How to Choose Patients for Decompression

Hey there, and welcome back. I'm Dr. Vince Leone, executive producer and co-host of the Practice Builders Podcast. With my partner in crime, Dr. Kyle Pankinen, we deliver proven strategies to help you grow fast, specialize with confidence, and build profitable staff-run practices. Let's go ahead and dive into today's episode now. Hello, and welcome to the Practice Builders Podcast. My name is Dr. Vince Leone.

And I'm Dr. Kyle Pankinen, and we're excited to be together as a team today. We are going to do a topic today that I think will resonate with all of you doctors, and it's, uh, it's an important topic not only from a business point of view but also from somewhat of a clinical focus here today as well. So a little, a little bit of both worlds today. Dr. Leone will introduce the topic and the big idea for you.

Yeah, so, and really quick, uh, on the last podcast we went over the decompression flywheel. So if you haven't checked that one out, that's more purely business, um, where it's really identifying the bottleneck in your practice and the growth of your decompression program. So if you haven't checked that episode out, definitely go back and, uh, watch or listen to that. Uh, all our podcasts are now, um, uh, streamed on the YouTube channel, so you can always, if you want to go there, check it out there, or wherever you get your podcasts. So our big idea is really how to identify the spine pain patients that are most likely to accept care, comply, and then get the best outcomes, which probably is the most important aspect. And, you know, of course, not every back pain patient is a full decompression candidate. You know, one of the biggest mistakes chiropractors make is trying to sell a full or offer a full decompression protocol to to everyone with back or neck pain. And, um, what we're seeing with the best decompression practices, they're not just good marketers, they're excellent clinically in terms of selecting the patients that need a full program or an adjusted program, or frankly, just chiropractic.

Yeah, I think the big thing with this, as we touched on that first Major truth is not every patient is a full program decompression candidate. A lot of doctors, as I consult with them, when they especially first get started with decompression, they're all excited about it and they want to help everybody and they want to grow that part of their practice, which I totally understand. And what they're doing though is they're offering decompression to every Just about every case that walks through the door of back or neck pain. And they are, in many instances, they're overwhelming the patient. They're offering care way above and beyond what the patient maybe truly needs or what they think they need for their condition. And in many instances, then their conversion rate is really low. And then the doctor gets frustrated and they get patients that are not signing up for care. And it really comes down to they just have a problem with selection.

Hmm.

Selecting the right candidates to offer the full program to, or those that need maybe a lesser program, maybe just chiropractic, or what we like to call single or double, That specialized practice. And so that's kind of the gist of what we're getting at here is you have to be clinically aware enough through their history and exam to determine which bucket, what spine pain bucket does this patient fall into and categorize them so that you're making the right recommendations. And this will increase your acceptance and compliance with patients.

Mm-hmm.

And it'll eliminate a lot of frustration on your part of trying to, in essence, sell plans that are maybe overkill for the patient, that's a mismatch. And so we wanna look next at just, you know, we need to educate what are ideal patients for a full program. So I'll start off with one of them and then we'll let Dr. Leone go into the next one here. Obviously, when it comes to chronic spine pain, you're really looking— most of these are chronic disc patients, right? No-brainer here when it comes to decompression. Most of these people, they know they have a disc problem, or they have maybe come to you and they've failed other types of treatments, and they're actively looking for some type of an alternative. So when they run out of options, and, you know, you and I all know that decompression should be one of the very first options for disc problems, but in reality, what happens? Oh, I tried physical therapy, I've tried other chiropractors, I've tried shots, I've tried ablations, I've tried, you know, all kinds of other things. Now I'm coming to you and you're my last hope.

Okay.

But bottom line is, when you start seeing things like that and you start seeing disc, okay, that's when you know this is a good potential candidate for decompression. So that's number one to look for.

Yeah, and I would just, just to piggyback on that, from a chronic disc patient, if this is degenerative disc, then you can differentiate out. I mean, if this is a Degenerative disc patient with radiculopathy, then full plan. But here's the differentiator, and this is where doctors, you know, kind of go to that next level. If you have a chronic disc degeneration patient, say they're 65, 70, without radicular symptoms, then they actually may be really good for what we call our double, which is a 12-visit program.

