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Don’t need facet arthropathy to have facet pain, especially if it’s an adjacent level IMOI do if facet arthropathy
SI if SI as adjacent pain generator
Don’t need facet arthropathy to have facet pain, especially if it’s an adjacent level IMOI do if facet arthropathy
SI if SI as adjacent pain generator
they are stenotic, tho.rf adjacent levels
You would be your reps best buddy with 100 trials a year even if only 50% convert to perm. That’s a pretty big numberI could do 2-3 per week if I wanted. I see failed back daily.
Most would go to perm, bc trials rarely fail.You would be your reps best buddy with 100 trials a year even if only 50% convert to perm. That’s a pretty big number
So what’s your day to day practice look like?Ahh good to.see the spinal industrial complex is still a force and running smoothly. The pain doc in the ortho group is a cog in the machine. Spine surgeon sends you a patient for esi after already telling the patient that the esi is just a temp thing to get them the fusion the patient needs. The fusion is the solution and the esi is the bandaid the patient needs until the surgery...
You do the esi
Patient goes back to surgeon to get fused. You see them months later for continued pain
The surgeon has already told them that their back was the worst back he has ever seen and it looked far worse then what the mri showed. He tells the patient He did the best he could given how bad their back was and tells the hardware looks great and the back is stabilized and the previous impending risk of paralysis is gone
You do tf esi at the adjacent segment. And the so-called band aid is.placed again. The patient goes back to surgeon to get adjacent.level fusion.
Several months later the surgeon refers back to the in-house pain doc for continued pain
And here two paths are available depending on the ortho practice you are in. You will either stim them or you opioid or continue their opiods.
Then patient still has pain and you do SI joint block patient will tell you yeah it worked because the patient is always looking for "the solution" and you or the surgeon then do the SI joint fusion.
After several hundred thousand health care dollars spent the spinal industrial complex churns on. The ortho is happy, the hardware reps and hardware companies are happy, the ASC is fed with facility fees and prosperous. And the pain doc in this ortho practice is the vital bandaid that gives the surgeon time to stagger cases
My perm rate is way down since switching to saluda. About 50/50. Pretty much black and white trial results now.Most would go to perm, bc trials rarely fail.
Tell me more - is that good or bad- like higher perm success rate?My perm rate is way down since switching to saluda. About 50/50. Pretty much black and white trial results now.
Don't forget intraceptI do if facet arthropathy
SI if SI as adjacent pain generator
Same. I rarely do stim. Chronic opioid population is the best way to get stims
Exactly the reason I am the way I am. I could get authorization for tons of stimulators but I don’t bc I think it’s a very limited therapy that only works for a small number of diagnoses.
Me too but I don’t see that many great SCS candidates. Lots of adjacent segment disease, degenerative foraminal stenosis, etc, but not so much of the “hurts all the time” back and leg nerve damage type of pain. Maybe it’s a function of the local surgeons? They’re all pretty conservative, very reasonable guys.
...and milds, spacers, PNSPatients with bad insurance or too much co morbidities. Those patients you do your therapeutic esi's and rfa's
I don't do MILD, spacers....and milds, spacers, PNS
I’m getting trained in 3-4wIf you have a developing practice it takes some time to find Intracept candidates. I like them to have failed facet interventions , esi etc before moving to it. Plus having an older population makes it easier. Look at every mri. Many have modic changes and go from there. It really does work for 60-70% of the patients that I have treated so far
That being said, I do 350 procedures in month- just mostly ESIs and SII’m getting trained in 3-4w
What’s your practice model? If office based you should easily be collecting 1 million plus annually just on procedures.That being said, I do 350 procedures in month- just mostly ESIs and SI
Still not as lucrative as I thought in Medicare based population
How the f can you do that many procedures in a month? Do you have a mid level or two? When do you have time to see patients to set them upThat being said, I do 350 procedures in month- just mostly ESIs and SI
Still not as lucrative as I thought in Medicare based population
Its not nearly as lucrative as that if mostly ESI or SIWhat’s your practice model? If office based you should easily be collecting 1 million plus annually just on procedures.
ASC based without ownership maybe 350-500 on based on ownership. Making bank for the ASC owners though.
HOPD. You are making them 3 M plus a year. Wrvu at least 10k assuming u have some office visits.
