475- Mastering Cervical Spine Assessment with Dr. Cameron Bearden

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode, we have a special guest, Dr. Cameron Bearden. And we're gonna discuss everything around cervical spine assessment. So if you take care of the cervical spine in your practice, you're gonna wanna pay attention to this episode where we dive deep on assessment tools, how you can utilize them, implementing your practice, and so much more. Without further ado, here's my interview with Dr. Cameron. Brian Bearder. Many people listening are going to be totally new to Net Care. Some have a loose familiarity. But what is Net Care? How does it stand out from other tools and techniques? What got your interest initially?

Net Care is a technology company out of Iceland and they have what I'll say though, they've digitized the cervical evaluation and so it's a headset basically with an accelerometer that sits on the top of the head or gyroscope and it tracks head and neck movement, accuracy, things like that. And what caught my attention actually was a social media post, you know, where we, the algorithm feeds and how it works, I don't know. But somehow it put a neck care we'll call advert in my, in my feed and I remember clicking on it and thinking I've never seen this before. And I'm, I look at a lot of things in terms of like cervical care and looking at the research and different products, I'd never seen this. And so I clicked and the rest is history.

Love to hear that. So as you began using Necare in your practice, what's like an aha moment that stands out to you early on, like making a real difference for a patient? Maybe it would, maybe they were challenging in terms of case presentation. Maybe results were a little bit lagging compared to where you thought they would be patient. But what's kind of a thought that comes to you or an aha moment when you think about Necare and the experience that you've had over the last year?

One of the biggest things, I'll actually take a step back. One of the biggest things that the entire tech being digital or at least the software joint position error is something that we were taught in school but we never really did anything with. And you know, you wear the glasses or the headset with the laser and you have the patient close their eyes and you know there's a target on the wall when you got a market and all that Net Care completely digitized that. And it is so accurate. It's time savings too. So it used to take minutes, right? You have the patient close their eyes, move their head, and then you have to have them hold still while you try and mark. That alone has saved my practice an immense amount of time, but it's enhanced my understanding because the results are immediate. I can clinically synthesize the data right then and there, along with the range of motion in the fine motor control. So like broad spectrum, it's changed almost everything I do with regards to my evaluation and how I use that data to understand what may be going on relative to the patient's condition. So I don't have one case. I literally have a year's worth of this. Changed my entire landscape of how I think and treat a patient.

That's powerful and I'd love to dig a little bit deeper there. So those changes, how has integrating Net Care kind of changed the way you approach patient care in your practice? Where does it fit in your evaluation process? How do you use it for communication and what's some of the clinical relevance as well that you've found?

So I use it in my initial evaluation, of course, and I do a follow up as well, typically at about a two week and a four week interval. And I have a very unique practice, or at least I would describe it as a unique practice, but I actually started using neck care. In particular, the range of motion, which seems kind of basic, but the range of motion probably is one of my favorite things because you get such a beautiful graphic, but it also gives you accessory movement. So, for example, you can see that when a patient turns their head to the left, they also have 6 degrees of right lateral flexion and 3 degrees of extension. We've never been, I've never been able to see that before and we've never been able to quantify it. And so when I see that in my initial eval, particularly range of motion, if there's an asymmetry with, let's say rotation, I then look at my imaging modality. So I use what's called a cone beam CT, which is 3D imaging. I will then look at that and try and correlate with why would they potentially have a range of motion restriction or an asymmetry and going a little bit deeper. I actually have started performing stress scans. So, for example, end range, like let's say rotation. If a patient has a 20 degree restriction on one side versus the other. I will have them turn their head, retake a 3D scan. I will have them turn their head, retake a 3D scan. And so I wouldn't know that or I wouldn't have a good grasp to show my clinical rationale on why I'm doing that. If I didn't have neck care, I.

