HENCE, AND ART OF AND REHABILITATION If you want to build a sound practice, you must include a rehabilitative exercise program. It will increase your: NEW PATIENTS PATIENT VISIT AVERAGE (HOW MANY TIMES YOU SEE A PATIENT) •PATIENT CASE FEE AVERAGE (THE AVERAGE COST OF CARE PER PATIENT) • PATIENT SATISFACTION AND COMPLIANCE •PATIENTS1 ABILITY TO HOLD AN ADJUSTMENT • AND, IF YOU FOLLOW YOUR OWN INSTRUCTION, IT WILL MAKE YOU A HEALTHIER HAPPIER CHIROPRACTIC PHYSICIAN! i\\\ of the above benefits can be accomplished without tens of thousands of dollars, medical doctors, multiple staff, or increased overhead. You could start with a 10' x 12' room, $500-$ 1,000 worth of equi-pment-which you will recoup from the first 1-2 patients-and a willingness to really understand and appreciate the "PHILOSOPHY SCIENCE AND ART OF WEIGHT TRAINING" as it relates to rehabilitation. MY OWN STORY I was your typical 5'10" "before picture", before I started to train with weights. I learned very quickly how weight training and the practice of chiropractic could dramatically enhance one another. They melded together like bread and butter. Doing one without the other was absolute madness. It would be rather obvious that, if you were going to create proper spinal balance while correcting spinal subluxa-tions, the muscles/tendons and ligaments need to be strengthened to support your correction. For, without proper strengthening techniques, all that you had accomplished would eventually revert to the patient's original state. Remember, the nervous system controls the musculoskeletal system; but, the musculoskeletal system supports the nervous system. Without functional support, neurological irritation is eminent. Whenever there is the existence of a subluxa-tion, you will always find soft tissue damage/involvement. Proper care addresses both factors for the following reasons: You must create proper neuromuscular coordination. Most people do not move properly. They use the wrong muscles for certain movements, which creates disharmony or loss of function. The way people bend, twist, and walk are a result of a plethora of abnormal muscle and joint usages, which distort and twist the body, putting unnecessary stress on the musculoskeletal system and further perpetuating subluxation. For example, most people cannot perform a simple squatting motion. First of all, if they can do a squat, they squat using the wrong muscles. they were able to fire the proper muscu-loskeletal response and you had a mus-culoskeleletal system strong enough, flexible enough and coordinated enough, you could recalibrate that movement, restoring the patient to a functional state. I do not care how old the patient is, or how long they have had the problem, if you do not use weight training to literally recalibrate the nervous system along with the musculoskeletal system, you will never have a functional patient. Through the use of weight training, you balance left (analytical mind) and right brain (creative mind) wave activity through stimulation via sensory input; and, at the same time, create musculoskeletal neurological recali-bration, exponentially increasing your patient's mental and physical powers far beyond his/her wildest dreams. Once I realized this, well, to say the least, I was very excited because: 1. I could improve my own health problem, since I had suffered from low back pain, for years-which was why I became a chiropractor in the first place. (I suffer from an S1-L5 spondylolisthe- sis). 2. I didn't have to look like the "before picture". 3. I could tap into a new realm of patient care, creating more new patients, more visits, more money and, at the same time, giving my patients a greater service than I was already giving them. So, I continually read all the bodybuid-ing, weight-training magazines, books, and videos that I could get my hands on. Like everything else in life, finding the truth under a whole bunch of lies, old wives' tails, innuendoes, and half-truths was a process that took me 15-20 years to learn; and I am still learning. Rather than your reinventing the wheel, let me save you the 20 years it took me to learn the truth. Creating a rehabilitation complex in your office requires very little outlay of money, and/or room. Start up cost is negligible: $800-$ 1,000. You can create a big production with start up costs ranging from $15-20,000, if you like; but, to start off, keep it small. Your monthly bills are additional rent on the required area (which can range from 0-1500 sq. ft. (Remember, you can always use a pre-existing treatment room, if necessary). 300-400 sq. ft. would be a good starting point (at $10-20 per foot, that is $4000-$8000 for 400 sq. feet, or between $333-$666 per month. Some part time-help, would be recommended ($10-15 per hour, 6 hours per week). (15x6=$90 per week; 90x4.3 weeks per month=$387 per month.) I suggest that you do most of the rehab sessions at the beginning, to get some experience, then hire and train someone else. Most so-called trainers, therapists, etc., do not know what they are doing. Just because they look good does not mean they can do rehab. I don't care how many courses they are certified in, and how much they profess to know, these are your patients we are talking about, your family, and your flesh-and-blood. You should train them first. If you are not sure about what to do, you can buy my book, Let Your Presence Command Attention, which is a step-by-step guide on how to utilize safe, and effective methods that increase strength, muscle growth, flexibility and endurance, everytime, all the time. I suggest, when starting up, you begin on the low side and grow increasing monthly profits first, before creating another headache. This way, you know how much you are generating in profit, as you learn additional ways to duplicate yourself prior to investing large sums of money. THE EQUIPMENT NEEDED 1. MIRRORS: These allow patients to observe proper form, posture and tech nique while performing exercises. Most people who exercise have very poor form and technique when lifting weights. This causes injury, as well as poor results Mirrors allow the patients to monitor their form, posture, technique-and witness their own progress! When patients like what they see, they become enthusiastic about their therapy! 