With the instant information available today, it is rather foolhardy to think you can just ignore your competitors' treatment methods. If the tide has swept adjusting instruments, drop tables, massage therapists, lasers or decompression into your competitors' practices, you can try to stoically resist, but you'll probably suffer. Most patients want their doctor to have what is being offered elsewhere, or have a very compelling reason why they don't.

Decompression therapy, like it or not, is coming into your home town from several sources: other DC or MD clinics using it and the inversion units (HSN, Sears etc). Decompression for back pain is here and it is easily recognized as a viable option by many suffering with disc-related pain. To doggedly stand back and say, "It is not for my practice," will probably cost you patients eventually. We know this from our research. I wasn't lying when I said: Have it or compete against it. The key now is to price it competitively and avoid hurting your reputation by gouging patients.

Excellent (and legal) turnkey marketing programs are available and easily displayed in any waiting room. I recommend brochures, occasional advertising and direct marketing for medical referral if your goal is to fill up a couple of tables quickly. That often means 15-18 patients per table.

A very conservative approach to calculating a return on investment (ROI) with decompression therapy stems from the "new-patient" equation. According to our surveys of thousands of practitioners performing this therapy, the typical patient who seeks decompression therapy has failed all other forms of conservative intervention including manipulation, physical therapy and injections. Some are surgical failures. These patients have generally abandoned physical medicine interventions and tend to be managing their condition with a cocktail of dangerous, even debilitating medications and yet continue to suffer with painful periodic episodes of discal low-back and neck pain. The vast majority will try decompression to avoid surgery. This is the virtually unlimited pool of "new patients" who tend to seek decompression therapy as their treatment of choice.

Do the ROI math. Ask yourself, what is a new patient generally worth to your practice over a course of treatment? Think of this as your case fee. This can include covered and non-covered services if you bill insurance, or it can be strictly cash. If you don't know, run a few reports on your computer and find out. Based on our surveys, the low-side number is about $1,500 per patient.

If you can attract only one new patient per week, you will easily net between $70,000 to $80,000 per annum by adding this therapy. Our surveys indicate that 2-5 new patients per week is common based on limited advertising and word-of-mouth referral. More aggressive advertisers tend to do a little better. Not bad for an investment under $12,000.

Another way to understand the profit potential is to measure cost per month on an affordable decompression system. The average lease payment is under $300 per month on an $11,500 system. You need only attract a single new patient to your practice that month to cover the lease payment and probably cover all your advertising as well.

Accepting insurance reimbursement (when covered) and using traction as one component of the day's billing is always an option, of course, but be careful of your carrier's rules (policy) and how you describe the service.

The traction/decompression patient has arrived at your office perhaps unaware or uninterested in anything but decompression. They may not have come if you hadn't enticed them with decompression therapy for their disc condition. Many patients regrettably will bypass or dismiss "regular" chiropractic (out of ignorance, fear or past lack of result) when they have a disc condition. They may, however, readily embrace you as a decompression provider.

Once we realize that having a decompression (traction) system is simply good business, how do we choose and where do we begin? I suggest that systems come in two types: those that are adaptive to the patient and those that require the patient to adapt to it. I prefer the former. Patient individuality, posture, directional preference, etc., all must be addressed for the best results. If you are force-fitting everyone into the table's inherent limitations (one position, one restraint, limited vectors of applications, etc.), outcomes will suffer and so will your patient referrals.

Challenging our entren-ched thinking in regard to clinical methods (adding traction to an adjusting-only practice, adapting global and active methods vs. intersegmental palpation, etc.) is not only an evidenced-based standard, but also a necessity in a marketplace in which patients' knowledge grows exponentially every year.

As mentioned, the more confidence you have in yourself (and your equipment), the more confidence your patients tend to have in you. So, you must first decide to become an expert in decompression. It isn't as simple as telling everyone you're an expert or buying a magic piece of equipment. decompression is, and has always been, a doctor skill and a legitimate technique.

Adjusting tables facilitate the skill of the doctor; they don't create it. I recommend getting the technique education first and then creating a marketing program promoting your specialized skill primarily (70 percent) and your equipment secondarily (30 percent). Doctors who know what they need to accomplish clinically tend to make better equipment decisions.

As to treatment volume: Standardizing traction to 10 or 20 (or some other arbitrary number of treatments) is fraught with the same trouble as having outside agencies tell you how many adjustments to deliver. It is case- and condition- dependent. That being said, many patients thrive on a three-day-per-week program for 2-3 weeks.

Decompression has been a global service for several years in as high as 20 percent of DC clinics. Adding decompression therapy can bolster a sagging practice, enhance confidence with disc conditions and hold market share. It will continue to offer benefits few other therapies can match.

Dr. Jay Kennedy, a graduate of Palmer College of Chiropractic, practices in Berlin, Pa., with a focus on decompression therapy and rehabilitation techniques. He is a frequent guest lecturer at chiropractic colleges and decompression seminars nationwide. For more information, visit www.kennedytechnique.com.