Would you like to have a practice that is all-cash, all-insurance, or a mix of cash and insurance payers?
Would you like to help people suffering from a chronic, mostly incurable condition? If the answer is yes, then consider creating a peripheral neuropathy niche practice. This Biz Quiz will teach you the basics.
A niche practice is a specialty practice that focuses on a particular illness or symptom (e.g., osteoarthritis or hand pain). To be a candidate for a niche practice, certain characteristics are desirable: The number of people afflicted should be large. The illness or symptom should be largely resistant to conventional allopathic treatments, and the disease or symptom should have a marked impact on the patient’s quality of life.
You should have a unique treatment that produces a better result than mainstream medical treatment, it should be safe, and if possible is one supported by bona fide studies in the medical literature. This last requirement is often difficult to meet as there is little funding available to evaluate most alternative treatments. If that is the case, there should at least be anecdotal information to support your treatment protocol.
What it is
Peripheral neuropathy is a debilitating and painful condition that affects the peripheral motor, sensory, and autonomic nerves. Because it affects the autonomic nervous system, it can affect any organ. It is caused by destruction of the protective myelin sheath with a resulting defect in neurotransmission.
There are many causes of neuropathy (infection, metabolic disorder, trauma, to name a few), but the most common cause—and the one you will likely focus on in your office—is diabetes. Common symp- toms that tend to occur in the feet and lower legs consist of burning pain, itching, numbness, tingling, skin discoloration, and ulcers that are difficult to treat and do not heal readily. Additionally, there may be balance defects secondary to loss of proprioception.
The mainstay of treatment is to address the underlying illness. Strict monitoring of blood sugar, aggressive foot hygiene, and monitoring of insulin levels is essential. The patient’s primary care doctor or endocrinologist should take care of this part of treatment.
Other than that, ancillary treatment given by neurologists consists of anticonvulsant and antiepileptic drugs, tricyclic antidepressants, and pregabalin. These drugs are largely ineffective and can have unpleasant side effects. Many patients can’t tolerate them.
As mentioned earlier, the most common complaint that neuropathy patients have, the one that brings them to the office seeking help, are the sensations of pain, tingling, numbness, and itching of the feet. These can be so uncomfortable and painful that they impact sleep, which these patients badly need. There is an alternative treatment that is effective for these symptoms, however. That is the cold (or low-level) laser.
Using a laser
A laser can be especially effective for reducing the pain component of neuropathy but less so for the tingling and numbness of the feet. Patients report improvement in their sleep due to decreased itching and pain. The laser speeds healing time for typical skin ulcers and helps to dry out those that are oozing.
Because it is a low-level laser, it is safe to use; you cannot burn the patient. The treatment is simple and involves moving the laser over several affected areas at each treatment session. In many states, the treatment can be done by a technician.
You do not need an MD to perform this treatment; it is within the scope of chiropractic (in every state that I am aware of). But although you do not need a medical doctor to perform the treatment, from a marketing standpoint it will make a difference if you have one on staff. Unfortunately, old prejudices die hard, and the sad truth is that most
people prefer to be treated by an MD. You will have a higher closure rate from telephone and internet queries if potential patients know an MD is involved.
The laser is a great marketing tool because there is a certain cachet about lasers; they project an image that is high-tech, cutting edge, non-invasive, effective, and scientific. Patients can be treated while in a relaxed position and environment and they will look forward to coming in for their treatment sessions.
The anchor of all your marketing efforts is the internet. Although you’ll likely have some competition in most urban and suburban areas, there are still far fewer doctors treating peripheral neuropathy with lasers than there are mainstream doctors using the standard drug protocols.
Go online and check out the competition in your area; get a feel for what they are charging and what their programs entail. Are they MDs? DCs? How long have they been in practice?
Knowing the number of doctors in your area that you have to compete with will give you an idea of how difficult it will be to get on the first page of Google search results. It is absolutely essential to be on that page.
For that reason, hire skilled people to design your website, create your multifaceted marketing plan—which can include Google+, other social media, a blog or newsletter—and a search engine optimization package.
The laser makes marketing easier, but you still need to hire pros to make your practice visible and the go-to destination. There are several ways to get reimbursed for laser treatment.
The typical plan is two or three treatments for several weeks.
You can have an à la carte price per visit and also offer sessions with advance package discounts. Getting the fee up front more than makes up for any discount you give.
Laser treatment is usually not covered by Medicare or private insurance, but you can be reimbursed for any physical therapy treatment that goes along with the laser therapy. Be sure to charge everyone the same amount and, if in doubt, speak with your healthcare attorney.
In the one peer-reviewed study on this that I am aware of, a relatively low-power laser was used. You do not need a class 4 laser to get started. A class 4 laser will give you shorter treatment times but not necessarily better results.
Peripheral neuropathy is a miserable scourge for more than 20 million people. You can make a difference in their lives and add a huge profit center for your practice by adding laser treatment to your offerings.
Marc H. Sencer, MD, is the president of MDs for DCs, which provides intensive one-on-one training, medical staffing, and ongoing practice management support to chiropractic integrated practices. He can be contacted at 800-916-1462 or through mdsfordcs.com.
