages of on-site diagnostic testing is that it enables your practice to keep control of all treatment and testing options for your patients. Some testing companies allow you to arrange a time that works for your patients, and then the company comes to your office to administer the tests. The testing company takes the data from the tests to a neurologist or radiologist, who then interprets the results. The results are given back to you in a matter of days.

Offering these services can greatly expand the scope of your practice and positively influence the perception your patients have of your practice. In addition, the convenience of having everything in one place for your patients is a huge benefit. These added services can be reflected in your marketing efforts as services that your practice offers.

Using on-site testing can also benefit practices by providing insurance carriers with documentation that helps justify prolonged treatment programs for patients who have not responded to care as anticipated. The value of justifying extended patient care without insurance carrier disputes is an enormous advantage and can amount to additional income in the long-run.

What to Expect
If you make diagnostic testing a part of a monthly routine and you choose to work with a testing company, you can schedule one or two days a month for diagnostics work. Some on-site testing companies offer verification of patients’ insurance, which can help free up your administrative staff.

On the scheduled day, a technician arrives with all of the necessary equipment and supplies. He or she will brief the patient on what to expect during the testing process. All tests are safe; however, some patients may feel slightly uncomfortable during some of the neurological procedures because of the electrical stimulation of the nerves needed to determine results.

Several days after the testing, you will receive a full interpretation from a neurologist and/or radiologist. The reading physician reviews any notes or clinical findings that you may send along and will call you if he or she has any questions. You are encouraged to contact the physician if you have any questions after getting the report.

Earning Power
It is true that you can develop a new source of practice income by making diagnostic testing available to your patients. However, like X-ray and physical therapy modalities that generate income, any increase in income from diagnostic testing is the direct result of carefully selecting patients to receive a service that will benefit them.

With on-site testing, the diagnostic testing provider charges a leasing fee for the equipment and technician. Some providers charge by the year, while others charge by the hour or the day. Check with the testing company to see if there is a test minimum.

Offering on-site diagnostic testing is relatively new for doctors and may not be right for everyone. However, if you are looking to expand your practice’s scope of services by offering the best tools for your patients, offering on-site diagnostic testing may be the way to go.

If you are not interested in having the tests done in your office, it is strongly suggested to have your patients tested at a hospital or lab in your area. The additional income generated by on-site testing is secondary to the benefits of the test results in the treatment of your patients.

Dr. Thurston is a licensed chiropractic physician and neurologist in Illinois who provides interpretations for Edward J. Herba, MD & Associates, SC. He is a diplomate of the International Board of Chiropractic Neurology. Dr. Thurston can be reached through Edward J. Herba, MD & Associates, SC, at 866-509-5959 or drherbamd@aol.com