The French medical missionary Albert Schweitzer once said, “Pain is a more terrible lord of mankind than even death itself.” Indeed, nobody wants it, but so many suffer from it. According to the American Chronic Pain Association, chronic pain is an affliction that disables, to some degree, about 86 million Americans.

With pain management becoming a growing concern among America’s health care consumers and medical professionals, it is no surprise that interest in electromedicine for pain management in select orthopedic patients is also growing. But just as physicians and therapists choose candidates for electrotherapy very carefully, so, too, are they selective about the providers they refer those patients to. Whether you already carry electromedical devices or you are planning to enter the niche, you should know what the experts are looking for in the way of products, services, and value-added offers.

A Common Sense Approach
Electromedicine is a complex field. Before you can even choose a product line, you need to be aware of the various methods of electrical stimulation. These range from the well-known transcutaneous electrical nerve stimulation (TENS) and muscle stimulation to the less-used microcurrent therapy, galvanic stimulation, and interferential stimulation.

The TENS device is a clinically proven tool used to treat many types of chronic and acute pain. It works by converting direct electrical current into pulses of stimulation transmitted through wires and surface electrodes on the skin to underlying nerves. The result is a tingling sensation that reduces the perception of pain.

Some common applications of TENS include the treatment of lumbar sprains, neck pain, lower back pain due to compression fractures, and myofascial pain associated with vehicle accidents. In addition, TENS is often used as a postoperative application following knee or shoulder surgery.

As a provider, you have many manufacturers to turn to, and choosing the ideal TENS units may seem an overwhelming task. Joyce Campbell, PhD, PT, at California State University Long Beach, suggests providers bear the following in mind. “From the clinician’s standpoint, there is absolutely no evidence that expensive is better,” she says. “In fact, a unit is relatively useless if it is not within a patient’s budget or covered by insurance.”

In deciding what to carry, Campbell suggests that providers focus on product features that will enhance patient comfort and ensure compliance and ease of use.

“Look for small, portable, inexpensive, battery-operated devices,” she says. “Throw out everything that is big and heavy, has to plug into a wall socket, or can’t be worn by the patient.”

In other words, use common sense. Physicians will prefer units that are the most practical for patients, such as units that can be clipped onto clothing or used while traveling.

Lynne Carr Columbus, DO, a pain management specialist, in Palm Harbor, Fla, concurs. “Big, bulky TENS units are a thing of the past,” she says. “Physicians want to send patients to providers who carry convenient, portable devices so they know the patient will be complying with treatment.”

Methods and Merchandise Mix
To be a player in this market niche, you also need to familiarize yourself with other electrical stimulation methods beyond TENS. Only then can you carefully consider what to add to your merchandise mix. For example, microcurrent therapy is often used in cases involving soft tissue inflammation or muscle spasm. It produces electrical signals that mimic those naturally occurring when the body is repairing damaged tissues. By applying similar currents, the healing process is enhanced. And because the electrical current used in microcurrent therapy is so small, it is rarely felt.

“Microcurrent therapy is used for very sensitive patients. If a patient is ‘electrically shy,’ this is an option that enhances their comfort,” says Gail Blom, MA, OTR, CHT, and founder/ owner of Covenant Hand Therapy, a clinic in Plano, Tex.

In addition to pain relief, muscle stimulation (often referred to as muscle stim) is widely used to reeducate muscles or to prevent atrophy after an injury, such as breaking a wrist. “Muscle stim implies that there is enough current or electricity that penetrates deep muscle tissue,” Campbell says. “One of the benefits of this therapy is that it is minimally fatiguing.”

Since muscle rehabilitation is often a treatment goal, Campbell advises HME providers to carry two main lines of electromedical devices—one for pain modulation (TENS) and one for muscle enhancement (muscle stimulators).

Whereas TENS is a low-frequency stimulator, interferential stimulation is a medium-frequency stimulator. It overcomes the skin’s resistance to electrical stimulation and penetrates deeper nerve roots. It is used for both decreasing edema and overriding pain.

“TENS can’t address the swelling around nerves or deep tissue problems, but interferential can,” says Gary Klass, director of business development at the home health care provider Progressive Motion in Santa Barbara, Calif.

However, interferential stimulators are more expensive than TENS units. As a provider, only you can assess whether they are right for your market.