Right.

Because it's just not quite as severe. And you combine that with chiropractic, maybe some laser therapy or shockwave, and I think you could get some really excellent results. And oh, by the way, you got a ton of these patients in your practice. So it's a matter of just sitting down and looking at who would be potential candidates, identifying them, and then going in and offering them a reduced plan. Because the goal here is not to, you know, Hey, let's get less people on decompression. The goal is to get more people on decompression, just the right people and in the right plans. So that's chronic disc. Next is radicular. Obviously, this is our kind of bread and butter. We have radicular symptoms. In practice, I'd always just go off 3 things for a patient to qualify for decompression. We would want to have So you have subjective symptoms that lined up with a disc and most likely radicular symptoms, objective testing that was positive for a disc, and then you have imaging that also lines up. So if you have all 3 of those things, you're going to be served very well in terms of selecting the right patients. So with patients with radicular symptoms though, I mean, they're typically going to already perceive this as a— Pretty significant condition and actively looking, you know, to resolve it prior to surgery.

100%. So the other point we'll touch on with this, this list here, so we touched on the chronic disc, we touched on if they have radicular symptoms, those are slam dunks. And we touched upon if they are, if there's an MRI confirming a disc, then you usually have enough to work with, as Dr. Leone said. The other thing you can do with their history is most disc cases are gonna have some positions that make their condition worse and some that relieve it. If they say, Doc, when I sit down, if I sit more than 30 minutes, it starts shooting, raging down my leg and shooting down my leg. Well, that's— There you go. And if I get up and walk around a little bit, it feels better. So in other words, it's positional. If they describe certain positions that make it worse and certain positions that relieve it, in your— in the history, in your mind, you're thinking, even before you examine that patient, you're thinking this is probably a disc condition. And then if you get some exam tests or imaging findings that support that, then you have what you need. So those are Those are just some of the things that you want to look for that are, okay, these are potentially, you know, an ideal candidate to move forward with a full decompression program. And that'll bring us to our next point, and then there'll be another— we're going to look at poor candidates in a minute. But I think an important reminder here is that Not every good clinical candidate is necessarily a good practice candidate. Okay.

This is where the rubber meets the road.

Yeah. You and I all know patients that are like, when you see them on the schedule, you're like, oh boy, they're really coming in today. That thorn in your side, that chronic complainer, that patient, nothing is ever right for them. They might have all the classic symptoms of a disc and sciatic and all that stuff, and you're like, there is no way in heck I want to see this patient for 24-visit protocol because it would be a nightmare for you and your staff. So that, that is something to keep in mind. A good candidate is going to be They're gonna be frustrated. They've tried other things.

Hmm.

They're open and looking for alternatives. They have maybe educated themselves, maybe through your marketing or just looking online and exploring alternatives such as decompression. And a lot of these candidates will just— they're just motivated. They wanna avoid surgery. I'll do whatever it takes, Doc, to not have surgery. They're searching, looking for answers. And usually these are people that know in their head, I'm willing to do something besides just whatever my insurance covers. They're willing to pay something out of pocket and they're willing to invest in something that's gonna bring them hope, in other words.

