Chiropractic publication surveys have shown that the average chiropractor sees about 25 new patients per month. A clinical study by Dr. John Hyland showed that at least 75 percent of patients are candidates for orthotics.¹ Based on these figures, the average doctor of chiropractic could be fitting approximately 18 patients per month for custom-made orthotics:

• 25 new patients per month x 75% = 18 new patients who need orthotics.
• 18 patients who need orthotics per month x 12 months = 216 pairs of orthotics per year (assuming one pair per patient per year).

It is important to keep in mind that this equation only takes into account your new patients. Of course, you should also take into account both your current and past patients (when they revisit) by evaluating their need for orthotic support.

It is also important to note that some patients will need more than one pair, depending on the different types of shoes that they wear (high heels would require a different pair than athletic shoes). So, as you can see, orthotics can end up being a major part of your practice.

How to Figure Out What You Should Charge

In terms of how much you should charge for orthotics, there are several perspectives to keep in mind.

First and foremost is this: You are taking clinical time to evaluate and recommend orthotics for your patients, as well as taking time to fit the orthotics once they arrive, and you should be appropriately compensated for that time.

Second, just as is the case for all your services, the rate you charge for orthotics on your fee slip should be consistent for all patients. Establish the same rate or "mark-up" for the orthotics and maintain it.

In terms of mark-up, there are several methods for setting your fee for orthotics. I personally recommend a set dollar amount for your mark-up. This will help maintain consistency of fees, as well as keep the cost of orthotics reasonable for your patients.

Additionally, some insurance policies might allow for partial or total coverage of orthotics if need can be demonstrated. Proper coding of patient complaints and documentation of orthotic need in your report of findings can greatly aid in the process of receiving appropriate insurance reimbursement for orthotics and related services.

The amount of added revenue can vary from practice to practice based on the size of your practice and the number of new patients you see each month. Revenue can vary from several thousand dollars to as much as $20,000 per year.

A Bit of History

Orthotics in some form have been around hundreds of years, with some historians dating their origins to innkeepers who made and sold felt insoles to weary travelers complaining of foot pain.

Then came arch supports, which shoemakers constructed from leather.

But the real leap in technology came in the 1960s when a new generation of thermoplastics became available. These products could mold to a form when hot and retain the molded shape after cooling. This was the beginning of true orthotics.

Adding Orthotics: The Overall Practice Benefits

Evaluation and recommendation of orthotics in your practice has at least three main benefits that make it a no-brainer addition to the services you currently provide:

1. By providing a higher level of service to your patients, their whole-body health can be dramatically improved.
2. The evaluation and recommendation procedures can easily be implemented.
3. Your clinic's bottom line can be positively impacted.

Reference

1. Hyland, JK. 77% of Participants Improve Body Balance by Wearing [custom-made orthotics]. Practical Res Studies, 2003;16(1):1-4.

Dr. Christopher Belluzzo is a graduate of Northwestern Health Sciences University and has worked in the health care industry since 2000. He has attended over 100 continuing- education seminars on a range of topics including muscular rehabilitation, whole-body family care, sports injuries, nutrition and numerous chiropractic adjustment techniques. Dr. Belluzzo maintains a full-time practice in Blacksburg, Va.