Issue 2 - February 2004

Interventional pain management
Add-on service creates true one-stop spinal healthcare center
By Marc H. Sencer, MD

Where there is pain, there is a patient needing attention. If you want to provide complete spinal healthcare for your patients — in addition to treating neck and back pathology and disorders of the spine — you may want to consider adding interventional pain procedures to your practice.

Interventional pain management is a subspecialty of medicine that uses minimally invasive procedures (usually performed on an outpatient, ambulatory basis) to alleviate pain. It is an alternative for patients who have been unable to relieve their pain and dysfunction through more conservative treatments such as chiropractic, physical therapy and medication.

Anesthesiologists or physiatrists who have special fellowship training in pain management have traditionally administered interventional pain-management procedures. Today, with appropriate training, some procedures may be performed by general internists or family practitioners.

If the idea of becoming a true “one-stop healthcare center” appeals to you, here are some steps to take:

1. Examine your motivation and your practice philosophy. Interventional pain management can add to your revenue base. But adding income should not be the driving factor to add this service. Rather, you must believe in its value. If you are philosophically opposed to the use of medications and even minimally invasive procedures, abandon the thought of incorporating this service into your practice.

2. Assess your situation. Interventional pain management is not right for every clinic. Clinics operated by solo practitioners, new practitioners or small group practices are usually not ready for this type of add-on service.

The best matches are with multi-specialty clinics that have been successfully practicing with medical doctors and physical therapists for at least one year.

3. Decide the level of pain management you will provide. The most basic intervention for pain management is trigger-point injection, which your staff MD or DO can master through weekend training.

Injections to large and small joints and injections of the bursa require a mastery of more complex techniques but are still within the realm of general practitioners and DOs.

More complicated procedures require the services of an anesthesiologist or interventional physiatrist.

4. Equip your office — or rent space. Advanced intervention pain management requires specialized equipment as well as a recovery room where patients can rest for several hours after undergoing a procedure.

You will either have to invest in the equipment and facilities or rent space in an outpatient surgery center. The drawback to rent is that you may lose certain reimbursements, such as those for use of the recovery room or the facility. A knowledgeable consultant can help you determine which option is best for your clinic.

5. Implement and give your patients options. Offer interventional pain management to patients who would otherwise have no alternative to relieve their pain and dysfunction other than surgery.

If you decide to enter the world of interventional pain management, the potential rewards are great. Reimbursement for these procedures ranges from several hundred dollars for a series of trigger-point injections to more than $7,000 for more complicated procedures.

But aside from the additional revenues, what could be more exciting to you than to be able to spare patients surgery and to see them pain-free?

By adding these services to your practice, you further reinforce your role as the expert in spinal disease and take the final giant step towards making your practice a comprehensive treatment center for all disorders of the spine.

Marc H. Sencer, MD, has established seven successful multi-discipline practices. He currently owns and manages a multi-specialty Pain Management Group practice in Florida. Dr. Sencer is the founder of MDs for DCs, a medical staffing and practice management company specializing in the needs of chiropractic multi-specialty group practice. He can be contacted at 800-916-1462 or through www.mdsfordcs.com