Vibration exercise has become increasingly popular among chiropractors. Doctors are becoming more educated and understand the differences in quality among the various vibration platform manufacturers out there. However, there is a lack of information on how to implement vibration training within a chiropractic office.
Patient Benefits
The underlying principle of vibration exercise is simple: The vibration platform drops a certain distance (amplitude) several times a second (up to 50 times per second). By working through the stretch reflex, muscles are contracted at a high rate through an involuntary mechanism, similar to a knee tendon tap reflex.
Research suggests a wide range of benefits, from arthritis and low back pain reduction, to improvement in balance, strength and flexibility for seniors and those suffering from MS, stroke, spinal-cord injury and Parkinson's. In addition, there have been reports and studies on fitness and beauty applications such as weight loss, lymphatic drainage and cellulite reduction. Those unable to engage in conventional exercise are now able to receive a strength training effect, with minimal impact to the joints.
Clinic Benefits
With so many applications, it's not hard to get confused about exactly how to implement vibration exercise into your practice. Do you use it for weight loss or rehab? Can it be integrated into a decompression program? What about the ability to establish a fitness program with vibration? All these things are feasible and are known to be successful. However, before we talk about specific applications, there are some key points to be aware of:
- Vibration exercise should initially be an extension of your own practice. If you are primarily interested in rehab, begin using it for rehab. You can then expand into other areas once you and your staff understand its applications
- Don't spend too much money on external advertising in the initial stages. Vibration exercise is one of the only modalities that we know has a significant "wow" factor. Patients talk about it to other patients and to their friends and relatives. Be prepared to internally market it from the very beginning, offering an open-house launch, mail or e-mail blasts, and setting up a weekly or biweekly seminar. Word of mouth has been a very effective advertising method. Eighty percent of your referrals after the initial stages should be coming from word of mouth.
- Do your research into the type of vibration machine to get. The quality of these devices varies widely. The ability of a platform to mimic the same parameters as used in research is also very rare. Ask the tough questions. Does the company have experience with chiropractors? Can the product handle a wide number of patients per day? Can the platform handle a 400-pound patient? If you are looking at vertical platforms, ensure the amplitude levels are sufficient to actually elicit a muscle contraction (some machines in the marketplace are nothing more than massagers disguised as vibration). If you are looking at pivotal machines, ensure the frequency actually goes to 28-30 Hertz. Most machines on the market don't go past 14 Hertz.
- Talk to other doctors about their experiences.
Billing as a CPT code
There are a wide variety of ways to generate revenue through vibration exercise.
If you are in a state that allows billing of exercise services, there are a few codes you can utilize. Payment varies by state. All of the following codes require direct, one-on-one patient contact. [Special thanks go out to Bharon Hoag from ACOM Solutions (bhoag@acom.com) for these coding recommendations.]
Procedure codes:
97110 – Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength, endurance, range of motion and flexibility.
97112 – Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.
97530 – Therapeutic activities, direct (one-on-one) patient contact by provider (use of dynamic activities to improve functional performance), each 15 minutes.
Please note that code 97112 is primarily used for neuromuscular re-education in the physical-therapy world. Unless you have used this code before for chiropractic care, I suggest you stick to the simpler 97110.
[pb]Integrating Vibration With a Decompression Program
Doctors have successfully integrated vibration as the exercise component to a decompression/traction package. Decompression/traction therapy is perceived by the patient as a high-technology type of treatment. Vibration exercise is an extension of that, and the perceived value is higher than for conventional (gym ball, pulley) programs. Hence, you can charge an additional cost for vibration exercise.
In my practice, I often recommend a continuum of care. Treatment can start with decompression/traction for 12 sessions. Vibration can be added after the 12th session, three times per week. A patient may be discharged after the 22nd session. The patient will continue with the active vibration exercise component to increase strength, balance and mobility. This can take place for another 12 sessions.
A total of 18 to 30 sessions with vibration exercise is usually required to achieve optimal function. A fee of $15-$30 for a typical vibration session of 15 minutes is usually recommended. Fee variation is dependent on whether the activity is supervised or unsupervised.
Vibration exercise can also be utilized as a loss leader to upsell the decompression/traction program. Inclusion of vibration at a discount can sometimes be utilized in the sales process to close a sale.
The addition of vibration exercise can add anywhere from $300 to $900 or more in extra income for a decompression/traction package.
Integrating Vibration With a Weight-Loss Program
Vibration exercise is an effective exercise component of a weight-loss program. It fits within any weight-loss program you may be using.
The majority of the overweight/obese patients who show up at a chiropractic office have medically associated conditions that prevent them from engaging in conventional exercises. Lack of time to exercise is another common objection that is clearly solved with vibration exercise, which can be utilized three times per week for the duration of the program.
Fees can range from fee-for-service to membership. Prices for fee-for-service can range from $15 to $30 per session. A typical three-month weight- loss program can generate anywhere from $500 to $1,000 in additional revenue with the inclusion of vibration exercise.
Integrating Vibration With a Fitness Program
When patients become regular clients on a fitness program, you now have a captive audience. Patients may come in three times per week for their fitness program. We find increased use of our various services (chiropractic, massage, etc.) when a patient is attending on a regular basis.
Some clinics offer a fitness membership-type of program post-discharge from care. Patients in need of long-term solutions to their care (e.g., patients with fibromyalgia, MS, arthritis) can now have a tool to facilitate this care.
Fees vary widely, dependent on geographic location and local demographics. Most doctors start with one machine and subsequently buy additional machines as they increase their revenue and patient numbers.
If you decide to develop a membership program, then I recommend researching the average gym membership price in your area and adding $10 to $15. A program under the same roof as health professionals like yourself should be valued higher than a typical gym program.
A single machine can support an estimated 35 memberships (with each patient working out three times per week).
I started a vibration exercise studio as a stand-alone in a predominately blue-collar town. We achieved over 300 members per month at a price of $99 per month with onsite trainer available. This is in a town with more than six fitness clubs.
The typical client was more than 40 years of age with some medically associated condition. These people needed an alternative solution to a fitness club.
We added a physical therapy practice and reduced the fees to $75 per month (decreased trainer overhead costs / increased competition) and now utilize it as a referral source to the physical therapy side.
Membership fees vary depending on the services you provide. For example:
$10-$30 per month:
Unsupervised exercise. Used as added-value service to the clinic. Doctors utilize this approach if the goal is to continuously market a captive audience. I find this is a great way to retain patients and continuously provide information that allows for more word-of-mouth referrals, in addition to impulse booking of massage or buying of other clinic products. Vibration is not the profit center. Selling additional products is. The successful fitness clubs utilize this model. Over 50 percent of their revenue is from profit centers, not memberships.
$30-$80 per month:
Unsupervised exercise. Prices are competitive with fitness clubs in the area. The goal is to generate some additional revenue and profit.
$80-$180 per month:
Supervised exercise program with a personal trainer or clinical assistant. Some doctors utilize a higher priced program, which may be limited in time frame and packaged with a specific program (e.g., osteoporosis program, fibromyalgia program, weight-loss maintenance phase program, etc.).
