Start your own practice??

[md2k]

I would like to hear other pain docs opinion of whether you should start up your own practice or be pimped out by a group. How hard is it to startup in a penetrated area?

---

Members don't see this ad.

 

[Aether2000]

The current medical climate (difficult to palpate) in a locale may largely determine the success of a new practice. Referrals can come from WC, PCP, surgeons, direct patient self referral, so depending on your connections, you can establish referrals from the former 3 without having to accept the latter. The breadth of services offered (medication management plus functional restoration plus interventional pain) rather than being a simple spine block jock will enhance your practice possibilities in a new area. Advanced services being offered by no one else in the area can be a useful tool for gaining referrals, but only if you market that part of the practice (marketing is not one of the strong points of Pain Medicine training). For that reason, some docs hire a slick marketing firm, or hire a Barbie look-alike to market the practice to the drooling PCPs.

 

[stim4u]

Algos:

How are you marketing in your region? Do you recommend standard newspaper ads, or have you found more benefit from radio (am vs. fm), or direct d/w PCP's? It would be nice to maket without hiring "barbie" marketers.

Thanks.

 

[Aether2000]

My situation is somewhat different...I do not market at all as I have a steady supply of referrals and a full practice. But I am adding 2 partners within the next couple of months and that may change. We plan to start off with a 4 page newsletter to selected physicians, specifically targeting groups of physicians that we want specific referrals from...for instance, targeting PCPs with nursing home populations for vertebroplasty and SCS for angina; other pain doctors for RF, cryo, intradiscal decompression, selective endoscopic discectomy, etc; neurologists for rehab services we offer through our PM&R, etc.
I plan on positive marketing only as much as I would like to point out the vastly increased costs to patients, lack of training, and shady ethics of another pain doc in town doing ageing medicine, Accuspina, and owning his own surgery center that doesn't participate in insurance forcing patients to pay thousands of dollars out of pocket for simple injections. I bite my tongue, and move on....

 

[paz5559]

My situation is somewhat different...I do not market at all as I have a steady supply of referrals and a full practice. But I am adding 2 partners within the next couple of months and that may change. We plan to start off with a 4 page newsletter to selected physicians, specifically targeting groups of physicians that we want specific referrals from...for instance, targeting PCPs with nursing home populations for vertebroplasty and SCS for angina; other pain doctors for RF, cryo, intradiscal decompression, selective endoscopic discectomy, etc; neurologists for rehab services we offer through our PM&R, etc.
I plan on positive marketing only as much as I would like to point out the vastly increased costs to patients, lack of training, and shady ethics of another pain doc in town doing ageing medicine, Accuspina, and owning his own surgery center that doesn't participate in insurance forcing patients to pay thousands of dollars out of pocket for simple injections. I bite my tongue, and move on....

Can you get paid for doing SCS with an angina indication?

 

[lobelsteve]

Can you get paid for doing SCS with an angina indication?

Is it always about the money? If it works well- ju t give them a freebee. And don't forget about PVD claudication pain either.

C'mon PAZ- it would be like putting Synvisc in an SIJ.

 

[Aether2000]

Surprisingly we did get reimbursed

 

[drusso]

Can you get paid for doing SCS with an angina indication?

Angina is not a reimburse-able diagnosis. However, if the patient has both both stable angina and a "thoracic mononeuropathy"----say involving one of the left T4-7 dermatones---then indeed this is covered.

 

[paz5559]

Angina is not a reimburse-able diagnosis. However, if the patient has both both stable angina and a "thoracic mononeuropathy"----say involving one of the left T4-7 dermatones---then indeed this is covered.

Can you give me a CMS or LCD/LMRP reference for the above?

 

[drusso]

Can you give me a CMS or LCD/LMRP reference for the above?

LCD ID 4603



Indications:

Dorsal column stimulators may be covered as therapies for the relief of chronic intractable pain under the following circumstances:

To treat chronic pain caused by lumbosacral arachnoiditis that has not responded to medical management including physical therapy. (Presence of arachnoiditis is usually documented by presence of high levels of proteins in the CSF and/or by myelography or MRI.)

To treat intractable pain caused by nerve root injuries, post surgical or post traumatic including that of post laminectomy syndrome (failed back syndrome)

To treat intractable pain caused by complex regional pain syndrome I & II

To treat intractable pain caused by phantom limb syndrome that has not responded to medical management

To treat intractable pain caused by end stage peripheral vascular disease, when the patient cannot undergo revascularization or when revascularization has failed to relieve painful symptoms and the pain has not responded to medical management

To treat intractable pain caused by post herpetic neuralgia

To treat intractable pain caused by plexopathy

To treat intractable pain caused by intercostal neuralgia that did not respond to medical management and nerve blocks

To treat intractable pain caused by cauda equina injury

To treat intractable pain caused by incomplete spinal cord injury.


Limitations:

No payment may be made for the implantation of dorsal column stimulators or services and supplies related to such implantation, unless all of the following conditions have been met:

The implantation of the stimulator is used only as a late resort (if not a last resort) for patients with chronic intractable pain.

Other treatment modalities (pharmacological, surgical, physical, or psychological therapies) have been tried and did not prove satisfactory, or are judged to be unsuitable or contraindicated for the given patient.

Patients have undergone careful screening, evaluation and diagnosis by a multidisciplinary team prior to implantation (such screening must include psychological, as well as physical evaluation).

All facilities, equipment, and personnel required for the proper diagnosis, treatment, training, and follow-up of the patient must be available.

Demonstration of pain relief with a temporarily implanted electrode precedes permanent implantation.

 

[Disciple]

Anybody considered incorporating musculoskeletal ultrasound into their practice for diagnostic purposes and/or to assist in guidance of in-office peripheral injections?

How much would such a machine cost, new or used?

Is use of this technology reimbursable for non-radiologists?

 

[Doctodd]

C'mon PAZ- it would be like putting Synvisc in an SIJ.

Steve,
Are you still using Synvisc? Even with the allergic/infectious type reactions?

T