Injections per week

[Yo GabbaPentin]

How many injections per week do you typically do? I'm not talking TPIs but epidurals, facets, rfa, etc. I think that 30-40 would be ideal.

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[SSdoc33]

40

 

[emd123]

100






















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(Jk)

 

[painfan]

Started in mid oct.
Averaging 18-20/week
40 be nice.

 

[Yo GabbaPentin]

How long does it generally take to get rolling? I'm seeing about 5-6 new patients per day.

Started in December with zero patients. Now at 15-25 injections per week. Started rolling and the first "wave" of patients either felt a lot better and went away, misused meds and went away, or opted for surgery.... and went away. I know the ones who feel better will probably return at some point but I'm in a little trough. Average about 7-8 in office injections and 12-15 ASC pet week. Really hoping to get to 35-40 on a regular basis.

 

[stim4u]

it not only about the total number of procedures only, it is about your contract fees as well.
50-80.

 

[Ligament]

My numbers have gone way down since 2014 hit.

1. Obamacare hitting us. Insurance companies now requiring pre-auths for almost everything, and issuing more denials. They are trying to hold onto money as they die off. This has decreased procedure volume, increased my staff costs dealing with pre-auths and denials, and decreased my pay.
2. 2014 Medicare rate slashes. I've stopped taking new medicare patients due to this. This has decreased my volume. Probably has had minimal impact on my income.

Either way the Marxist Tyrant Obama and his cronies initiated both problems. Fcku them.

 

[clubdeac]

In the 30's and 40's on average. Would like to consistently get 40-60. Been in pp 11 months.

 

[stim4u]

My numbers have gone way down since 2014 hit.

1. Obamacare hitting us. Insurance companies now requiring pre-auths for almost everything, and issuing more denials. They are trying to hold onto money as they die off. This has decreased procedure volume, increased my staff costs dealing with pre-auths and denials, and decreased my pay.
2. 2014 Medicare rate slashes. I've stopped taking new medicare patients due to this. This has decreased my volume. Probably has had minimal impact on my income.

Either way the Marxist Tyrant Obama and his cronies initiated both problems. Fcku them.

Amen....brother.

 

[olafa]

what was your approach to trimming medicare with your existing patients? Did you cut all commercial MC plans as well?

My numbers have gone way down since 2014 hit.

1. Obamacare hitting us. Insurance companies now requiring pre-auths for almost everything, and issuing more denials. They are trying to hold onto money as they die off. This has decreased procedure volume, increased my staff costs dealing with pre-auths and denials, and decreased my pay.
2. 2014 Medicare rate slashes. I've stopped taking new medicare patients due to this. This has decreased my volume. Probably has had minimal impact on my income.

Either way the Marxist Tyrant Obama and his cronies initiated both problems. Fcku them.

 

[Ducttape]

so... decreased volume due to not taking medicare patients.
decreased procedure due to auths.
increased staffing costs due to auths from private insurance.

so why not take a lot of medicare patients, which would increase your volume, increase your pay, not worry about prior auths (straight medicare)?

 

[bedrock]

so... decreased volume due to not taking medicare patients.
decreased procedure due to auths.
increased staffing costs due to auths from private insurance.

so why not take a lot of medicare patients, which would increase your volume, increase your pay, not worry about prior auths (straight medicare)?

Exactly. I take straight medicare, because I can do whatever I want, when I want, and no auth necessary. However I'm no longer taking new medicare advantage plans with all the rules, which never auth or pay for anything. I let my referring docs know why that is. They all hate the medicare advantage plans too, and have convinced many of their medicare pts to go back to regular medicare and we all can take care of them with MUCH less red tape,( and minimal support staff time).

 

[Louisville04]

In the 30's and 40's on average. Would like to consistently get 40-60. Been in pp 11 months.

When you worked at the VA, how many injections/week? How far out were you booking?

 

[clubdeac]

When you worked at the VA, how many injections/week? How far out were you booking?

