Monday, January 30, 2012
Monday, January 23, 2012
Lessons in Laser Therapy
Low-level laser therapy uses light-emitting diodes to alter cellular function and is based on photochemical and photobiological effects of the cells and tissues. Laser light stimulates the function of cells, in particular, increasing cells' ATP (adenosine triphosphate).
"Great things will be accomplished with laser. The field is comprised of some very strong experts who are working hard to prove the overall effectiveness of the modality and in doing so, are publishing to educate the clinicians," said Paul Higgins, PT, DPT, ATC, CSCS, assistant professor, University of Hartford Physical Therapy Department, and co-owner of University Physical Therapy LLC.
As both an educator in a physical therapy program and a rehabilitation clinic owner, this clinician has a unique perspective on the evolution of laser therapy as a modality in a physical therapy setting. Dr. Higgins studies the published works of laser therapy, teaches doctorate students and conducts research on the effectiveness of light therapy.
Dr. Higgins increasingly spends more time on this modality in the classroom by having his students analyze relevant literature and complete a related lab activity.
"Laser is an up-and-coming modality," Dr. Higgins told ADVANCE. "It's a matter of producing a body of literature that supports its use and provides standard parameters and reproducible work."
Dr. Higgins would like the rehab community to understand that laser treatment is a safe modality; that literature supports its use for pain control, and that there is a lot of literature available that discusses how the body uses light during the phases of healing.
"Laser treatment is undervalued in the PT community," he said. "Although the opportunity for use has been around since 2002, there is so much to still learn about its effectiveness, the treatment parameters and the types of light therapies available."
In the Classroom
From his spot at the lectern, Dr. Higgins has had the unique experience of watching light therapy evolve as a modality. In the first course he taught, he recalled telling his students that light therapy had not yet been approved by the U.S. Food and Drug Administration. "My first lecture on the topic of light therapy lasted seven minutes or less."
Fast forward nearly 10 years, and Dr. Higgins now spends an entire class on the physics behind laser, its effects on tissue, adverse effects, recommended uses and the wide variety of parameters including dose, materials and wavelength.
When defining laser treatment to his students, Dr. Higgins turns to published works by experts including Douglas Johnson, ATC, EES, CLS. As a jumping-off point, he uses the phototherapy definition of "a therapeutic physical modality using photons (light energy) from the visible and infrared spectrum for tissue healing and pain reduction."1
"My goal is for students to gain exposure to the topic of light therapies," Dr. Higgins shared. "I want them to be able to go out into the clinical setting and make their own judgment of if, how and when to use light therapies."
Dr. Higgins would like his students to make their decisions based on the literature. "I do my best not to bias my students and instead allow them to make clinical judgments based on the rationale behind laser (light therapy) use," he said.
"At the very least, I feel that my students are able to join in on the conversation around light therapy with other professionals, support their own theories behind whether they feel light therapy is an effective modality, and most importantly, provide a platform for their own clinical decision making," he observed.
In a Clinical Setting
In his own clinic, Dr. Higgins uses this modality because the literature supports it as a safe modality with little or no adverse effects. "I do not believe that light therapy's true potential has been reached, but the literature is inching forward," he said.
Dr. Higgins acknowledged that there are reimbursement issues that may prevent providers from making the treatment available to clients. "Having the opportunity to travel and teach different courses, I ask clinicians about billing codes for light therapy and if they are being reimbursed," he said. "On the practice management side of things, why would a PT want to purchase equipment that will not eventually pay for itself and the clinician's time of use? On the clinician side of things, however, PTs generally will use a modality if they have seen that it works."
Dr. Higgins believes that literature has not yet shown this modality to be more effective than current care due to the variance in parameters. This modality is thought to be most effective in the treatment of painful conditions. Recent research is beginning to whittle down the long list of claims.
At first glance, the literature and several text books suggest that laser therapy is best suited for: carpal tunnel syndrome, soft tissue injuries, arthritis, muscle strains, tendonitis, swelling / edema, tennis / golfer's elbow, nerve regeneration, fibromyalgia, repetitive stress injuries, bone healing, and joint sprains.1,2
More recent literature seems to support light therapy when used for pain control (decreasing pain) and possibly pain due to fibromyalgia. According to Dr. Higgins, pain control is a broad brush.