Yeah, that's a really great distinction between, you know, A good clinical candidate and a good practice candidate. And I think, you know, for our doctors at, you know, a specialized practice, that's where Dr. Pankinen is, I think, so valuable is because being able to really turn to someone with a deep history of decompression and being able to discuss potential candidates between day 1 and day 2, because you're not required to take everyone under care. You know, and now if you're kind of struggling with growth with decompression, that may sound kind of crazy, but a lot of doctors are not struggling with growth. A lot of doctors are doing quite well with decompression. In fact, most, I would say, of our, of our clients are doing excellent with decompression. And so it really does come down to a selection process of who you will allow into your practice, because it's not just you that A poor practice candidate affects, it affects your team and it affects your other patients. So you really gotta be, you know, selective in terms of who you serve. And there's tests that you can run patients through that will kind of identify problem candidates if you don't recognize that right away. So I think, again, as you go through your decompression journey and you continue to increase your skill sets, There's several different skill sets, right? It's not just clinical, it's not just marketing, but there's several areas that you'll want to lean into to become better at so that you create a practice that grows consistently, that has the right people in the right places. So let's take a look then at poor candidates for the full program. And I think this first one is pretty straightforward. Just simple mechanical neck or back pain. This just doesn't warrant a full decompression program. Now, we are finding that decompression is extremely helpful outside of just disc cases, right? So it's not that they can't have some decompression, it's just not a full plan. And in those cases, um, you know, depending on severity, we'd be looking at a single or a double. Hey there, it's Dr. Vince, and if you're getting value from this episode, please make sure to hit that subscribe button so you never miss an episode. And if you know another doc who's ready to grow their practice, share this with them. It might be exactly what they need right now. Thank you in advance, and now back to the show.

Think of it this way, docs, with those, those simple mechanical cases, just to follow up a little bit on that. If you, if you're only using your decompression table for the big full meal deals, in a sense, well, that's, that's 10 to 20% probably. If you had 100 consecutive patients that came up with back issue or neck issue, probably 10 or 20 of those are like, okay, this, this needs the full meal deal. But what about that remaining 80 or 90%?

Mm-hmm.

It's not that we're saying they're not decompression candidates, we're just saying they're not Candidates maybe for the full meal deal. And so that's where we teach our docs to think in terms of singles and doubles. If your decompression table's not running full time, or you want to get another, or a second or third decompression table, singles and doubles may be the way to fill your decompression schedule with those milder cases. So give that strong consideration. Another poor candidate for a full program is they just— you get history of non-compliance. So you have a chiropractic patient and they miss appointments, or they— you give them something to work on at home, some exercises, or take this supplement, and then you follow up. How do you come with those exercises? Yeah, I haven't done them, doc. And are you taking that supplement? Oh, I took a couple, but I haven't taken them since.

Well, I took a couple.

I took a couple. I tried it. And, uh, you know, these, these, these candidates or these patients, just, they're not gonna stick with a full program. They're not gonna keep their visits. You just know ahead of time, probably, maybe you could get 'em to do a small package at some point if there was a lesser case, but you move on from some of those cases because you just, in a sense, you're, You're not wasting your time, but it's, it's just not a good use of your time to try to win over some of these patients to a full plan because they're just— they have that established history of non-compliance.

Yeah, great point. Um, so the next, you know, potential patient that would, would be under the poor candidate would be those patients that are looking for the cheapest option. They may even be price shopping. They may even be offer jumping, right? They, you know, have been into 3 other chiropractic offices getting their trial decompression treatment, or they just want to use their insurance. You know, I was at a, you know, a couple— I don't know, a year ago or so, I was at a birthday party for my daughter, and one of the dads, you know, was complaining about Really significant knee pain, and I was like, "Oh, you know you should, you know, look into shockwave, look into laser therapy, etc." And the first question: Will my insurance cover it? So when they have that, you know, now can you convert those patients? You know, yeah, probably, maybe. Is it the best thing? You know, who knows? Probably not, because these patients are just. You know, frankly, they're brainwashed into the insurance model. And it's going to be extremely challenging for them to wrap their heads around having to pay for things themselves, right? Because they're not making— most likely not making a whole lot of money in the first place. They're paying a pretty hefty premium per month. And they're like, I need to use this, right, one way or another. Again, can you get these patients under care, you can, you know, there's ways to kind of present things and some things are covered by insurance and some things are not. But by and large, gonna be a challenge.

Yeah, I actually literally have over the years had patients come in where they will call the front desk and they'll literally, can we have your insurance card? And they'll say, I only want services my insurance covers. Period. So they— that, that's a tough patient. I mean, yeah, you can offer them chiropractic and so forth, but you know, that's probably not going to be your candidate you're going to offer a full decompression program to.

