Why you need Chiropractic Digital X-Ray in 2011

On an average week I have the opportunity to talk to 15 to 20 chiropractors about their office procedures and how they can best document their daily patient encounters. During these discussions I am frequently asked whether or not they should purchase an X-Ray Machine for their office and I am more than happy to give them my view since I have practiced with and without an X-ray Machine.

I opened my first Chiropractic Practice in 1988 right out of Chiropractic College. I had 650 ft. of office space and this included a very well used GE x-ray unit with hand development tanks. I paid $500 for the system and I personally helped remove it from the employee health room of a closed glass plant, I transported it in my pickup truck to my office location and assisted with the installation. This machine worked great for the first two years of my practice and was instrumental in helping me grow to the point that I had to build a bigger office.

My second office was 5000 ft. and I purchased a Used X-ray Machine with a Mini-Med automatic processor. This unit lasted about seven years and when I converted my office to a multidisciplinary practice I added a newer model x-ray machine, full body bone densitometry, videoflouroscopy, and Doppler ultrasound. This practice had two medical doctors, three chiropractors, four massage therapists, a physical therapist, an x-ray technologist, and a total of 42 employees. The X-Ray Machine was definitely used more than any of the other diagnostic modalities. After about six years the stress of running a multidisciplinary practice got the best of me and I decided to downsize my practice and moved to another state.

I decided to open a small Chiropractic Office with no more than four employees and I opted to refer my X-rays to a nearby diagnostic center. I was able to access the requested radiographs over the Internet, view the images and do my report findings with my patients. However, over the next three years I began to notice that I had lost more than just an x-ray machine. My patients were very inconvenienced when they had to travel 15 minutes out of their way, fill out more paperwork, wait for 15 to 60 minutes to have the x-ray taken and more importantly I have lost the ability to control their experience and perception of my practice. It was no longer my team that was handling their diagnostic needs, but rather, a medical practice that although they were extremely professional they were completely out of my control.



More importantly, I realized that I was not ordering as many x-rays as I had in the past for situations that really should've had x-rays. In my previous offices, if the patient would present with chronic low back pain that had never been imaged it was very likely that radiographs of the lumbar spine would be obtained in my office on their initial visit. Since I no longer had an x-ray machine I would very often tell the patient that we would “try a few visits and see how you do” before I would order x-rays. I thought back to how many times I'd seen compression fractures, aneurysms, surgical hardware and other abnormalities in the thousands of x-rays I had looked at over the years. I began to wonder how long it would be before this “let's wait and see how you do” way of thinking was going to get me into serious trouble. So I started ordering more x-rays again. It didn't take long before many of these patients were told by some of the radiologists at the diagnostic center that they may need surgery, perhaps they should consider physical therapy, all they really need is some anti-inflammatory medication, or some other statement that quickly sent them in some direction away from my practice. I decided there was time to put x-ray back into my practice.

That was two years ago. I requested several estimates, considered my options, and had a Direct Digital Chiropractic X-Ray System installed in my office. Because I never really enjoyed the actual task of taking x-rays, I hired two very personable state licensed x-ray technologists and trained them to be my chiropractic assistants. There's no darkroom to deal with, no films to store, no chemical's to smell, and no view boxes hanging on the walls. I can look at my x-rays in any of my treatment rooms, and share them with my patients with just a few mouse clicks. If I need a radiologist interpretation I can send my films through a secure link over the Internet and incur no mailing charges. It has really changed my practice.

I actually get new patients from other chiropractors because I have x-ray. Just a few weeks ago I was doing an initial consultation on a new patient. After I greet a patient for the first time my very first question is always “so how did you hear about my office?” This gentleman told me that he had been seeing a local chiropractor for several weeks and was not getting better. He asked the doctor if he thought he should have some x-rays taken. The patient was quite surprised when the chiropractor told him that he did not have an x-ray machine and “really didn't believe in x-ray because it only showed what was happening right now.” Well right now is what that patient was concerned about and he then decided to find another doctor that was willing to look for the cause of his pain.

Doctors, you probably don't realize how many times a week you could be utilizing a Chiropractic X-ray Machine. Think about how many times one of your patients has gone to see the medical doctor after your initial visit. How many of those patients that you did not x-ray were later sent out for CT scans or even MRI scans on the area that you were treating by the patients' medical doctor? Many of these patients would not have gone to their medical doctor had they been convinced that you were fully aware of their health problem. Diagnostic x-ray goes a long way in not only letting you know exactly what's happening with that patient but more importantly letting the patient know that you know what's happening and that you have a firm grasp on the solution to their problem.

Now when a patient presents with wrist pain from a fall on the ice, knee pain from a sports injury, a shoulder injury from a weekend project or even with heel pain that may be related to a heel spur, I can take an x-ray, read it, and share the results with my patient within 5 to 10 minutes of the examination.

I now practice three days a week but still see 30 to 40 new patients a month. Because I have skilled x-ray technologists taking my films I now order a complete series on the area of complaint, not the two views that are typically seen in a chiropractic office. It is not uncommon for a patient to present in my office with neck pain and low back pain that radiates into their hip. This patient may have clinical indications for radiographic studies of all three areas of complaint. If all three regions were imaged my lowest third party reimbursement, without co-pay, would be about $133.30 and would look something like this:

Cervical complete 72050 ($48.38), Lumbar complete 72110 ($52.18), Two-view hip 73510 (32.74)

In my part-time practice we average about 90 x-ray series per month and this takes no time away from adjusting patients. It is really not difficult to find licensed x-ray technologists and they make excellent chiropractic assistants because they fully understand anatomy and are very well trained in handling patients.

Let's suppose that you put a $65,000 into a Direct Digital DR X-ray System in your practice. With just the insurance reimbursement alone you would pay off this x-ray machine in slightly less than two years, if your practice is busier than my part-time practice you could pay it off in less. I guess that what I'm trying to say is that chiropractors fail to order imaging on many of their patients that have clear indications for x-ray because they don't like to take x-rays, they think x-ray is too expensive, or they just haven't considered the overall potential. Chiropractic Digital X-Ray can improve your diagnostic accuracy, demonstrate need for care to third party payers, help your patient's understand the need for care, decrease the loss of patients to outside imaging opinions, and improve the bottom line of your practice.

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