Pain management can be lucrative. Short cases. Minimal supplies. Decent (but decreasing) reimbursement. And repeat customers. Our 2-room pain ASC handles between 525 and 600 patients a month, putting us on track for around 6,800 visits this year. Here are 5 keys to a profitable pain service.

Hire only RNs — and train them to operate the C-arm. As you can see in the photo, when we do a procedure, only 3 people are in the room: nurse, patient and physician. We don't employ X-ray techs or LPNs, only RNs who are ACLS-certified. And within 6 months of hire, our RNs must take and pass an American Registry of Radiologic Technologists exam so that they're credentialed to operate a C-arm. It's not rocket science — plus, RNs are under the direction of the physician. Our RNs also take radiation safety in-services from our C-arm manufacturer. Money we've saved by eliminating X-ray techs from our staffing equation falls to the bottom line. Including me (yes, I work cases), we employ 4 full-time RNs and 2 part-timers. Our full-time nurses average 40 hours a week, but it's understood that nurses will clock out early on slow days.

Standardize your pain tray. Do you really need more than 1 pain procedure tray? You can save time and money if you standardize your pain trays. It took us a few attempts to get it right, but we've found the perfect bare minimum: 27Gx11/2 needle, 18Gx11/2 needle, 22Gx31/2 needle and a 20Gx31/2 Touhy needle, a loss-of-resistance syringe, 10cc syringe, 3cc syringe, sterile drape, 3x3 sterile gauze and skin-cleaning applicators. We save time because we don't have to worry about which tray we pull for a case. We've leveraged volume discounts to negotiate better prices on our trays.

Save the sedation. Sedating pain patients for such routine procedures as lumbar epidurals wastes time and money. It almost takes more time to sedate and recover patients than it does to perform most pain procedures. Our nurses are skilled at talking patients through procedures. We do sedate for such lengthier procedures as lumbar discograms (sedation also makes this a more objective procedure), spinal cord stimulator trials and sometimes for cervical rhizotomies.

Keep the schedule moving. Appointments for new patients or re-evaluations (patients we haven't seen in 6 months or more) are 30 minutes long. We want to allow enough time so that patients feel taken care of. But for at least 1 hour each day, and sometimes 2, we'll shift to 20-minute appointments for repeat, routine patients. We do the procedure, and then turn the room over quickly. Reserving 1 or 2 hours of your day to treat 3 patients instead of 2 adds 1 or 2 procedures to your day — and to your bottom line — without additional staffing. The key to making this happen is stacking at least 3 routine cases on the schedule.

Invest in a Super C-arm. You'll pay more for a C-arm with a larger opening, but it's an option that's well worth it. Oftentimes, physicians want the C-arm angled so that they can get an optimal view of the site they want to inject. A Super C-arm makes this easy. If your docs can't see what they want to see, it'll take longer to do the procedure.