The VA was ridiculous. I had a good nurse and got them to be pretty efficient (as far as the VA goes) actually with my procedure time . Every morning I would do procedures and would average b/w 8-10 in a morning. So I was probably doing about 40-50 a week. I was booking out 3 months on average. Ridiculous

 

[jsaul]

wow you guys are doing a lot. I have been in this practice for 4 years and get maybe 20 per week

 

[emd123]

wow you guys are doing a lot. I have been in this practice for 4 years and get maybe 20 per week

I'm in a supersaturated area for about 1 1/2 year and not up to their numbers yet, either. They should count themselves very fortunate. If I was at 40 procedures per week, that would be pretty busy.

 

[Dr. Ice]

wow you guys are doing a lot. I have been in this practice for 4 years and get maybe 20 per week

Im with Jsaul..about 18-25 per week. I took a huge hit this year because of geographic logistics, c arm location, obamacare and high deductibles. 2012 was my best year and I probably did about 30/week.

 

[futurdoc12345]

Random off topic questions for you guys with pain practices, but how many weeks do you get for vacation, I know its up to you, but it seems people go into anesthesia because no doubt its a great speciality but you get a lot of time off, then when someone decides to go into pain, they are basically doing clinic with IM hours/vacation time...

 

[nvrsumr]

Most are m-f 8-5 with 4-6wks and holidays. Home call and never go in or get calls.

 

[stim4u]

Random off topic questions for you guys with pain practices, but how many weeks do you get for vacation, I know its up to you, but it seems people go into anesthesia because no doubt its a great speciality but you get a lot of time off, then when someone decides to go into pain, they are basically doing clinic with IM hours/vacation time...

when you own your practice there is no 'vacation time'.... You take 3-4 day weekend trips every few months.... going to vegas for that pain billing conference in a couple weeks. Need to get up to speed on crappy icd 10 bullsh.t

 

[Ducttape]

when you own your practice there is no 'vacation time'.... You take 3-4 day weekend trips every few months.... going to vegas for that pain billing conference in a couple weeks. Need to get up to speed on crappy icd 10 bullsh.t

i just got an email about a webinar for $199 - pain specific. if you want info, ill PM it to you.

 

[specepic]

I am in a ortho joint group and do 'comprehensive' (i.e. lots of non-interv consults) pain so my fluoro cases are lower than average, at least c/w above. Probably 15 fluoro cases per week, and probably at least that many US cases per week. I am RVU based though so make about the same RVU/hr clinic vs fluoro in reality, esp after ESI cuts.

 

[normalforce]

60-70 flouro cases
3-4 stim trials
0-1 kypho

My PA-C does 20-30 ultrasound guided bursa, joint, carpal tunnel, etc

My NP helps me see patients....

I work 5.5 days/week

 

[Ligament]

My PA-C does 20-30 ultrasound guided bursa, joint, carpal tunnel, etc

I hope you are kidding about allowing your PA to do your injections for you!

 

[clubdeac]

60-70 flouro cases
3-4 stim trials
0-1 kypho

My PA-C does 20-30 ultrasound guided bursa, joint, carpal tunnel, etc

My NP helps me see patients....

I work 5.5 days/week

I hope you are in the top 1% MGMA with those numbers. And agree with ligament, You are training yourself into extinction. Congrats! Hopefully you'll be retired before our field is destroyed

 

[lobelsteve]

I hope you are in the top 1% MGMA with those numbers. And agree with ligament, You are training yourself into extinction. Congrats! Hopefully you'll be retired before our field is destroyed

Looks like he is the reason the field is being destroyed.

That's twice as many as the rest of us. And almost as many total patient's that we see in a week. You must be super efficient.

 

[stim4u]

60-70 flouro cases
3-4 stim trials
0-1 kypho

My PA-C does 20-30 ultrasound guided bursa, joint, carpal tunnel, etc

My NP helps me see patients....

I work 5.5 days/week

normal force, this was my work load in the past. Is is really worth all that radiation, and physical effort with the current reimbursement rates and tax rates???
For me it is not worth it. Get rid of your bad insurances, medicare/medicaid, obamacare, etc. You will live just fine with 30-50 cases per week.....
Once this socialist is out of office, it may be worth expanding again......

 

[emd123]

Dudes....

He posted that on April 1st.

