As bob dylan sang, “the times they are a-changin’.” When electromedical stimulation treatment first came into popular use in the 1970s, the mainstream medical community was skeptical. However, today more and more conventional medical practitioners are accepting the use of electromedical stimulation devices, such as transcutaneous electrical nerve stimulation (TENS) devices, electronic muscle stimulation (EMS) devices, and neuromuscular stimulation therapy devices. In addition, many medical schools are teaching the use and effects of properly applied electromedical treatment, and many physical therapists and chiropractors are taught the use of electro-stimulation during their formal training.

Payment has also become somewhat easier as the Centers for Medicare & Medicaid Services (CMS) have made the requirements for reimbursement somewhat more reasonable, and most private insurance companies now authorize reimbursement for the devices and supplies.

New product designs will soon offer medical practitioners additional modalities for use in treating patients, which could increase the number of people using electrical stimulation therapy devices even more.

With a growing number of patients receiving a prescription for electrical stimulation, HME dealers need to learn about the units and how to sell them. The profit margins are reasonable and the ongoing supply needs of the patient create a revenue stream over many months.

New To The Market
In the next few months manufacturers will introduce at least two improved electromedical devices to the US market. They are a better interferential stimulator and a bone growth stimulator.

Interferential stimulation is already one of the preferred modalities used for the treatment of pain and to hasten soft-tissue healing. Considered medium-frequency devices,¹ currently available units have generally been limited to between 4,000 Hz and 4,200 Hz. However, the newest interferential stimulators, labeled as IF4250, can reach 4,250 Hz. The increased frequency will allow practitioners new treatment options. In addition, new design and manufacturing developments will allow the manufacturers to lower the cost of producing and selling the IF4250. Currently available electrodes will be compatible with the new unit.

The second device, the bone growth stimulator, is also an improvement on an established treatment method. Electromedical stimulation via older versions of this device is known to effectively reduce the amount of time necessary to heal broken bones, although the mechanism by which this happens is unproven. One theory is that the electrical stimulation increases blood flow to the broken bone, which in turn promotes rapid healing.

In the past, effective bone growth stimulators were too large and expensive for home use. But the new device will be both small and available at a greatly reduced cost. Look for these units to begin shipping in the United States in less than 2 years.

New Referral Sources
As reimbursement problems begin to dissolve and medicine in general becomes more accepting of electromedical stimulation treatment, additional referral sources will be looking for someone to supply their patients with units and supplies, such as electrodes. But before jumping into this niche, be aware that electromedical stimulation devices are different from most equipment supplied by HME dealers.

Not only is a prescription required to obtain the devices, but in the vast majority of cases, the unit will also be applied to the patient by a medical professional. Many physicians prescribe a unit that will be applied by a physical therapist, while chiropractors often apply and fit the unit in their offices. That means that the provider will usually deliver the unit to the medical office instead of to the patient’s home.

A starter kit, included with all units, provides initial electrodes and other supplies. Ongoing supply requirements are met by sending products directly to the patient via the mail or other third-party delivery system. This greatly reduces the time and cost associated with providing electro-therapy products.

Another good thing about this market is that the referral sources can also be good customers for electrodes and other related supplies used in their offices.

Getting Paid
If you decide to participate in this burgeoning market, you need to know how to get paid for the units and supplies you provide. If you are going to apply to Medicare for reimbursement, you must learn and follow all of the applicable rules for covered devices. Contact your Durable Medical Equipment Regional carrier (DMERC) and your electromedical device sales representatives to learn the rules and get tips on billing. Medicare is making it easier to get paid for these treatment modalities, but you must still be savvy about reimbursement rules.

Other third-party payor sources, such as workers’ compensation, traditional insurance, and Medicaid, usually require that you take specific steps before you deliver the unit in order to get paid. In most cases you must obtain preauthorization before the unit is delivered to the medical professional for application on the patient. In some cases the payor will require that the unit be rented for 1 to 3 months successfully before the unit can be purchased.

Getting the proper documentation for reimbursement is usually fairly simple and most manufacturers and distributors will teach HME billing departments how to go about getting the required information. With preauthorization and proper documentation, payment from a third-party payor is usually prompt and denials rare.

Operations and Inventory
Delivering units and supplies to the referral sources and the patients is easy and inexpensive. All supplies are mailed or delivered directly to the patients by third-party delivery systems. In addition, you can use the least expensive shipper for the devices because even with a lengthy delivery time, the devices will still arrive at the offices of the referral sources before the insurer preauthorizations do. Referral sources will normally wait until you receive authorization to bill the patient’s insurer before scheduling a fitting appointment with the patient. In addition, remember that a salesperson making regular calls to the medical professional’s office can deliver units.

Because of the nature of the treatment and provision process, a large inventory is unnecessary. You will have time to get whatever unit is needed to your warehouse for delivery. Therefore, you should limit the inventory you carry to one or two examples of each unit for demonstration and rapid delivery if necessary. Supplies that are normally delivered once every 3 months, with proper authorization, can be mailed from your office as needed. These supplies are perfect for “virtual inventory” wherein you do not actually deliver the supplies to the patient, but rather your distributor delivers them in your name when ordered to do so. This also reduces your inventory requirements and is the most cost-effective method of distribution.

Adapt to the Times
Electromedical stimulation units are becoming mainstream medicine. The advantages and effectiveness of the therapy are recognized by most payor sources. As an HME provider, carrying and selling the units and supplies can be a profitable niche market for your company. New referral sources that prescribe these devices can often write orders for other HME you already carry. In addition, reimbursement is no longer as difficult as it once was, and new technical developments will increase the size of the market and the demand for the products. Finally, the provision of supplies will create an ongoing revenue source for your company.

So what are you waiting for? Get involved in selling electromedical stimulation units.

Steve Lutzker is principal consultant with The Lutzker Group Inc, Escondido, Calif. If you are interested in more information about the electromedical device market, or any other niche marketing opportunities for HME companies, phone Lutzker at (760) 480-9060 or email him at consultlutzker@sprynet.com.

Reference
1. Jaskoviak PA, Schafer RC. Applied Physiotherapy: Practical Clinical Applications. 2nd ed. Arlington, Va: American Chiropractic Association; 1997:352.