Electromedicine has come a long way. Today, transcutaneous electrical nerve stimulation (TENS) is an established modality with more than 250,000 units prescribed annually in the US alone. The operative word is prescribed. To stay competitive and stimulate success, providers must be prepared to face tough business challenges and provide real value to physicians.

Chronic pain affects millions of Americans each year. Effective pain management is a multidisciplinary challenge, but one that usually starts with the physician. That is why smart providers of electromedical devices—TENS units, muscle stimulators, galvanic stimulators, and interferential stimulators—place paramount importance on the physician relationship. “The physician controls the prescription and that is the bottom line,” said Larry Faigh, co-owner of Dallas-based Sienna Medical, a 16-year-old business specializing in the electrical stimulation (e-stim) market. Indeed, building strong relationships with physicians is critical to success because it leads to referrals.

Referrals can come from secondary sources such as physical therapists (PTs) as well. At Sienna Medical, approximately 80% of the company’s revenue is TENS-related. While Faigh acknowledges that PTs are a valuable source of referrals, he notes that physicians remain unmatched in terms of sheer volume. “For every three or four referrals a month we get from physical therapy clinics, we will get 15 to 20 referrals from physicians,” says Faigh.

Moreover, a physician-driven business can prove more cost-effective. Physical therapy clinics often require a consigning process which can be expensive for the HME provider. The provider must buy the TENS units from the manufacturer and leave an inventory of three to five units on the shelf at each clinic. Depending on your market, that can add up to hundreds of units “on hold” until the clinic finds a patient in need. Conversely, physicians have no interest in the consigning process. “It is a less expensive process because you are filling an individual patient need versus a pipeline,” says Faigh.

Winning the pain game often means winning over influential physicians. How do successful dealers increase referrals from physicians? “Patients are your best tools,” says Faigh. “If the therapy is successful, they will inform the physician and you can’t get a better endorsement.”

Getting In the Door
Your initial challenge is perhaps the toughest: securing a face-to-face meeting with the physician. That means you must first get past the gatekeepers—assistants, secretaries, technicians—the professionals who oversee the doctors’ business schedule. There are a few key things you can do to establish a rapport with the gatekeeper.

Before you arrive, try to have at least a minimal understanding of the practice. Knowing whether this is a general practitioner’s office or a pain specialist’s will help you determine the scope of information you will convey to the gatekeeper. At a pain specialist’s practice, the gatekeeper is more likely to be familiar with TENS and electromedical devices.

Next, ask the right questions. Gatekeepers can help you determine if the practice is a good prospect for you. For example, inquire about the demographics of the practice. If the physician sees primarily young patients, there may be less need for TENS. Does the physician handle many worker’s compensation cases? If so, this tells you there are several patients with injuries who could benefit from electrotherapy.

In short, get as much background as possible from the gatekeeper so you can qualify your leads and speak more intelligently once you see the physician. Moreover, learn to play by the gatekeeper’s rules. If he or she tells you the doctor only meets with reps on Thursdays, be flexible and return on a Thursday. Finally, always be polite, patient, and respectful. Remember, the gatekeeper can make or break your opportunity to meet the physician.

Your initial meeting with a new physician is critical to building a strong relationship. Remember that any time a doctor spends away from patients is time when he or she is not earning money. So, be brief. Keep your initial meeting to 5 or 10 minutes. Focus on positioning yourself as an expert, setting yourself apart from competitors, and demonstrating how you can provide genuine value to the physician by delivering turnkey service to the patient.

Finally, it never hurts to remind physicians of the benefits of electrotherapy. For pain control, electrotherapy is highly effective, nonaddictive and noninvasive. 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.

Undoubtedly, you will encounter some physicians who are skeptical about the success of electrotherapy treatment. “We like to emphasize that we see ourselves as part of a pain control program that may include drug therapy as well,” says Faigh. “Moreover, we stress that we are patient responsive which takes the burden off the physician and puts the responsibility for successful therapy on us.”

Increasing Compliance
As an HME provider of electromedical devices, there is only one way to build long-term credibility with physicians. You must do everything possible to ensure successful therapy with patients. The process begins the moment the physician refers a patient.