2. BODY FAT ANALYZER (COMPU TERIZED CALIPERS): This is an excellent tool that is a giant when it comes to your patients' health. A body composition unit measures how much of a patient's weight is body fat. You need not be as concerned with your weight as much as with how much of that weight is fat. If a patient has a body fat of 28- 40% or higher, his/her health may be in jeopardy of heart disease and/or certain cancers. And you, through your rehab program, cannot properly address this issue, without this kind of objective test ing. This testing procedure is a real eye- opener for most people, especially for those patients you know exercise, but still have a bad body composition. You will be able to help these patients through diet and exercise. This type of program does require commitment from the patient, since it does take months to see changes in a patient's body composi tion. When you become a master at changing a patient's body composition, you will never lack for new patients. 3. EXERCISE EQUIPMENT: STRETCHING MAT, FLAT BENCH, DECLINE BENCH, SEATED BENCH, DUMBELLS AND RACK ('Sets of 2-lb., 3-lb., 5-lb., 7-lb., 6-lb., 10-lb., 12-lb., 15-lb., 20-lb., 22-lb., 25-lb., 30-lb., 35- lb., 40-lb., 45-lb., 50-lb. Dumbbells). You can usually find excellent equip ment in second-hand shops or people selling equipment. You can do all body parts such as your chest, back, arms, legs, etc., with dumbbells. So, don't Continued on page 26... ...from page 25 worry if you don't have the latest machi-nes-the ones that cost $15-20,000; dumbbells work just as well or, in most cases, better. Put together an exercise manual and chart that patients can read and refer to for rules to follow when exercising. This is easy to do, since chiropractic exercise equipment suppliers make mul tiple forms available. Any of the many bookstores have volumes of charts, explanations, and pictures. Again, my book, Let Your Presence Command Attention, or my patient manual is all you need. Patients will need nutritional supple ments, so make sure that you have plen ty of supplements and dietary instruc tions which will assist in promoting the recovery of the musculoskeletal system, as well as your bottom line. Reserve 1-2 hours, 3 times a week for your Rehab Sessions-during treat ment times, if you want; or before or after, if need be. Your front-desk assis tant can help, by the way-and would probably love to! If you do not have the extra room, convert your treatment room after/before hours, into this Rehab Cen ter. Get your butt in there at least a few be fired up to make this program successful, and you cannot do that if you, yourself, are not exercising. Who knows, maybe when your staff, spouse, (significant other) and patients see the change in you, maybe-just maybe-they will become enthusiastic about exercise. 8. CODES AND FEES: I use the code "97530" for Rehab Sessions. Please remember, though, that this code is only for the first 15 minutes of Rehab. You need to use a modifier with this same code for the second 15 minutes. The fee for procedural code 97530 is $50 for the first 15 minutes, and $50 for the second 15 minutes, realizing that, due to the modifier, you will be paid less on the second 15 minutes. You could easily train 2-4 patients per half hour, or 4-8 patients per hour (3 times per week) at an average insurance billing of between $400-$800 per hour, 3-6 hours per week ($1200-$4800 per week; $4800-59600 monthly). "Not too shabby". And you're doing your patients a real service! It may be that carriers will only pay a percentage of the above; but, as my father would say, it's found money. If you fail to do rehabilitation or think it is not necessary, you are losing thousands of dollars weekly by ignoring a simple, easy-to-implement program, which will benefit your patients, as well as your practice. You are, in fact, doing your patients and your practice a terrible disservice and injustice. Look, you don't have to go out and get new patients to do this. You already have an existing practice to draw on, patients who need this service. It's also a simple matter to implement a newsletter and telephone campaign aimed at past patients to keep them informed of your new rehabilitation facility, welcoming them and their family members to come in for a complimentary session. Once a patient begins a rehabilitation program, nutrition and supplementation become a must; and who is better qualified than their doctor of chiropractic to facilitate the program. Your patients are more likely to remain under your care, referring their friends and family, because you offer more than the guy down the street. And for the additional service you provide, you enjoy increased earning capacity by providing nutritional supplements, and nutritional consultations. Continued on page 27... ...frontpage 26 THE PHILOSOPHY, SCIENCE, AND ART OF EXERCISE PHYSIOLOGY AND REHABILITATION Listen, in order to be HMO- and PPO-proof, you need to be different. Doing the same thing everyone else is doing will not make you successful. You will only wind up sucking channel water, hoping and praying for new patients. Why waste time and money on all these crazy advertising schemes that waste tons of your time examining and consulting with patients, looking for a bargain, when you have numerous patients already, that you care about, and who care about you, to introduce this program to? So, what are you waiting for? If you want a boost in yourself, your practice and your patients, start a Rehabilitative Exercise Program. Have a great day! «$» To contact Dr. Cima, call 561-627-3810.
