Two DCs share their journey into adding rehab and professional physical therapy to their practices
Sean Riley, DC, had some rehabilitation education during his chiropractic training and was always interested in that aspect of his practice. But it was about 15 years ago, when he began following Gray Cook’s teaching in functional movement, that he knew professional physical therapy could be a great addition to what he was doing.
Though he enjoyed physical therapy, manipulation was his main treatment tool. And as his practice Tulsa Spine and Rehab grew, Riley began to feel the limitation of his toolbox — he could help rehabilitation of spinal issues but didn’t have expertise for patients who needed work on knees, hips or other joints. Eventually he brought in physical therapists.
“I felt that offering a rehab option would make the practice more integrated and provide more comprehensive care,” he said. “I was trying to develop a model where people could receive multiple treatment options under one roof.”
Chiropractors and physical therapists
Of offices that have other specialists in-house, fewer than 7% are physical therapists. But some chiropractors think that number should be much higher. Instead of vying for patients, the two practitioners could be working together. Chiropractors who perform professional physical therapy or have brought therapists into the practice say it increases referrals and income and broadens the patient population.
Expanding into rehab, PT and complementary practices
If done well, offering physical therapy and rehabilitation complements what a chiropractor is already doing.
Jeffrey Tucker, DC, with Total Health Center in Los Angeles, says adding exercise and education to a spinal manipulation regimen helps prevent acute low-back pain. Other modalities to employ include light therapy, fascial massage and acupuncture.
For patients with persistent low-back pain, he performs spinal manipulation and adds a number of treatments including exercise and cognitive behavioral therapy, therapeutic fascia manipulation, acupuncture, blood flow restriction movement therapy, yoga for posture and better balance, mindfulnessbased stress reduction using virtual reality glasses, and interdisciplinary rehabilitation.
Riley in Tulsa also uses physical therapy to augment his treatments. For patients with core or trunk weakness, for instance, exercise and rehabilitation may give more sustainability to his adjustments. Over time, professional physical therapy would help the patient hold the adjustment longer and better manage their symptoms. Prescribing rehabilitation also allows patients to be more involved in their own care. Spinal manipulation is a passive treatment but many of his patients, he says, enjoy taking an active role in their recovery.
“Adding physical therapy helps people hold adjustments longer, stay out of office and manage things on their own,” Riley said. “It makes for a more compliant, happy patient and they are more prone to refer back to the office.”
Bringing in physical therapists has also opened his group up to physician referrals they might not have received previously. Once patients are in the office, treatment often becomes a hybrid approach. He can often get involved with a patient in the clinic for physical therapy.
“Sadly, some doctors don’t refer to a lot of chiropractors, but they may to physical therapy,” he said. “People can get multiple service lines under one roof, then get the treatments all at the same time.”
Professional physical therapy: implementing a program
Those new physician referrals — at least in the beginning – likely won’t be enough to keep a physical therapist busy. As with any new treatment, it takes getting the word out.
“Patients are looking for alternative therapies, so focus on that aspect of marketing,” Tucker says. “My message is to talk about longevity, health span and quality of life.”
And until patients are coming in regularly, a physical therapy program can be started nearly on a shoestring budget. Offering movement therapy can be effective and inexpensive, Tucker says.
He recommends beginning with stability pads, a resistance-band station and a yoga mat.
“I always start with posture training, isometric body weight exercise, proprioceptive training programs, and then I progress to resistance bands,” he said. “If you decide to invest further there are a host of free weights, kettlebells, sandbags, Pilates-type devices, etc., to outfit a room or an entire office.”
If a space is going to be dedicated to physical therapy and its necessary equipment, Riley said that usually takes at least 800 square feet. An office can start with the smaller equipment and then grow, purchasing more technology and more expensive gear along the way. Tucker is a fan of biofeedback sensors for improving posture and movement dysfunction. Beyond that, there are myriad technologies that can be used including artificial intelligence, mobile devices and gaming that are “blending together to make for the best exercise therapy you can ever imagine,” Tucker said.
Before making any purchases, it’s important to have some education and a vision of what the program will be. Riley knew the direction he wanted to take. He started small with minor equipment, then aligned with a physical therapist and moved forward from there.
The initial outlay for offering rehabilitation and professional physical therapy may be small, but how long does it take to see a return? A 2019 Chiropractic Economics salary survey found that, for offices that have physical therapy, it makes up about 13% of the revenue. Physical therapy pays slightly less per hour than adjustments, according to another Chiropractic Economics report, with therapy in the low- to mid-$40s per hour and adjustments starting at about $50 hourly.
Tucker thinks of earnings in this way: if a practitioner is working 50 weeks a year, 40 hours a week, there are 2,000 hours for potential income. If the goal is to earn $200,000, then a doctor would need to make about $400,000 annually to cover expenses. That means it takes about $200 per hour to reach that goal.
Offering modalities like exercise therapy during a visit, and billing for it, is a good way to enhance income.
“As soon as you start talking about exercise, teaching and demonstrating, then the billing clock starts,” Tucker said. “Providing exercise therapy creates revenue and, to me, is one of the best services I can provide.”
Riley said the biggest opportunity for increasing revenue when adding physical therapy to an office is through referrals. But before bringing someone into the clinic, it’s important to look at state laws that regulate referrals between practitioners.
“Adding a therapist allows the clinic to see a more diverse group of patients,” he says. “It allows the chiropractor to focus on what he’s doing, and a physical therapist can perform rehab protocols.”
Tammy Worth is a freelance writer based in Kansas City, Mo., specializing in business and health care subjects. She can be contacted at firstname.lastname@example.org.