"I know I'm not going to get deep penetration, plus the fact that I have a cluster probe that is more diffuse and less directional than a laser diode, so an elbow epicondlyitis, infrapatellar tendonitis, plantar fasciitis and wrist pain due to over-use are common examples where I would use the LED and have some success with its use," he said. "I'm only one clinician who has been working with light therapies for four years, so my sample size is too small to have measurable clinical outcomes."
"When I lecture, I refer to Douglas Johnson as 'the expert,' given his body of work and the intricate details of his work," Dr. Higgins relayed.
In the book Phototherapy 101, author Douglas Johnson, ATC, EES, CLS, explains that light alters cell membrane function, cell permeability, intercellular function and can act as a trigger for cellular reactions. He further writes about how light can improve ATP synthesis and promote active transport across the cell. Injured tissue has photo acceptors which increases their ability to encourage the receipt of photons, more readily than uninjured tissue. Single oxygen is formed which enhances the development of ATP.1
The author also lists stabilization of the cellular membrane, enhancement of ATP production and synthesis, stimulated vasodilatation and histamine response, increased leukocyte response and increased angiogenesis. Dr. Higgins points out that these factors occur without an increase in tissue temperature.
Dr. Higgins believes that the rehab sector would benefit from more research in the area of light therapies. "Light therapies can be an effective tool for the clinician for pain control, but there needs to be more consistency with the treatment parameters," he explained.
"It is an exciting time for modalities, knowing that this is new and on the horizon," shared Dr. Higgins. "As clinicians and educators promoting evidence based medicine, once the parameters are understood, there may be no limit to the use of laser as a physical modality."
References
1. Johnson, D. (2007). Phototherapy 101. Sports and Industrial Rehab: Taylor, MI.
2. Cameron, M. (2009). Physical Agents in Rehabilitation, From Research to Practice. Elsevier, St. Louis, MO.
Rebecca Mayer is senior regional editor of ADVANCE
For further information please visit www.theralase.com or call 1-866-843-5273
Wednesday, January 4, 2012
Convert Your Medical Practice to Cash Only
Discover how building a cash laser medicine practice with Low Level Laser Therapy (LLLT) technology will increase medical and financial outcomes in today’s world of declining insurance reimbursements
As a whole, medical practitioners are a dedicated group of professionals, yet we face many unique financial and clinical challenges. Addressing the issues of declining insurance reimbursements and finding better outcomes for patient’s has become a main concern in these challenging economic times.
Properly integrating a laser medicine program into your practice using LLLT on a cash basis can not only help to deliver better medical outcomes, it may dramatically enhance your bottom line. The emerging field of laser medicine now offers medical practitioners the ability to transform their facility into a specialty practice that treats medical failures. LLLT offers your profession the ability to treat medical conditions that have failed all forms of medicine, such as peripheral neuropathy, failed back surgery, disc pathology, spinal stenosis, severe degenerative joint disease and even non-healing wounds just to name a few. In order to reap the benefits of a cash practice and prosper for years to come, you need to deliver results commensurate with the remuneration you are seeking.
Basic Scientific Principals of Laser Therapy
Unlike all other treatments available to medical practitioners, LLLT is the only therapy that results in both chemical and metabolic changes at the cellular level. This unique modality enables the medical practitioners to actually accelerate the healing of human tissue1. Best of all, LLLT can be virtually side effect free as long as the laser beam is delivered in a safe and precise manner.
A scientific study out of the University of Toledo Medical School has documented using a wavelength of energy at 905nm found that it is best suited to stimulate tissue regeneration and proliferation2.
They also determined using sophisticated computer models how laser energy penetrated through human tissue. From this and many other studies we know that up to 60 -70% of all laser energy is absorbed in the skin and subcutaneous tissue. This is due to the large amounts of melanin, water, and hemoglobin in the body, which have a high affinity for light energy. Because every layer of tissue absorbs more and more laser energy, it is important to start a treatment with a high enough dosage of energy so there will always be a bio-stimulatory dosage available at every level of tissue you are trying to heal. This statement cannot be overemphasized when treating conditions like disc pathology and spinal stenosis.
Fundamentals of a Successful Cash Laser medicine Practice
Nationwide, slightly more than 21 percent of chiropractors operated cash-only practices in 2006, up 230% from 2004, according to Chiropractic Economics magazine. Reimbursement for chiropractors fell 2.2 percent in 2006 and 5.4 percent in 2005. I am sure similar scenarios exist within other medical disciplines and may even be more severe.