Totally get that, that, that's powerful. And let's talk about the, that visual component because what I've always said is they have the best combination of hard and software from a cervical assessment tool that's on the market, bar none. I always like to think in terms of communication and when I think about communication, it can go a few different ways. It can go to how you describe and explain what's going on to a patient, their ability to comprehend and understand what's going on. And ultimately I think this drives towards the terminal points which are patient satisfaction and retention. If they don't understand what's going on and they're not seeing benefit, your retention is going to struggle. And of course from a satisfaction perspective, when they understand what's going on and they're getting the benefit, functional pain, whatever that might be, based upon them, their case, the practice, they're going to, et cetera, that's a really great combination. How have you seen neck care either interact with your retention or patient satisfaction?

Great question. I would start with patient satisfaction. Right. Patient has to be satisfied to stay. Neck care being what we'll call a three in one. So range of motion, joint position and fine motor control. This is stuff that not many people in the entire country are using. Right. Net Care is a little bit of a newer company, but it's growing extremely fast. But in terms of the patient satisfaction, where I've been able to use Net Care and use the graphics which are beautiful to easily explain, hey, here's an issue that wasn't potentially discovered or fully understood before. And the retention I would say probably comes down more to me than it does the system itself.

Right.

You have to deliver. If you find the good stuff, you have to make something out of it.

Could not agree more. Implementation. Now bringing in a new technology into a practice, especially during your evals and re evals, is always. Can be nerve wracking, let's say from a, from a clinician perspective because time is money and we're trying to do the best we can with the best tools. And while being cognizant of also running the business at the same time our workflows, we all get in habits in terms of our communication talk tracks. So adding in new diagnostic technology can sometimes be intimidating, if not, not just seemingly overbearingly cumbersome. Talk about implementing neckcare in your practice. What was that process like? How easy was it? Or what challenges and speed bumps did you have along the way?

It probably was one of the easiest things I've ever implemented. And I promise I'm not just saying that it truly has been one of the easiest things. If we want to talk about the hardware, it's a headset, right? It's a flexible headset. It doesn't take. It's not an X ray machine. It's not, you know, a huge desk or a gyro stem or, you know, a table or something like that. It literally is a small piece of hardware. So in terms of, like, trying to fit it in in my exam room, I mean, you put it, you know, you put it on the shelf or you put it in a, in a drawer or something like that. But, you know, in terms of flow, there's a little bit of a learning curve. There was a learning curve more so when I first joined the netcare family, in that they were operating on their previous version of the software, which was still extremely easy. But, you know, the learning curve more was understanding the nuances of how to instruct the patient on what to do. And so I believe if my memory is serving correctly, range of motion, you can do between one to five reps. So, I mean, you're spending probably less than two minutes there. Joint position error, you can do one to five different readings for flexion, extension and rotation. So maybe three minutes there and then fine motor control usually clocks at about a little bit less than three minutes. So, I mean, we're talking, you know, depending on how much you instruct the patient or how much you discuss with the patient while you're doing it, we're talking maybe like seven to 10 minutes. And the reports are immediate. So you don't have to wait, right? You don't have to do all of these different things. So, quite honestly, the implementation was very easy. It is something that calibrates as well. So the newer version of the software, it has an extra step in terms of calibration for accuracy that maybe takes an extra 16 seconds.

Sounds easy, and I've experienced that myself. It's just to have the wireless aspects and the auto connection just makes it so much easier to be able to actually just get it going, Right?

Get it going, exactly. Just pick it up, go.

That's exactly that's exactly right. So you mentioned earlier a little bit about how you correlate with imaging or look for, look for correlations. Talk a little bit about how you've integrated necare alongside the care and treatment. You know, when you think about that, how does, how does that play out? In other words, is this something where you're using it only for correlation on imaging? Are you seeing what goes on with the care and delivery day in and day out? Is it something you're also using, you know, with a visual reference point in terms of how people are moving? Again, visit by visiting. How does this, you know, sit in within the full complement of how you evaluate a patient?