 

[SSdoc33]

i dont think its a joke

 

[Tenesma]

depends on season --- busy summer month can hit 40-50/week
slow winter month w/ storms can be about 25-30/week

 

[Pain Applicant1]

60-70 flouro cases
3-4 stim trials
0-1 kypho

My PA-C does 20-30 ultrasound guided bursa, joint, carpal tunnel, etc

My NP helps me see patients....

I work 5.5 days/week

That's really busy. How do you do so many procedures, kyphos, and stim trials? Do you belong to an ortho/neuro surg group? I'd love to be that busy although I think I might burn out.

 

[nvrsumr]

50 kyphos a year and 200 stim trials... I just don't see that volume of high level of pathology but would be fun. My stim trials have fallen off a cliff in 2014 for whatever reason.

 

[bedrock]

50 kyphos a year and 200 stim trials... I just don't see that volume of high level of pathology but would be fun. My stim trials have fallen off a cliff in 2014 for whatever reason.

I don't know how you could have that volume without 3 PAs or 3 spinal surgeons, just feeding you procedures.

 

[clubdeac]

50 kyphos a year and 200 stim trials... I just don't see that volume of high level of pathology but would be fun. My stim trials have fallen off a cliff in 2014 for whatever reason.

For whatever reason... Maybe bc the procedure got raped by CMS?

 

[Ligament]

I hope you are kidding about allowing your PA to do your injections for you!

April fool's joke? Got me!

 

[willabeast]

40 or less per week

 

[normalforce]

Looks like he is the reason the field is being destroyed.

That's twice as many as the rest of us. And almost as many total patient's that we see in a week. You must be super efficient.

I have been a contributor to this website for 11 years. Steve, why do you feel the need to be judgmental when you know nothing of my clinical practice. I promise you, there is nothing wrong with how I practice medicine. Yes, we are efficient, but, you are supposed to be efficient.

I am 6 years into my practice. I have 2 C-arms, 2 ultrasound machines. I do 20-25 procedural cases (ESI, facets, SI, etc) from 7-noon, 3 days a week, using 2 Carms, no sedation for anyone except valium or Ativan. Every Tuesday from 1-5 I do stims/kyphos. usually 3 stim trials and an occasional kyphoplasty (about 15-20 cases/year).

I see NP on Monday, Wed PM, Thurs, Friday pm. Follow-ups are seen at same time period with my extenders, after their treatment plans are stable.

We have 3 docs, 1 NP, 3 PA's.

We do the numbers I posted above and we do it correctly from every clinical and ethical perspective.

NF

 

[willabeast]

i am not a judgmental person. not even close. i think most docs are judgmental. it is an asset to be judgmental in the medical profession for most of the specialties.
this is an observation i have made through the years. not a judgment

 

[Ducttape]

NF, for clarification, are you the only one doing injections, or are those numbers for each one of you?

If your office is performing 3x the numbers you posted, then it is hard to refute any claims that your office us not a block shop.

Even with the utmost in efficiency, those numbers if they were by a solo practice would put you way above the 99% - on a rough guesstimate - of magma.

 

[bedrock]

I have been a contributor to this website for 11 years. Steve, why do you feel the need to be judgmental when you know nothing of my clinical practice. I promise you, there is nothing wrong with how I practice medicine. Yes, we are efficient, but, you are supposed to be efficient.

I am 6 years into my practice. I have 2 C-arms, 2 ultrasound machines. I do 20-25 procedural cases (ESI, facets, SI, etc) from 7-noon, 3 days a week, using 2 Carms, no sedation for anyone except valium or Ativan. Every Tuesday from 1-5 I do stims/kyphos. usually 3 stim trials and an occasional kyphoplasty (about 15-20 cases/year).

I see NP on Monday, Wed PM, Thurs, Friday pm. Follow-ups are seen at same time period with my extenders, after their treatment plans are stable.

We have 3 docs, 1 NP, 3 PA's.

We do the numbers I posted above and we do it correctly from every clinical and ethical perspective.

NF

Normal force -

The question is- Do u see each patient for an office consult before they are scheduled for a procedure? Are many of these patients evaluated by one of the other two physicians or one of the mid-levels, and then simply scheduled for a procedure with you?

