Chronic pain practice without advanced procedures

[Dr. Ice]

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See other thread, where he’s the OP discussing adding it. Based on what you’ve described and the “turf issues,” I would consider punting regen to the docs who do it frequently if you have a decent working relationship and there is not a significant incentive for you to do it.

If you’re already busy, you will be looking to narrow your focus soon. Don’t add something that you’re not really in to.

If you are really interested in regen, and the option is not readily available for your patients, then I would certainly not discourage you from pursuing it.

I have added PRP to my services offered, but in the RVU model it’s not particularly lucrative. There are several other procedures that I readily punt to colleagues in different situations. I sent kyphos to a private practice doc. He does them in office, takes good care of people. Same goes for many of the newer “advanced“ procedures.

Sound advice. Thanks. I was offering it in my previous private group. Those patients have been calling for it. Honestly we didn’t charge nearly as much as many of the other private groups offering it. I’m sure that factors in. Will have to see if it makes sense, but thanks for the input

 

[specepic]

Are you RVU based? Do you do regen? If so, does it make sense to do it in that set up? I have been debating adding it, but I’m already booking out a few weeks and I’ve only been working since July. It’s also a little bit of a turf issues, as the sports guys already do it

We are considering PRP, whether we proceed will have to do with how much RVU we get, and that is unclear as of now

 

[CleanUp]

Ah yes the GLPs..no one to get an emergent surgery because anesthesia will block for fear of that undigested piece of chicken hanging around in there..,

NPO guidelines don’t apply for emergent surgeries.

 

[Centurion38]

Treat as aggressively as you desire. As you move on in your career, you realize how little a difference we make. Especially compared to diet and exercises and mental health.

Disagree here Steve. 10 years in. Sounds like burnout. Don't discount the difference you make every day

 

[Ducttape]

i have been punting BVN and ortho PRP to other docs in the area.

Ah yes the GLPs..no one to get an emergent surgery because anesthesia will block for fear of that undigested piece of chicken hanging around in there..,

involved in aspiration case when a resident at ASC. patient swears he was NPO after MN, but the amount that came out - he must have been at Golden Corral at 11:59. fortunately he was hospitalized only for a few days.

 

[DOctorJay]

Are you RVU based? Do you do regen? If so, does it make sense to do it in that set up? I have been debating adding it, but I’m already booking out a few weeks and I’ve only been working since July. It’s also a little bit of a turf issues, as the sports guys already do it

I really wanted to add it in my practice but the admin here simply wouldn't remunerate us in any other way than the current wRVU codes for "similar" injections. Not worth the additional hassle. our primary care sports med docs do PRP though.

 

[Eurycea]

Really helpful thread y'all. Early career, wondering if I even want to be doing some of these "advanced" procedures- almost feeling guilty for feeling that way. Didn't sign up to be a surgeon. Good to know it's still reasonable to not do the full spectrum.

 

[klumpke]

Sorry to keep bumping this thread lol one more question- What type of practices do you think would be more likely to hire for B&B/Peripheral joints without advanced? It sounds like maybe HOPD/Ortho groups and less likely PP Pain clinics?

Just wondering what types of groups to reach out to when looking for jobs. TIA!

 

[Dr. Ice]

Bread and butter is what drives hospital employment

 

[MitchLevi]

Every practice you apply wants you. Advanced procedures do not pay the bills. Besides, you keep the line moving and internally refer for advanced stuff and everyone is happy.

 

[mille125]

Every practice you apply wants you. Advanced procedures do not pay the bills. Besides, you keep the line moving and internally refer for advanced stuff and everyone is happy.

agreed

 

[MitchLevi]

I should also say, last yr I did around 15 less stimulators than 2024, but I did like 150 or so more basic spine injections. Overall collected less money by around $35k. Saw more clinic pts in 2025 as well. Found that sort of weird.

 

[Taus]

I should also say, last yr I did around 15 less stimulators than 2024, but I did like 150 or so more basic spine injections. Overall collected less money by around $35k. Saw more clinic pts in 2025 as well. Found that sort of weird.

Prob easiest explanation is payor mix

Also site of service, office global fee vs asc pro fee

 

[MitchLevi]

Prob easiest explanation is payor mix

Also site of service, office global fee vs asc pro fee

Did more office procedures actually.

Made more money overall bc the ASC is busy and doing well. I do 38% of my stuff in an ASC. The growth in that surgical center has been good. It’s annoying to be in there and I dislike a lot of the ppl who work there

 

[Taus]

Did more office procedures actually.

Made more money overall bc the ASC is busy and doing well. I do 38% of my stuff in an ASC. The growth in that surgical center has been good. It’s annoying to be in there and I dislike a lot of the ppl who work there

Got it. Payor mix then

 

[mille125]

I should also say, last yr I did around 15 less stimulators than 2024, but I did like 150 or so more basic spine injections. Overall collected less money by around $35k. Saw more clinic pts in 2025 as well. Found that sort of weird.

Get a billing audit...That doesnt sound right to me.

 

[mille125]

I guess it could be payor mix but would your payor mix change that much?