Addressing balance and fall prevention in the integrated practice.
Dizziness, balance disorders, and falls are major health concerns in the U.S., with more than 6 million Americans seeking treatment for these problems each year. Moreover, falls are the leading cause of injury in patients over 65 and the leading cause of death due to injury in this age group.
If you operate an integrated practice that incorporates a medical doctor (MD) and a physical therapist (PT), you can add the diagnosis and treatment of these problems to your practice. This can provide a rewarding way to treat patients and realize a lucrative income stream.
Assessing the patient
Balance disorders and dizziness fall into two main groups:
- disorders of central origin (such as brain tumors), and
- disorders of the peripheral vestibular system in the inner
Vestibular problems are much more common and can be aptly addressed in the context of an integrated chiropractic setting. Some of the causes of vestibular dysfunction include infection, trauma, vascular ischemia, and Meniere’s disease. The most common cause is benign positional vertigo (BPV), which is treatable.
In addition to the primary symptoms of vestibular dysfunction, secondary symptoms such as headaches, depression, anxiety, and muscular stiffness may occur. To make a diagnosis, you will need specialized equipment to perform videonystagmography (VNG) testing. The system includes goggles that measure certain eye movements and response to visual stimuli.
This device is connected to a laptop, and software analyzes the data and organizes it into a report. The primary report is then interpreted by an MD who generates the final version.
In most states an MD does not need special training to be reimbursed by Medicare for these services. In Florida and California, some training is required, but the number of hours and form of training are not stipulated.
Several of the VNG system distributors offer training both in administering and interpreting the tests.
You can find this equipment used and refurbished at a steep discount online, but unless your MD is familiar with VNG testing, knows how to set up the equipment, and can offer ongoing support if something goes wrong, you should stick with new or refurbished equipment from a company that offers training and support.
The treatment of dizziness and balance disorders of vestibular origin is centered on physical therapy. This consists of exercises that result in vestibular rehabilitation and balance retraining. The goals of therapy are decreasing or eliminating dizziness and vertigo, improving visual motor control and tolerance of motion, increasing activity levels, and decreasing the risk of falling.
Some PTs have specialized training in balance disorders, but all PTs can perform the treatment. PTs can also opt for training through VNG equipment distributors.
Specialized equipment and software are available to create therapy exercise programs specific to the deficits found through testing. In addition to completing the physical therapy sessions, the patient is monitored by the PT and MD at regular intervals.
Patients are seen one to three times per week for therapy, usually for a total of 12 to 20 visits depending on their progress. The testing can be performed by a chiropractic assistant, or medical assistant training is available from some equipment distributors.
Creating a balance and fall prevention program offers a number of economic benefits to your practice. For one, it is a cost-effective and profitable use of your space. In addition, VNG testing requires no more than an average treatment room. The physical therapy can be performed in spaces also used for musculoskeletal treatment.
The majority of your balance patients likely will be over 65. Patients in this age group often have no problem with early morning appointments. Therefore, you can schedule balance patients without overloading your already-busy late morning and afternoon appointments.
Offering balance treatments and fall prevention opens up new doors for marketing and may increase traffic in your office. Many balance patients will have other problems that you can treat such as peripheral neuropathy, so the extra volume can prompt opportunities for cross referrals.
The earnings derived from this add-on service is passive income for you. Your PT and MD generate the revenue, and you do not have to be in the office during treatments.
Although the diagnosis and treatment of vestibular dysfunction isn’t associated with any additional liabilities, take precautions to avoid any falls in your office and give patients a handout on minimizing the risk of falls at home. Ensure your staff provides clear instructions to patients on what they can and cannot do at home while therapy is progressing.
Although the equipment is expensive, when you work the numbers and calculate based on a lease or amortized purchase, these services are still quite profitable. Before buying or leasing, verify insurance reimbursement from your major payers as well as any special restrictions. Do the same for your local Medicare carrier as there are some variations.
During your calculations, include the initial doctor and physical therapy evaluations as well as follow-up visits. Detailed coding and reimbursement information is available from the equipment distributors.
Dizziness, balance, and fall prevention can provide you with a chance to help many people while you add a profitable new revenue stream to your practice.
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 reached at 800-916-1462 or through mdsfordcs.com.