The foundation of a successful cash laser practice needs to be built around technology which can function as a “stand alone” modality, which at the end of the day must also consistently deliver results. The greatest secret in modern pain medicine today is that patients who have failed traditional insurance based treatments will pay out of pocket to get results. This is a concept which most chiropractors are afraid to actually embrace and make their own, yet if they do so they can control their financial future, especially in today’s world of declining insurance reimbursements.
Most medical practitioners who decide to ultimately move in this direction soon learn that the cash paying patients which they are attracting have failed all forms of traditional healthcare. Because patients are responsible for payment, they expect results almost immediately. In order to meet this expectation the medical practitioners not only needs to have the appropriate laser to deliver the appropriate dosage of laser energy to the target tissue, they also need the training to learn how to achieve and consistently deliver the outcomes necessary to perpetuate the cash model. When choosing a laser and laser manufacturer I cannot express the importance of the need to have the training necessary to deliver when these medical failures show up at your door step.
With LLLT, I have found there is absolutely no apprehension on the part of the patient in receiving the treatment since it is painless. Once a patient sees even the slightest improvement, they will stick with the duration of the treatment plan simply because they have failed everything else and have no other form of treatment to turn to. As a result, patients are eager to refer friends and family for this revolutionary treatment which can be administered from head to toe.
Economic Factors of a Cash Laser Medicine Practice
Revenues generated by laser patients can be substantial and typically exceed those which are generated by traditional insurance practices. The national per minute average for laser specialty practices ranges between $5.00 and $10.00 per minute. This fee range appears to be more heavily influenced by the level of confidence the doctor has as opposed to their geographic location. Treatment times range from 10-20 minutes for the majority of conditions, but can be as high as 30 minutes for peripheral neuropathy. Typical treatment plans range from 6-15 visits and generate between $750 for wound healing cases, up to $5,000 for a complicated case of failed surgical back syndrome or peripheral diabetic neuropathy. Despite our best attempts, some patients do ultimately require maintenance doses periodically in order to keep chronic intractable pain manageable. Maintenance doses range from 1 visit/month to 4 visits/year. It is not uncommon for a good laser patient to exceed $10k in patient fees in a year as once you successfully treat one problem they look for you to help them with other conditions. Remember, in order to keep them coming back and continuing to pay, you must be able to deliver the result.
A laser capable of delivering these types of financial outcomes will cost around $25 to $50 per working day on a lease basis depending on the configuration of the system. Many leasing companies offer deferred lease payment programs which allow the lessee to generate cash flow before having to make their first payment. Doing the math one can see you can be cash flow positive in a matter of minutes. One important thing to remember is the most expensive laser you can buy is the one that doesn’t deliver results.
Because of LLLT’s effectiveness with both acute and chronic pathologies, its safety, and the fact that it can be used to treat a wide array of conditions from head to toe, most medical practitioners are discovering success in treating and marketing solely to medical failures. This is truly an untapped market where there will always be an abundance of patients desperately needing help. These conditions include post-op pain syndromes, peripheral neuropathy, disc pathologies, stenosis, chronic foot, knee and ankle pain, and degenerative joint disease. Another positive feature of a cash only practice is your patient referrals will already know beforehand that they must pay out of pocket.
Effectively marketing your laser medicine specialty practice requires strategic planning including a high return on investment advertising campaign. Also as good as LLLT is - it’s only as good as the knowledge base of the operator using it. That is why it’s highly recommended that the practitioner and his/her staff attend continuing laser medicine educational seminars, and seek out a total laser practice management solution to move forward successfully.
Because cash practices are not at the mercy of the insurance companies 100% of services billed will be collected. Your time will now be better spent in practicing medicine and getting the results you and your patients expect and not those controlled by third party reimbursement.
In closing, if you’re looking for a program which will definitely change the way you practice medicine, the outcomes which you can achieve, as well as your financial freedom and success, then you should definitely consider implementing an LLLT cash laser medicine into your practice today.
Dr. S. Goldberg, D.C.
References
1. Skopin, Mark D. and Molitor, Scott C. “Effects of Infrared Laser Exposure in a Cellular Model of Wound Healing”; Department of Engineering, University of Toledo, Toledo, Ohio.
2. Skopin, Mark D. and Molitor, Scott C. noted as in Reference 1.
For further information, please call 1-866-843-5273 or visit www.theralase.com.
Subscribe to:
Posts (Atom)