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Adding Pain Management Painlessly
If you've got a C-arm and a table, there's no reason why you can't add pain cases.
Connie Casey
Publish Date: October 3, 2012   |  Tags:   Pain Management
— SHORT STOP Most pain management procedures only take about 15 minutes, and can be done in a procedure room.

Our multi-specialty surgery center built a few occasional spinal injections in a procedure room into a busy and profitable pain management program with its own dedicated workspace. Looking back, it was a relatively simple expansion for us. You might not be thinking as big as we were, but equipping and staffing a pain management service line is well within any facility's reach. Here's an overview of how we added pain, painlessly.

pain management READY, SET, GO If your facility already has a C-arm, you're suitably equipped to handle pain management cases.

Opening shots
A few years ago, a pair of anesthesiologists who practiced at our ASC asked if they could perform some pain management procedures there. Cervical and lumbar epidurals, basic stuff. We hosted them in our small procedure room. Why not? It cost us hardly anything to do so. Pain procedures don't require much in the way of capital equipment. In fact, if you're a multi-specialty center and hosting orthopedic or other surgeries, you may already be suitably equipped with a C-arm and table.

Fluoroscopic imaging is necessary for the injections, which got us more mileage out of our C-arm. At $125,000 to $150,000, I wouldn't advise purchasing a new machine for 4 pain procedures a month, but for 50 or more a month, it'll definitely pay off. Otherwise, buying refurbished offers significant discounts and leasing makes the latest models accessible.

The use of a C-arm necessitates a C-arm table, one that's built from carbon-fiber components for radiolucence and cantilevered for imaging access over the procedure sites. New tables cost about $20,000 to $25,000, but refurbished models can be had for a fraction of that.

Beyond those devices, all our pain management practitioners needed was their single-use supplies — skin prep kits; custom trays of syringes and spinal needles; anesthetic agents, steroids, contrast dyes and other medications — which cost about $19 to $27 per case.

Profit motives
Total up the expenses of hosting pain management injections (2 pieces of OR equipment we already owned, minuscule case costs) against facility reimbursement rates ($300 to $400 for many common cases), and you can see the service's appeal. Especially as most interventional procedures are very short in duration, 15 minutes maximum. They didn't even have to take up our OR time, because they could be done in our procedure room.

To successfully add pain management, however, you must be mindful of a few scheduling and time management issues. First and foremost, it's imperative to schedule a sufficient volume of cases to make the service profitable. It's not likely you'll see much of a bump in your center's net revenues if you're only hosting 10 pain cases a month. But booking 130 a month, for example, will make a huge difference. So you'll have to attract physicians who treat pain elsewhere to your facility, or enlist the assistance of a good referral system. Ask your orthopedic surgeons whom they recommend their patients to for post-op pain complaints.

Once you have the cases on your schedule, throughput is key. Make sure the cases are done efficiently and the room is turned over quickly. Many practitioners can conduct 4 patient encounters per hour. Workflow efficiency is a critical factor in ensuring that your reimbursement outpaces case and labor costs by a wide margin.

Also, plan ahead to prevent equipment use conflicts. Because our center only has 1 C-arm, our scheduler marks cases that require fluoroscopic imaging in red. That way, when pain or ortho docs request times, she can easily look across the schedule for red and conflict with others using the C-arm at the same time. If there's a conflict, a bit of scheduling diplomacy can help to keep cases moving.

— QUIET ROOM Because many pain management patients are uncomfortable on arrival, a separate waiting room from surgical patients can offer comfort.

Making room for pain
When you're adding pain management to your multi-specialty services, it's certainly possible to make do and even succeed by using the equipment you already have and your facility's existing space. As our pain case volume grew ever larger, though, we began considering the value of clinical space built specifically to accommodate it. We needed more room for our pain procedures.

In 2008, we got the state's approval for our construction plans. The plans included adding a separate entrance, dividing an existing room into a pre-op space and converting a large, previously unused space into a procedure room. The contractors walled off and ventilated out the construction area, working over the weekends. We hosted pain procedures in our ORs and worked a bit later than usual. The total cost of this renovation was about $100,000. The value of this expansion would be twofold. Any pain practitioners we might recruit would, without question, be delighted with their own entrance and patient waiting room. But the separate waiting room and pre-op area would also provide better care for pain patients, who tend to arrive in severe discomfort. A quiet, less-bright area that doesn't require mixing with surgical patients eases the path to treatment.

In addition to the renovated space, we also expanded our pain management service by hiring nurses who specialize in caring for pain management patients. Two for the pre- and post-op area and 2 for the procedure room would go a long way toward supporting the specific needs of the chronic pain patient. If business is really booming, you might find it useful to hire a couple of coders and billers specifically to handle the increased pain management volume.

Pain possibilities
We now host about 200 pain management cases a month, which keeps us busy and reimburses well. If I were a surgical administrator with blocks of OR time to fill, pain management would be the first thing I'd add. If you've got a C-arm and a table, there's no reason you can't.

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