Here are five thoughts on targeted injections with Dr. Michael Port of DISC Sports and Spine Center in Marina del Rey, Calif.
1. Treatment is moving beyond epidural steroid injections. Dr. Port says in the past, a diagnosis of back pain automatically precipitated an epidural steroid injection. However, he says, the way back pain is diagnosed and treated has come a long way since then.
"The newest approach is a more targeted, minimalistic approach," he says. "It used to be that everything equaled epidural steroid injection. Back pain was one category of pain. If you had back pain, you got an injection."
2. Targeted injections can treat small problems that might have been dismissed before. Small injuries, such as tiny disc bulges or a small annular tear in a disc, are often dismissed in most patients. The physicians at DISC work regularly with elite athletes and are practiced at identifying small injuries and treating them appropriately.
"Athletes are at a higher level; they are being pushed to the brink everyday," he says. "If there's even one little thing out of whack, it can cause a problem."
One of the ways they treat pain in both athletes and other patients is through targeted injections rather than an epidural steroid injection that can treat pain in many areas of the body. Using targeted injections ensures the patient undergoes the least invasive surgery required to get the job done by avoiding operating on unnecessary levels.
3. The use of ultrasound guidance allows for the targeted approach. One of the ways physicians have been able to perform targeted injections is through the use of ultrasound guidance. The center's physicians use ultrasound guidance for interscalene blocks for rotator cuff surgeries and femoral blocks for ACL repair, for example. Using ultrasound guidance allows physicians greater control over exactly where the injection goes.
"With the ultrasound, you're actually seeing the nerve structure," Dr. Port says. "You can see the needle go in. You can see it fill up the nerve sheath."
The ultrasound provides high resolution images without the radiation associated with X-ray exposure, and Dr. Port says physicians are starting to use ultrasound guidance for epidural steroid injections, which are still one of the most common procedures interventional pain management physicians perform.
4. The equipment is costly, but reimbursement is good. The biggest capital expense in order for a practice to add targeted injections is the cost of the C-arm for fluoroscopy guidance or the ultrasound technology. Dr. Port says a C-arm can cost from $20,000-180,000 depending whether it's used or new. He says C-arms can also be leased on a per-day basis.
Physicians can still bill ultrasound use as a separate CPT code on top of the code for the injection itself. Beginning this year, imaging (fluoroscopy or CT) is now included in the procedure code for epidural steroid injections, whereas in the past, it was an additional code.
5. Effective communication is key for marketing targeted injections. DISC treats elite athletes — including the United States Olympic Team, Red Bull's North American athletes and the Los Angeles Kings — who are more aware of treatment options, but for regular patients, Dr. Port says effective communication is key. He says the best way to market targeted injections is actually through associating with reputable spine surgeons and developing a relationship with each surgeon to enhance patient referrals.
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1. Treatment is moving beyond epidural steroid injections. Dr. Port says in the past, a diagnosis of back pain automatically precipitated an epidural steroid injection. However, he says, the way back pain is diagnosed and treated has come a long way since then.
"The newest approach is a more targeted, minimalistic approach," he says. "It used to be that everything equaled epidural steroid injection. Back pain was one category of pain. If you had back pain, you got an injection."
2. Targeted injections can treat small problems that might have been dismissed before. Small injuries, such as tiny disc bulges or a small annular tear in a disc, are often dismissed in most patients. The physicians at DISC work regularly with elite athletes and are practiced at identifying small injuries and treating them appropriately.
"Athletes are at a higher level; they are being pushed to the brink everyday," he says. "If there's even one little thing out of whack, it can cause a problem."
One of the ways they treat pain in both athletes and other patients is through targeted injections rather than an epidural steroid injection that can treat pain in many areas of the body. Using targeted injections ensures the patient undergoes the least invasive surgery required to get the job done by avoiding operating on unnecessary levels.
3. The use of ultrasound guidance allows for the targeted approach. One of the ways physicians have been able to perform targeted injections is through the use of ultrasound guidance. The center's physicians use ultrasound guidance for interscalene blocks for rotator cuff surgeries and femoral blocks for ACL repair, for example. Using ultrasound guidance allows physicians greater control over exactly where the injection goes.
"With the ultrasound, you're actually seeing the nerve structure," Dr. Port says. "You can see the needle go in. You can see it fill up the nerve sheath."
The ultrasound provides high resolution images without the radiation associated with X-ray exposure, and Dr. Port says physicians are starting to use ultrasound guidance for epidural steroid injections, which are still one of the most common procedures interventional pain management physicians perform.
4. The equipment is costly, but reimbursement is good. The biggest capital expense in order for a practice to add targeted injections is the cost of the C-arm for fluoroscopy guidance or the ultrasound technology. Dr. Port says a C-arm can cost from $20,000-180,000 depending whether it's used or new. He says C-arms can also be leased on a per-day basis.
Physicians can still bill ultrasound use as a separate CPT code on top of the code for the injection itself. Beginning this year, imaging (fluoroscopy or CT) is now included in the procedure code for epidural steroid injections, whereas in the past, it was an additional code.
5. Effective communication is key for marketing targeted injections. DISC treats elite athletes — including the United States Olympic Team, Red Bull's North American athletes and the Los Angeles Kings — who are more aware of treatment options, but for regular patients, Dr. Port says effective communication is key. He says the best way to market targeted injections is actually through associating with reputable spine surgeons and developing a relationship with each surgeon to enhance patient referrals.
Related Articles on Pain Management:
Bringing Laser Therapy Into a Pain Practice: Q&A With Dr. Curtis Turchin of Pivotal Health Solutions
8 Statistics on ASC Pain Management Case Revenue Based on Net Revenue
5 Ways to Boost Collections at Pain Management Centers