It's uncommon to generate 3 stim trials a week and 70 procedures a week from just 3 days of new office visits by one physician.

 

[lobelsteve]

A good part of my income is because I am paid to be judgmental. I find it hard to believe that there is a locale that has a need in the patient population for this volume of procedures. I find the sheer volume incompatible with the statistics for a given population in the USA. Unless you are the only pain doctor within 100 miles (but you posted you are not). If I can see it from the other end of a screen, think about what the RAC guys see in your CMS-1500 and UB-04's.

 

[Dr Manhattan]

i am assuming a portion of those patients are referrals specifically for a procedure, whether by PA/NP or surgeon. working within an ortho group dramatically increases procedure volume, as for them you are a proceduralist for certain patients. but the caveat is that they will tax you for a portion of your reimbursement and make you split the group's overhead

 

[bronchospasm]

40-50 fluoro cases a week.

It has been raining facets over the past few months. I have been doing about 2 RF's a day since January

Logically it makes sense worsening facet arthritis related back pain.

Have others noticed a significant increase in facet related complains during winter.

 

[willabeast]

i have noticed a lot of patients demanding i do facet RF on them. some of them have clear disc mediated pain. used to be everyone wanted opioids.
now they want RF. i figure there is a talk show on TV somewhere...

 

[Ligament]

we do it correctly from every clinical and ethical perspective.

NF

Except you are allowing your midlevels to do the injections. Great way to help destroy the field ala the CRNA and Anesthesiology all over again. There is nothing ethical about allowing midlevels to perform our work.

 

[geauxg8rs]

i have noticed a lot of patients demanding i do facet RF on them. some of them have clear disc mediated pain. used to be everyone wanted opioids.
now they want RF. i figure there is a talk show on TV somewhere...

I have seen quite a few rfa requests as well . I found out that a local pcp was telling patients that I do this "new procedure" for arthritis. About half that she sends are facet patients the other half are 20 year olds with clear cut disc
Pathology. It is nice to be "cutting edge." lol

 

[hyperalgesia]

I've also seen an increase in the rfa requests. Most patients don't want to bother with the mbb they just want to 'burn the nerve'. They already know which nerves are affected because the pain is really sharp 'right there at L5'.

 

[normalforce]

Except you are allowing your midlevels to do the injections. Great way to help destroy the field ala the CRNA and Anesthesiology all over again. There is nothing ethical about allowing midlevels to perform our work.

I can not possibly do it all. There are not enough hours in a day. Ultrasound guided joints, bursa, carpal tunnel are in no way out of the scope for a well trained PA. I liken it to IR. The PAs are doing liver, lung, kidney biopsies, unsupervised. In ortho some PAs do a lot of the surgical case.

We have to work as a team, the right way. There is no way I can do it all, but my PCP referral base expect me to take care of their patient, no matter what it is. I pride my practice on a well organized, well trained group. We work hard, we work well together. I helped write the new opioid pain laws in Indiana and our office has garnered a lot of respect for it.

And yes, my area of practice is undeserved, we get 10-20 new patient referrals a day.

The numbers above are for me. One other doc does about 1/2 that, the other is non-interventional.

 

[SSdoc33]

Undeserved? Freudian slip perhaps?

If you work hard, those numbers aren't impossible. I can think of lots more things to get upset about than a PA doing a joint injection.

 

[normalforce]

Undeserved? Freudian slip perhaps?

If you work hard, those numbers aren't impossible. I can think of lots more things to get upset about than a PA doing a joint injection.

Thank you.

I would understand the concern if it were me and 10 extenders or something crazy. Or me training CRNAs. But our group is 3 docs, 3 PAs and 1 NP. Only 1 PA is doing the peripheral injections because I taught him. And Paul Lento and Chris Visco and DJ Kennedy and Cplas and Joel Press and Gary Chimes, etc.... Taught me.

I work hard guys, that's it. Honest, ethical, good outcomes, multimodal pain.....that's what I do and try to do the best of my ability. And, my patients and medical community think it's pretty good.

So, please know what you are judging before you judge. Or, please take note of the Good Book, and try not to judge at all.