Mm-hmm.

There's always— with poor candidates for a program too, you always got to consider with decompression— this is a little clinical, but there are some candidates that are contraindications for Decompression. So the obvious ones, which are red flags— fracture, tumor, infection, any severe osteoporosis. We always say if the DEXA scan is -2.7 or less, that's probably a little too brittle to put on the decompression table. If they have any cauda equina type symptoms, progressive neurological deficits, Spondylolisthesis of grade 3 or 4. 1s and 2s you can treat. And if there's instability, those are some contraindications. And certain types of past surgery, if they have multiple fusion levels or any hardware instability, things like that. So that's just a kind of a clinical point to keep in mind when you're thinking about, do I have a candidate here That is a decompression patient or not. And you have to do the good clinical work to know, okay, you have this, therefore you are not a good candidate. By and large though, if you go through these things, these lists that we've talked about, you should be able to identify by the time their, their history is done, their exam is done, maybe you've had some imaging you can review. You can then present it in a way to a patient saying something like this. Mrs. Jones, based upon your history, your exam, your imaging findings, what we're showing you on your extra MRI here, you appear to be a good candidate for a nonsurgical approach. And that's your open door then to, hey, let me tell you about Spinal decompression therapy. I have this literature I'm gonna give to you to take home and read. And that's, that's what you're really doing sometimes on their first visit is you're establishing, is this a good candidate? Is this a full-blown meal deal, full 24-visit? Could this be a double? Could this be a single? Or is this not a candidate for decompression at all? But those are the things that you should be—

Mm-hmm.

thinking through every time a new patient comes through the door with a back or a neck problem. If you're a decompression doc, that's the mindset you gotta have of how to categorize each of those patients. And if you do it right, you're gonna get your decompression table busy, hopefully in a hurry.

Yeah, absolutely. Excellent points there by Dr. Pankinen. And, you know, in terms of the presentation, the report of findings, Just, you know, we're not going to go into how to do a proper report of findings, but suffice it to say that if you are doing your typical chiro report of findings for a full decompression plan and expecting them to close, I believe you'll be sadly mistaken because these patients, if they're going to invest their hard-earned money, they need a very structured approach so that they understand They have clarity, they have confidence that you can help them, that this is their path to transformation and getting that outcome that they're really looking to achieve. So we have other past episodes on that. So just go back and take a look on that. But we've definitely done training that, you know, will help you on your ROF. We certainly go deep in that process at SP with what we call our Alchemical ROF training. And the good news is you don't have to hard sell. You don't have to use any NLP or Scientology-based training to quote unquote close patients into care. There's a highly ethical education-based approach that we teach and utilize. And you can enroll significant number of patients using that approach. And then you can sleep well at night. So in conclusion, if you want to grow decompression, your selection process is one of those skill sets that you want to lean in and develop. And of course, if you need help, you can always reach out. So any closing thoughts there, Dr. Pankinen?

If you combine clinical expertise and some of the things that selection we talked about, and then Dr. Leone's Alchemical Report of Findings, which is the best in the profession, that's a— you're going to become a decompression dynamo. And you're going to grow and you're going to produce and it's going to be a fun ride. And so I just encourage you to dig in and it's worth the investment of time and learning.

The juice is worth the squeeze, as they say. So, okay, well, that's going to wrap up this episode, and thank you for joining us again. We appreciate it. Hope you got a lot of value out of this. If you did, please share it with a friend or a colleague. Give us a like and a subscribe. If you could write us a review, we would be, um, uh, even more in your debt. We would love to see more reviews and, uh, So for Dr. Pankinen, I'm Dr. Vince Leone. We'll see you all on the next episode. It's Dr. Vince again, and hope you enjoyed that episode. And if you're ready to grow your practice fast with high-value decompression patients, then the Decompression Accelerator could be a phenomenal option for you. This is our 90-day sprint to help you scale with proven systems, staff-driven protocols, and full marketing support. And it's All guaranteed. Spots are limited. Head to www.decompressionaccelerator.com to learn more.