Durable Medical Equipment (DME), when an increase in stability is needed for proper healing and rehabilitation
Durable Medical Equipment (DME) has been used by doctors and patients for hundreds of years.
The most commonly used by chiropractors, but not the only, would be lumbar and knee braces. Historically chiropractors have been poorly reimbursed by insurance companies, resulting in chiropractic use of back and knee bracing seldom being included in a therapeutic treatment plan.
DME and chiropractic
A chiropractor’s primary interest is in delivering the spinal adjustment. One of the effects of the chiropractic adjustment is to mechanically release a joint or articulation, attempting to establish a free and normal range of motion. The chiropractic adjustment tries to deliver an effect that allows joint motion to naturally assume normal ranges of motion — not too much and not too little.
While the neurological effects of the chiropractic adjustment are much more significant for the health of the patient, when an increase in stability is needed for proper healing and rehabilitation, bracing comes into play as one aspect of patient care. To ignore therapeutic or rehabilitative use of bracing in patient care will result in a detriment to the patient. That is never good for anyone trying to help sick or injured people get well and stay well.
Over many years of private chiropractic practice I’ve noticed that most chiropractors would frequently use bracing when they were reimbursed a fair level of compensation. For example, in an auto accident injury to the cervical spine it was, and continues to be, the community standard of care to supply a cervical collar to a cervical sprain, strain or whiplash syndrome. To not do so in the beginning stages of the healing process to aid stability to an injured area could be considered neglect.
Bracing and reimbursement
Worker’s compensation would often reimburse for bracing used in treating injuries. Private insurance, depending on the policy, would also reimburse, some very well indeed. And while Medicare would only reimburse for spinal manipulation, those chiropractic offices that became certified did get very healthy reimbursement for a lumbar or knee brace.
In my private chiropractic practice I enjoyed seeing a Medicare patient and was reimbursed many times more for a brace than an adjustment with fewer documentation hassles. It was and continues to be the best of both worlds — superior clinical care for the Medicare enrollee and very high reimbursement for the chiropractor.
Of course, there must be a time to use the brace and a time to stop using the brace in patient care. While there are conditions that require constant use when the joint area is being loaded, such as the OA (osteoarthritic) knee joint to avoid further damage, pain and disability, most patients will only use a brace when it helps them.
Patients often see immediate relief when they are fitted with a brace. While patient reduction in pain was always desired, patient increase in mobility and stability was very important and wonderfully easy to document.
Documenting the benefits
Take, for example, the “Get Up and Go” test. I would document the test results both before and immediately after putting a lumbar brace on a patient. If there was a significant positive change, then I always used the brace in the patient’s care and treatment.
The test goes like this:
- Have the patient sit in a chair without arm rests.
- Instruct the patient to, when you tell them to start, get up and walk a set distance of about 10 feet, turn around, walk back to the chair and sit down and get comfortable.
- During the patient’s performance of the test I would be timing them. A normal time to perform the Get Up and Go test is 10 seconds. Some patients would take 20, 30, 40 or more seconds to perform the test without the brace. Some could not perform the test at all.
- Then I would apply a lumbar brace to the patient and have them perform the test again.
For example, let’s say the patient can perform the test in 30 seconds without the brace and 15 seconds with a brace on. The improvement of the reduction of time shows clearly that the brace allows the patient to function better. Then I would retest the patient until they could perform the test normally without the brace. At that time, I would tell the patient the brace was not necessary anymore. I found that this documentation was both easily performed by me and easily understood by reviewers.
Using braces helped me as a chiropractor in caring for my patients. I never saw a time when a brace, used properly, hurt a patient or interfered with their care and results. Braces are easy to use, and you’ll receive great patient feedback and great financial returns. DME and chiropractic — a great team in delivering excellent patient care.
JAMES C. ANTOS, DC, DABCO, lives in Windermere, Fla. He serves as a consultant helping chiropractors, medical doctors and others become certified to be reimbursed under Medicare for DME supplies. He can be reached through his website at antosdmebrace.com, 386-212-0007 or antsjm@hotmail.com.