One way to prove yourself valuable from the get-go is to offer the physician options. For an initial TENS set-up, be prepared to meet with new patients either at the physician’s office or at the patient’s home. Your flexibility demonstrates your commitment to the patient. Once the prescription is written, it is up to you to schedule the meeting with the patient and provide turnkey service.

The primary goal with a new patient is to ensure compliance. According to Faigh, one of the biggest problems industry-wide is the practice of mailing a TENS unit to a patient. The technology is complex and the patient has no one to guide him. Unfortunately, units that are mailed often sit on a shelf and never get used. Clearly, compliance is directly related to proper patient education. This requires a face-to-face visit. Taking short cuts will only short-circuit your electromedical business.

During the initial visit, successful providers demonstrate the set up of the TENS unit, explain how the therapy works, and show the patient how to use the equipment. An initial setup can be time-consuming and expensive. It may take an hour or two to fully instruct the patient on how to use a TENS unit effectively. Moreover, it’s important to leave ample time to answer questions.

Choosing the right unit is another way to increase compliance. Small, portable, battery-operated devices are more practical than big, bulky equipment. Patients are more apt to comply if the unit is user-friendly and comfortable. Manufacturers offer a variety of units that can be clipped onto clothing or used while traveling, too.

Bear in mind that whatever unit you select for a patient will often be on a test basis. Typically, a TENS unit is rented for a month then converted to purchase. Your goal is to choose the right unit upfront. Otherwise, your business incurs the extra expense of recovering equipment that isn’t working for a patient and beginning the set up and education process anew.

Sienna Medical enjoys a success rate of 85% when it comes to rent-to-purchase conversion. This kind of success requires researching product lines and understanding various insurance parameters. “We tell physicians we can offer patients the best technology within their insurance parameters,” said Faigh. Good technology increases patient compliance and compliance increases the physician’s trust in the provider.

When it comes to selecting a unit, there is a perception that a low-end unit is just as effective as a high-quality one. But the fact is that low quality equipment breaks down. Providers then spend additional time and money on service calls, paperwork, repairs and replacement equipment.

Timely Follow Up, Ongoing Service
After you have educated the patient and selected an appropriate TENS unit, the true test begins. You have paved the way for compliance, but now the patient is on his own. However, smart providers pride themselves on supporting patients with careful follow-up strategies.

Timely follow-up with new patients is critical to long-term success. Within a few weeks of the initial setup, you should contact the patient via phone and get a good understanding of how the electrotherapy is progressing. Sienna Medical created a series of questions that allows them to assess compliance and effectiveness of the treatment. The goal is to develop a patient record and troubleshoot any problems. Early follow-up also allows you to recover and exchange a unit that simply is not right for the patient before he or she gives up on treatment altogether.

Overcoming Obstacles
Today’s electromedical market is more competitive than ever. To make it, providers must be highly dedicated and ready to tackle tough business challenges. Sienna Medical is putting 40% more TENS units on patients today than it did 10 years ago, yet margins are much lower. Reimbursement has been cut dramatically on electromedical devices leaving providers with the question of how to make up for lost revenue.

Faigh offers some strong advice to providers considering the TENS market. “You can’t dabble in TENS,” said Faigh. “If you can generate upwards of thirty referrals a month it may be worth your while.” In short, you need to be committed to building your TENS business to a critical mass otherwise low margins and the cost of doing business will chip away at your profits.

On the upside, once you’ve built strong relationships with a physician base you can offer them additional, related product lines. Sienna Medical recently added a new bracing product line specifically because it fits the needs of the customer-physicians they serve. Once you have a solid reputation with a physician he or she is likely to remain loyal and turn to you for other solutions as well. Using the same sales force to offer additional products to existing customers is an efficient way to generate revenue.

Another obstacle you’ll face in the TENS market is the lack of new, breakthrough technology. “While there are a few new product features, TENS technology hasn’t changed much in the past ten years,” said Faigh. Presently, providers simply can’t rely on technological advances to give them a competitive edge.

Marianne Matthews is a contributing writer for Dealer/Provider.