About 83 million people in the U.S. (42% of the adult population) used at least one alternative therapy in 1997. Usage among those 35-40-years-old is even higher, at 50%.
The estimated number of visits in 1997 to providers of “unconventional therapy” (629 million) was greater than the number of visits to all primary care medical doctors nationwide (386 million).
Americans spent $21 billion out-of-pocket on visits to alternative practitioners in 1997 (an increase of 45% over 1990’s total). This does not include money spent on retail products, such as herbal products ($5.1 billion), books, classes and equipment ($4.7 billion). By comparison, out-of-pocket expenditures for physician visits were $29.3 billion and for hospitalizations were $9.1 billion.
We have to ask why 42.1 percent of U.S. citizens surveyed used at least one of sixteen alternative medicine practitioners, increasing from 427 million in 1990 to 629 million in 1997, exceeding the total visits to primary care physicians. What is of greater interest is that these statistics have continued to increase—by 3.6% between the years of 2001 and 2002.
None of these statistics, however, come close to the billions Americans spend on exercise and fitness. Over 50% of the American population is overweight and the number is growing. What does this all mean for the primary healthcare provider such as a DC? The DC, basically, has to be prepared to diversify his/her services and, most of all, create a center where exercise and rehabilitative therapy are key components.
DC’s have always looked for ways to increase their income, often by learning new techniques or buying some expensive piece of diagnostic equipment. While these can be valuable investments, they are not as effective as knowing how to establish, manage and/or promote a rehab center.
Following are the basic protocols, which have to be put into place to establish a rehab center. (See Table 1).
Table 1. basic protocols to establish a rehab center
1. Necessary Education: Proficiency in sports medicine.
2. Professional Staff: Exercise physiologist, physical therapist, physical therapist aide, and/or assistant, fitness trainer, massage therapist.
3. Equipment: Minimum equipment necessary is a full body station, treadmill, enlarged physical therapy table, various weights, stationary bike, exercise mats. Miscellaneous: towels, theraband, cold packs, etc.
Approximate initial cost of total equipment, between $10,000 to $15,000
Certification is a must for all professionals
Ideal size room, 800 sq. ft.
Table 2. Most Common Scenario Used in Rehab Facility
1. Doctor initial exam
2. X-Ray/ancillary services
3. Treatment protocol established and started
4. Diagnostic testing
5. Rehab with PT (4 weeks)
6. Re-exam to update or change diagnosis
7. Rehab with PT (4-8 weeks)
Table 3. 10 Steps to Opening Date
1. Plan out (draw out) rehab room space
2. Interview and hire professional staff
3. Design marketing plan (newspaper ads, coupons, flyers, etc.) and allocate marketing budget ($3,000 to $5,000)
4. Purchase equipment (ask accountant if leasing is better option)
5. Understand billing codes and implement rehab form (See Table 4)
6. Create appointment script for front desk
7. Train office staff
8. Send letter to all local businesses
9. Send announcement letter to all active patients
10.Have grand opening day (balloons, prizes, music…)
Expected Reimbursement in Rehab Exercise Facility
The above scenario is by far the most practical flow that will allow the highest reimbursement. It is important to take into consideration that insurance companies do not approve “medical maintenance care”. Insurance companies will pay for treatment, but not for exercise physiology and/or rehabilitative medicine when used to enhance a patient’s stamina or endurance. Insurance companies are interested in treating patients and rehabilitating them, given serious practice medical diagnosis.
Table 4. reimbursements for rehab patients
Total reimbursements for rehab patients vary between $4,500 to $6,500. CPT codes most often used are as follows:
97535 Activities of Daily Living
97112 Neuromuscular Re-education of movement, balance, coordination, kinesthetic sense, Posture, and/or proprioception for sitting and/or standing activities
97110 Therapeutic procedure, each 15 min., therapeutic exercise to develop strength and endurance, range of motion and flexibility.
97530 Therapeutic activities, direct patient contact by the provider, each 15 min.
97799 Unlisted Physical Medicine/Rehab service or procedure
97139 Unlisted Therapeutic Procedure (specify)
97150 Therapeutic procedure(s), group (2 or more individuals)
97750 Physical Performance Test or Measurement w/report
97504 Orthotic(s) fitting and training, upper and lower extremities, each 15 min.
97520 Prosthetic Training, each 15 min.
97140 Manual Therapy techniques (Manual Traction), each 15 min.
97124 Massage Therapy, including effleurage, petrissage, and/or tapotement
97113 Aquatic Therapy with therapeutic exercises
97537 Community/Work Reintegration Training, direct contact, each 15 min.
97542 Wheelchair Management/Propulsion Training, each 15 min.
97703 Checkout for orthotic/prosthetic use established patient, each 15 min.
97545 Work Hardening/Conditioning (initial 2 hrs.)
97546 Each additional hour (list separately in addition to code for primary procedure). (Use 97546 in conjunction with code 97545)
97116 Gait Training
95833 Total Evaluation of Body w/o Hands
95834 Total Evaluation of body w/ Hands
95851 ROM Measure w/Report, each extremity
95852 Hand w/ or w/o Comparison to Normal Side
Objective Testing That Can Be Used to Support Medical Necessity and Enhance Medical Records
2. Digitized Radiographic Mensurations
4. Neurological Diagnostic Testing
Overall, a rehabilitation center is a great addition for any practitioner. Using diversified healthcare, the doctor has the ability to promote the best treatment protocol available. The core problem in healthcare today lies in the fact that there are currently not significant entities that can provide quality care at sufficiently low prices on a large enough scale to service the overwhelming needs of the population.
By creating a rehab sport center, a clinic will provide a viable solution to the healthcare crisis, by integrating the skills of the chiropractor and various other healthcare practitioners, such as exercise physiologist, physical therapist, etc., leading to the development of a profitable venture. This, by all means, is the wave of the future.
Dr. Daniel H. Dahan owned and operated one of the most successful clinics in Southern California. As previous chairman of the West Coast Medical Advisory Board and writer/editor for the Sun’s Weekly Health Column, Dr. Dahan, the President of Practice Perfect, developed a successful management and consulting health care system for doctors throughout the United States. His seminars are rated among the best and most proliferate lectures in the country. Dr. Dahan has taught over 4700 doctors and integrated 800+ offices in 45 states. He can be contacted at [email protected]. For more information, go to www.dahan.com.