Decompression therapy Is it right for your patients?
By Linda McDonald

A rose by any other name is still a rose. Whether you call it spinal decompression therapy or spinal distraction, the therapy relieves pressure from the spine, and as part of a comprehensive treatment program, it can have long-lasting results.

The consensus among industry experts is that for the right patients and in the right practices, spinal decompression therapy offers a noninvasive, nonsurgical option to reduce or eliminate back pain. Most tend to agree that it is an evolution of traction, even if they do not agree on what to call it.

But is this therapy right for your practice? After all, the investment is significant, (equipment costs up to $100,000), the tables require adequate office space, and you may have to hire additional staff to support the treatments.

Just as you would do before adopting any other emerging technology, it is important to conduct sufficient due diligence to determine if it is the right choice for your practice.

HOW IT STARTED

Definitions of spinal decompression therapy are “fuzzy,” according to Don Eggebrecht, DC, professor of physical therapy (PT) modalities and extremities conditions at Northwest Health Sciences University in Minneapolis.

Eggebrecht described it as “separation that reduces pressure between vertebrae and relieves muscle spasm or tension. How much separation is the ‘art’ of it.”

One of the first decompression tables was developed by a Canadian orthopedist, according to Mark Cummings, principal of Mark Cummings and Associates and Tri Star Consulting of Alexandria, Va.

Over a nine-month period in 1999-2000, Cummings and a physical therapist conducted a clinical-outcomes study of 52 patients. The unpublished study incorporated a combination of spinal decompression therapy, physical therapy, and patient education.

All patients had radicular symptoms, which had been diagnosed by an orthopedic surgeon, and the protocol excluded patients with spinal stenosis, spinal tumors, or fusions. The result was an 84 percent success rate. One-year post-study, Cummings et al contacted 43 of the original 52 patients and found that all 43 remained pain-free.

DOLLARS AND SENSE

Table manufacturers often invite groups of chiropractors to events where they can learn about the respective manufacturer’s product. You should make the most of such opportunities to research the tables and question the manufacturing representatives before investing, to be sure you make the best business decision for your practice and your patients.

According to Cummings, all spinal decompression tables are similar in their functionality. The differences come in the design of the belting, patient comfort, or the angle of pull, for example, and those differences fuel the wide range of prices. He likened the choice to that of choosing a car.

A Lexus and a Toyota travel down the highway at the same 65 mph rate of speed, but one might offer fine leather interior with wood finish. The buyer has to decide how many of those extras are important.

For a chiropractor in an area with a small population base or for a new practice, a basic “no frills” spinal decompression table might make economic sense.

Because the investment in a spinal decompression table is considerable for the doctor, even at the low-end of the pricing spectrum, there can be a tendency to want to use it for as many patients as possible in order to accelerate the return on investment. Unfortunately, that can lead to improper use of the treatment which in turn can diminish the practitioner’s reputation.

Cummings believes this therapy “does get people better.” But because his research was not published, it has not effected change on the third-party reimbursement side of the equation.

Barbara Flynn, vice president of health information management services for the Florida Hospital Association, recalled that a few years ago, Medicare did not cover any chiropractic care. But the American Medical Association (AMA) finally acknowledged chiropractic, thanks to “lobbying” by patients and chiropractic groups, and developed a limited number of CPT codes for chiropractic.

According to Flynn, if doctors are licensed and have uniform provider numbers from Medicare, they will get reimbursed. Flynn recommended that chiropractors use traction codes when billing for spinal decompression therapy; however, as many have learned, the reimbursement for traction is inadequate. Decompression therapy therefore needs to be considered a cash business.

CONSIDERATIONS BEFORE INVESTING

Practice due diligence and research as many tables as possible before deciding on a table to purchase or lease. Here are some things to think about:

• Training. Eggebrecht said, “A good [manufacturing or distributing] company will give you training and their protocols, will explain how to select patients and what to do for them, and be a resource.”

That’s important considering the significant financial investment you can make when purchasing a spinal decompression table.

• Table mechanics. “The basic tables have the same FDA approval,” said Cummings. “Some have different belting systems, but the mechanics of operation are the same.” Consider the mechanics that are easiest for you to use and are best, in your estimation, for your patients.

• Marketing. In addition to training and protocols, table manufacturers often provide marketing and advertising packages. According to Matthew McCoy, DC, editor of the Journal of Vertebral Subluxation Research (www.jvsr.com) and an expert witness/consultant in malpractice cases and board actions, these are often “canned” ads that require only that the doctor’s name and contact information be inserted. He recommends judicious use of those ads.

• Space and staffing. Keep space and staffing issues in mind. Does your practice require a table that can be moved easily or will it remain in one location in your office? Cummings noted that a physical therapist on staff can administer the entire treatment, but with a chiropractic assistant, you will need to check that the patients are properly positioned and belted on the table before the treatment can start.

• Staff education. Educate all office staff so everyone is able to handle patient or prospective patient questions regarding spinal decompression therapy. Perhaps more importantly, remind all staff members to be good to the patient first, above anything else.

• ROI. Central to all of this is the need to weigh reimbursement issues and the impact on your return on investment.

Cummings noted the need to carefully balance appropriate diagnosis against the cost of the table. Will your practice or the community you serve support the investment? Many, if not all, patients will be forced to pay for spinal decompression therapy out of their own pockets because insurance reimbursement is limited for this modality. Depending on local economics, the timing may not be right for your practice.

• Positioning. One way to position the therapy is to set it up as a separate business unit. Another way is to incorporate spinal decompression therapy into a complete back program. Cummings recommended building a comprehensive back program that helps your practice amass success stories. Patients can often provide the best referrals and help to grow your practice.

SUCCESSFUL IMPLEMENTATION

Eggebrecht is among those who view spinal decompression therapy “approximately the same” as traction.

“It’s been around for a long time. How it’s been marketed and packaged has changed,” he said.

Take advantage of the resources manufacturers provide, but be cautious about using aggressive marketing that seems to make promises that you may not be able to fulfill. According to McCoy, the nature of the advertising and marketing might attract complicated cases and the chiropractor must be confident that he or she has the background and experience to deal with such cases.

“The chiropractor should also make sure he monitors motor, sensory, and reflex function on these patients and keeps excellent records documenting the patient’s status,” said McCoy. “Pay special attention to the ordering of additional diagnostic tests such as MRI, and don’t hesitate to refer patients to the appropriate specialist should any unforeseen problems arise, especially adverse changes in motor function.”

Correct diagnosis is the key, and is perhaps why the treatment has gotten a questionable reputation. For the right patients, based on an indicated diagnosis, spinal decompression therapy can achieve good results.

Cummings advised that chiropractors build a back program, avoid the “numbers game” mentality, and be good to their patients first.

Chiropractors who understand their own financial constraints and are willing to communicate realistic expectations about outcomes to their patients, could use spinal decompression therapy to expand their practices.

SIDEBARS:
How to ‘guarantee’ good care
False hope may lead to malpractice
Colleges weigh in
Spinal decompression therapy: general protocol

Linda McDonald is a freelance writer from Jacksonville, Fla. She can be reached by e-mail at Linda@mcdscreations.net or through her Web site, www.mcdscreations.net