As a chiropractor, there are two simple goals I have in practice. Of course, there are many expansions to be made to make these goals achievable. The first and foremost of these two goals is: how can I help this patient, who is in front of me right now, get well and stay well? The second goal, every bit as important as the first, is: how I can make a profit so I can continue to help patients get well and stay well.To me, the first reason is the very heart and soul of being a chiropractor. This is the real reason why so many good chiropractors work deeply into an advanced age. One of my mentors was still practicing at age 96 (4 hours per week). It is in our blood. Chiropractic had become a major mission and purpose in our life. In so many ways, it is who we are.
Becoming a DME (Durable Medical Equipment) provider/supplier for Medicare solidly enhances both goals. Supplying durable medical equipment such as lumbar braces, helps patients burdened, for example, with lumbar instability syndromes achieve stability. The net profits, as predetermined by DME Medicare (the reimbursement rates are set by Medicare), are very good at this time. A typical brace commonly used in the lumbar spine can easily have a net profit anywhere from $300 to $1,000 per brace.
I talk with chiropractors and medical physicians every day concerning becoming a certified DME provider for Medicare and how to enhance the implementation of DME supplies for a practice. In fact, a chiropractor and a medical physician are under the same credentialing criteria. Both are entitled to the same rights and privileges with one exception. Both, as recognized physicians within the Medicare system, are able to deliver these supplies to patients. This is the same credentialing process that neurosurgeons, orthopedic surgeons and general practitioners must use in order to deliver a back brace to Medicare patients and to be paid for this service by Medicare. Chiropractors can do the same. (Ed. Note: For more information on credentialling, contact the author directly. Info is in his bio.)
Interestingly, chiropractors use very few lumbar braces. In my early years, I did not understand how helpful lumbar braces are in stabilizing difficult spinal conditions and, honestly, because I was paid very poorly for using them. Once I understood how wonderfully lumbar braces enhanced my clinical ability to help people with spine issues, and I found out how well Medicare paid a chiropractor who was properly certified, there was no stopping me from doing this.
Why Offering DME Works
I understand that some chiropractors do not see the need for using DME items, such as lumbar spinal braces, often called LSOs or lumbosacral orthotics. After all, we chiropractors have been caring for these patients with our own ways for a long time now. Medical physicians, however, seem to accept and understand much better the need and usefulness for lumbar braces in patients. Many Medical experts I have heard speak on this subject estimate that more than 99% of all orthopedic physicians use back braces. I guess that we chiropractors make up the "less than 1%."
While there are many peer reviewed papers and opinions supporting lumbar brace use (this is one reason Medicare pays so well for them), I want to share with you one opinion given by Khan AM., Salih M. and Lnach B. from the Department of Orthopedics and Trauma at King George Hospital and Nothwick Hospital in Essex. They report that "there is good compliance and control of back pain ... with a visual analogue mean pain scale reduction from 8.30 to 4.90."1 This is, in my opinion, a very significant point clinically. The conditions studied in this article consisted of various diagnoses such as spondylolitheses, osteoarthritis and "unspecified back pain."
In another study by the University of South Florida, College of Public Health, OSHA Training Institute Education Center on 1,100 workers, using a very small lumbar belt (covering the L5-S1 junction), found strong effectiveness in reduction of both pain and exacerbations of back conditions in subjects that used the lumbar support.2 Both are components that are highly desirable as patient care outcomes.
How a physician, such as a chiropractor would decide when a lumbar brace (LSO) would be appropriate is worth exploring. Let us look at the most common DME supply, a lumbar brace, a chiropractor would use in practice and how it works. Lumbar support orthotics (LSO) offer core or thoracic/lumbar/sacral stability to a person. The LSO will hinder the person from normal or excess movement in flexion, extension, rotation, lateral flexion or combinations of these movements. The LSO will also add core trunk compression, similar to, but not quite the same as, strong abdominal muscles. Braces thereby offer a safe, non-invasive way to help one heal from current conditions of prevent future problems.3
Spinal braces are commonly used for low back pain, trauma, infections, muscular weakness and osteoporosis.4 Spinal instability is a common indication in conditions such as chronic facet syndrome, herniated disc syndrome, sciatica, spondylolitheses and lumbar stenosis. Braces are also used for a variety of reasons such as controlling pain, lessening the chance of further injury, allowing healing to take place, to compensate for muscular weakness and to prevent or correct deformity.5