It’s all just math
for ASC or HOPD, 350 procedures/month x 12 months x $95 (averaging ESI at 102 and SI at 89) = 399,00 on professional fees alone. add in facility fees, which an ASC would charge on average $300 for $1.2 million, on top of the $400k.That being said, I do 350 procedures in month- just mostly ESIs and SI
Still not as lucrative as I thought in Medicare based population
That is a MONSTROUS amount of procedures and cannot imagine how you’d churn that volume with one mid level, but you should be making 1M per yr EASILY. With office visits and ancillary added you’re in the top 1% in our field. Very few ppl do procedure numbers like that, and those that do are generally supported by a very large team of midlevels and scribes and MAs.That being said, I do 350 procedures in month- just mostly ESIs and SI
Still not as lucrative as I thought in Medicare based population
I wishAgree. Sounds like surgeons are putting injections onto his ASC procedure block.
Dude, please get a clinic procedure suite if that’s in any way possible.
Why would they do that. They are all benefiting off of those juicy facility fees.Agree. Sounds like surgeons are putting injections onto his ASC procedure block.
Dude, please get a clinic procedure suite if that’s in any way possible.
This is way more than any block shop I’ve ever heard ofAs much as u may like the volume. This is the definition of a block shop. So take the experience and move on to something with a future
Hang on man…How many clinic visits do you have per week?So my last job this guy I knew was going like 35-40 procedures 4.5 days/week. Honestly I thought that was the norm and I had more ways to go.
I’m surprised @BobBarker that you’re not hitting this no with your prior posts on volume/seeing patients
The only way to get to those numbers is Medicare practice and all direct referrals for shots, no clinic time, unless 84 hour work week..but even thenHang on man…How many clinic visits do you have per week?
Difference being you’re generating all those procedures yourselves.Me and the other doctor were in office a total of 6 days last week and maybe 55 total injections were done.
We have 25 surgeons in group.Difference being you’re generating all those procedures yourselves.
Are you doing ablations if the ESI fails?We have 25 surgeons in group.
So I have these patients eval and rx for “right L5-S1 TFESI”, say hi to them and book. Honestly some of easiest consults of my life- all MRIs uploaded and medical necessity done by PT before they see me
since mostly surgical patients, if TFESI or ILESI don’t work, they go back so large outflux hence only one APP- if injections work, I ask they call me PRN if it’s been three months
***
Some direct bookings as well ~5% as some come from far away
This is a very poor care modelWe have 25 surgeons in group.
So I have these patients eval and rx for “right L5-S1 TFESI”, say hi to them and book. Honestly some of easiest consults of my life- all MRIs uploaded and medical necessity done by PT before they see me
since mostly surgical patients, if TFESI or ILESI don’t work, they go back so large outflux hence only one APP- if injections work, I ask they call me PRN if it’s been three months
***
Some direct bookings as well ~5% as some come from far away
If primarily axial back pain and facets as pain generatorAre you doing ablations if the ESI fails?
Why?This is a very poor care model
So, the surgeons send to you for management and you refer back if everything fails? That’s my set up.If primarily axial back pain and facets as pain generator
Patients generally want some time spent with them. To just say hi let me give you a date for your shot doesn’t seem like anything that would fly where I’m at. Just don’t get the sheer volume if you actually spend at least 5-10 minutes with them. Don’t they want to see the mri? The surgeons in my group rely on me to show them the mri.Why?
They’ve done PT, I give neuropathic meds, they have acute radic, I try steroid injections
The surgeons see like a kajillion patients for me to be able to have this practice
How do you set up your practice?Patients generally want some time spent with them. To just say hi let me give you a date for your shot doesn’t seem like anything that would fly where I’m at. Just don’t get the sheer volume if you actually spend at least 5-10 minutes with them. Don’t they want to see the mri? The surgeons in my group rely on me to show them the mri.
Ortho, patients sent to me for intervention. I don’t take direct referrals for shots. I eval all of them before deciding on a procedure except hip injections and even those I’m screening beforehand. 3 clinic days 2 procedure days. I’m a 4% owner of an asc. Very very little med management.How do you set up your practice?
Do you feel you’ll do same interventions with new patient evalsOrtho, patients sent to me for intervention. I don’t take direct referrals for shots. I eval all of them before deciding on a procedure except hip injections and even those I’m screening beforehand. 3 clinic days 2 procedure days. I’m a 4% owner of an asc. Very very little med management.
The model is going to change as historically I’ve seen very few new patients because surgeons would see all the news and then send to me for intervention after PT. It’s apparently going to change with the addition of a mid level under me.
The number of phone calls that many procedures generate is significant, and it requires a lot of help. You also run into more and more denials and documentation issues.
At least, that’s my experience.
Who manages your post procedural issues like failed shots, worse pain, neuritis, insomnia, etc?Yeah I agree.
I am going to try and slow down.
There is another pain doc hired so should help