It is patient dependent. Like I mentioned earlier, one of my, my practice is unique. We have some very odd cases that come in and, but globally how I see this fitting into what we'll call more higher volume practice or even a moderate volume practice, you can be as data driven or you can dive as deep as you want with this to understand that patient's intricacies or quite honestly you can use it at face value and you could still get a tremendous amount of data to improve your understanding of that patient's condition. One thing that you know, I've talked to the Net Care team about this. A lot of this data is something that we were taught but we never really honed in on. And so there's been a little bit of a gap. I don't think I'll get in trouble for saying this, but one of the beauties of Net Care is that this company is growing and they want to help their customers so much. They take then they cherish feedback tremendously. They're going to be building an online academy. So basically on demand. We're talking world class, world class physicians from all over the country and they're going to be putting together series of videos and instructional materials to help better explain the data and what it may mean. We know we've never been able to quantify data like this before and so in terms of bringing it back to the original question, how does this fit into the global spectrum? My practice is unique so I'm a little bit more of a mad scientist. So I geek out on the data. But you can simply how I see this for a, what we'll call a more traditional practice is you run the data, you run the test, you do your intervention and then you reevaluate and you see what's changed and what hasn't. You're able to understand objectively this improved, this didn't. And then you compare it to the patient's symptoms, to their feedback subjectively about how well they've done. So like there's so many plug and plays that you can do. You can be mad scientist 1000% or you can just use the data to have a baseline and then reevaluate down the road. It really is. The sky's the limit.

That's fantastic. Let's talk a little bit about the business of this. So when anytime we're instituting a new diagnostic, a new modality, something to that effect, there's an expense that goes along with that. And we're always, you know, we're business owners, entrepreneurs, as chiropractors by definition. So talk a little bit about the business of that care. How does this work within the realm of, of your billing, wherever, whatever you're comfortable sharing. How do you think about instituting that care? Because it is as you're, as you've highlighted and I agree with, it's a massive value add into a practice. Never before has a patient been able to walk out within a matter of minutes with unbelievably specific testing around what's going on in their cervical spine related to motion. As and as movement based healthcare providers, nothing very few things could be of more importance to us. But the business side is something that's important. So how do you think about the business of neck care within your business?

Absolutely. The good news is there's no one that has to tell you what to do. So my experience has been I originally did it, didn't charge for it in that this was a new technology, I wanted to understand it and that's just my personal mantra. But as I became more confident, I started to charge and now I charge a hundred dollars per net care test. So, you know, if you see 20 new patients a month, that's quite a bit of revenue. And if you would charge for the reevaluation, you could double that revenue. So in theory, the sky's the limit. Now I'm a cash based direct payment practice as opposed to, you know, we don't accept insurance assignment, but I do know colleagues that use insurance and they use net care and they bill insurance for net care. I know in particular there's several larger clinics that are using this to enhance their understanding of motor vehicle collisions. You know, so like if you have an MVA clinic, this is data that is potentially going to change the tide of that patient's accident in terms of, you know, if it goes to litigation or whatnot. And I know for a fact that those Offices have created a tremendous, tremendous additional revenue stream. I also know of other upper cervical chiropractors that are, that are doing very well in terms of, of adding this. So in terms of what it costs for the, the service, the hardware and the, you know, the Software people are 10, 12, 15 Xing their investment on a monthly basis. That's not an exaggeration either that actually that number has been data mined.

One of the things that really stuck out to me, hardware component we've discussed, software we've touched on, but the graphs and really how I'm going to say elegant they are, how easy they are to really be able to look at once and understand what's going on when you, what's been your experience communicating that with the patient. Right. So we get these reports and I think we've all probably used tools in the past, whether in chiropractic school, if you're an older guy like me, you know these, all these products from yesteryear and man, some, some of them created great stuff. But it was literally impossible to translate the knowledge to the patient. What's been your experience translating the output of this that I think we can all geek out on from a clinician sense, but that there's still that bridge to get to the patient's understanding of what's going on with themselves and how that correlates to being in the practice. Patient experience, patient conversations, interpretations of the graphs. What have you seen with it?