Improvements and Innovations
While it is the physician’s role to choose the right type of electrotherapy for a given problem, smart providers want to keep current with general innovations in the field.

Blom, who has been working with electrical stimulation for 20 years, cites preprogrammed settings as an improvement in the new stimulators. “We used to have to set everything manually—the type of waveform, the number of pulses per second, and so on,” she says. “Now the units come with programs and a list of what program is suited to what problem.” This improves efficiency, allowing Blom to spend more time with patients.

Providers should also know of the many microprocessor-based stimulators currently on the market. Physicians often prefer these units as they ensure ease of use and improve patient safety. “With the old units, patients had to adjust the frequencies themselves and there was room for error,” Klass says. “The new ones act like computers and automatically make adjustments.”

There are also ambulatory units, which allow patients to walk around while receiving electrotherapy. A trigger or switch is built into the patient’s shoe, which turns the unit on and off as the patient walks.

Other features that physicians and therapists look for in stimulators include comfortable current, adjustable pulse duration, minimal patient fatigue, and external triggers so patients can use it when they want.

Equipment Advances
As for new products, multifunction units are one of the latest innovations. These units offer multiple types of stimulation in one product. For example, a multifunction unit allows a patient to use TENS, interferential, and muscle stim, therapy thereby addressing pain relief, swelling, and muscle re-education.

“Multifunction units have been on the market for about 2 years and are used for applications like common knee surgery,” Klass says. “They’re small and portable, the way physicians and patients prefer.”

Electroconductive garments are another, relatively new product line attracting the attention of medical professionals. Instead of applying surface electrodes to the skin, the patient wears a garment with built-in electrodes. There are elbow wraps, knee wraps, back wraps, and gloves, to name a few.

“They offer significant benefits, like patient comfort,” Blom says. “The garment electrodes diffuse electricity over a larger area and it’s easier to reach certain small areas, like fingers.”

Klass sees the garments becoming more mainstream. However, as a provider, you need to carefully assess adding this innovation to your product line. Blom acknowledges that while she favors them for select problems, electroconductive garments are quite expensive and insurance coverage varies from state to state.

Service for a Competitive Edge
Experts agree that one key to success for an HME provider lies in what you offer beyond the products. Smart customer service with patients, physicians, and therapists can give your business a competitive edge.

Klass suggests providers visit the patient, set up the unit, and fully instruct the patient on how to use it effectively. “Delivering turnkey service to patients is absolutely critical if your goal is to increase referrals from physicians and stay competitive,” he says.

Some providers even offer 24-hour services to answer patient inquiries, but this is not necessary for all companies. You can also assist by providing prompt delivery of supplies and timely repairs.

From a financial perspective, patients appreciate providers who accept payment plans and offer a rental option. Blom says providers also should be prepared to put a unit on a patient for a free trial basis of a few days. The patient begins treatments while the provider finds out if the insurance will cover the unit. If not, the provider advises the patient on other lower-cost options.

“I’m more likely to use a provider who offers this service, because the therapy process can proceed without delay,” she says.

There are other simple things you can do to make life easier on physicians and therapists. When looking for a prescription for an electrotherapy device, find out how the physician prefers to communicate—via phone, fax, or email. Then, do business his or her way.

Schedule appointments at busy clinics as opposed to just dropping in. Once there, provide therapists with thorough demonstrations of the units their patients will be using. And keep your inventory full. “A good provider is reliable, has stock on hand, and can deliver the units within 24 hours,” Columbus says.

Your customer service efforts also will help cut down on patient phone calls to busy physicians. “If the provider keeps the patient happy, he keeps the doctor and the therapist happy, too,” Blom says.

Most important, physicians and therapists want to work with providers who have a genuine understanding of electrical stimulation and what they are selling. “The single best thing a provider can do to be more effective is to get some bona fide education in the field,” Campbell says. She suggests providers take classes in electrical stimulation through the physical therapy department of a local university.

You also can bone up on the field by inviting an expert to give seminars to you and your employees, attending physical therapy conferences, visiting Web sites to review current research, and speaking with various manufacturers about their brands.

In the end, the most educated providers will be the most successful. While you may have to put in a good deal of effort to gain the knowledge that gains you ongoing referrals, remember, when it comes to building a profitable electromedical business, no pain means no gain.

Marianne Matthews is a contributing writer for Dealer/Provider.