I'll categorize it. So we have Net Care Pre Software Update. Net Care Post Software Update. You've seen both. The Pre Software update was already great. Very, very straight to the point, visually appealing, immediate. I was in love with it. I didn't think it needed to be improved. But you know, these guys are wanting to improve and be at the cutting edge. So previously it was fantastic. You know, of course, maybe some coloring or whatnot. But here's the critical thing and I really want people to hear this. I've been in health care in some capacity since about 2010. Okay. I've worked just like you with a lot of companies. This company thrives on feedback from their customer. They asked me for feedback early on. I gave them a lot, but one piece in particular that they have now are there within the next week are going to be implementing system. Yes. That is insane. Like what other company do you know is interested in listening, truly listening to their customers? I haven't really found that but. So we have Pre Software Post Software update. Pre Software update. It was pretty basic. They didn't have the advanced features. So it's very easy to tell a patient, this is what normal should look like. This is where you are Post software update. They almost have categorization of do you want the basic or do you want to go deep level? You can keep it basic. It's still. They updated the graphics. It's still unbelievable. The patient can understand it because there's things that Net Care has put in to enhance the visual portion of patient understanding. And that's all been based on feedback from their customers, myself included. And so when it comes to the charts in the graphs, you can go as simple or as detailed as you want. I've had patients ask, can you explain it a little bit deeper? And of course, my eyes light up and I show them all the data and, you know, they're kind of overwhelmed because I'm sitting here so excited about it. But one of the things in particular that's going to be really cool with the reporting as they do a second new software update. Define motor control. I'm sure you've seen this. You love this one. Everyone loves this one. I remember when I early on purchased the platform, one of the first pieces of feedback I had was, it would be really cool to be able to play this back, right? So the patient has the headset and they're following the fine motor control. The, you know, the dot on the screen and then you see the squigglies. And we all, we're looking at it and we're like, man, it looks like a kid took a crayon here. But the patient, we're visual, we, we like videos. Especially in this current day and age. I said, man, wouldn't it be awesome if we could play that back? And guess what's happening next week? They are now rolling out a feature to be able to play that back that is going to. A patient doesn't even have to know what is happening from an anatomical and physiological standpoint. They will be able to see how good or bad they did in a replay, video replay. I mean, you can't even mine that date. Like, that's the deepest gold vein that is worth so many Bitcoin. It's crazy. That data is invaluable from a patient perspective and an education perspective. I literally am speechless. There's really not much else that I get excited about when it comes to advancement with this stuff.

I think that that's fantastic and being able to utilize that feedback, get it implemented and get it out there to everybody else for the benefit of not only you and your patients, but Everybody's patients is super powerful and that's awesome. Everyone, great job. That was a great job coming up with that bit of feedback by the way. Well done. So the docs listening, they might be interested at this point saying, hey, maybe Net Care might be right for my practice. What kind of advice would you give to a doc that reach reaches out to Orey and his team that maybe is considering bringing Net Care in based upon your own experience?

Well, first reach out, you have nothing to lose. There's no sales pitch. They're not going to try and sweeten the deal with like a timeshare, a set of steak knives or like, you know, the typical stuff like oh wait, if you do it now. When I first spoke with the team, I actually spoke with Orey the CEO, completely blown away by that. But you know, I didn't feel that he was saying we need to make this sale. He wanted to make sure that I was going to be happy with the product. It wasn't about the sale. He wanted to make sure that I was going to be satisfied and that I was going to be able to use it to my patients benefit, my practice's benefit. So just reach out. There's literally nothing to lose, you know, and I know I've come to know the company and I know some of their sales team, their pts, their kairos. These guys are so invested in making sure that the prospective client gets what they're looking for as opposed to, oh, we just have another sale to add to our sales team.

Well said docs listening and watching. We're going to drop that link down below. Neckcare.com can connect with Ori and the team ask any questions that you want. I know they're happy to do a demo. You can see exactly how neck care works. Additionally you can check out all of my channels where there are little clips, bits, screen grabs, everything you need. But Orey and his team over@neckcare.com are going to be the best place for you to learn more about this technology. There's almost no non invasive cervical spine objective diagnostic assessment tools out there. Man, that's a lot of words. But there is very few out there and if there are a competitor, Neckare, I can tell you Net Care is the best, bar none because of the hardware and software complement and component. Dr. Cameron, thank you so much for coming on and chatting today and docs out there listening and watching. Visit Orey and his team@neckcare.com.

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