5 Big Revenue Generators for Spine Practices

Written by Laura Dyrda | September 24, 2012 | Print  |
Here are five big revenue generators for spine surgery practices.
1. Pain management specialists. Spine practices will boost their revenue by keeping specialists and services in-house. "It makes economic sense to keep everything under one roof," says Hal Blatman, MD, founder of The Blatman Pain Clinic in Cincinnati.

Besides bringing in additional patients and keeping referrals in-house, partnering with a pain management physician can increase revenue because surgeons can spend more time in the operating room with surgical patients while pain management physicians treat the pain patients. "The practice becomes more lucrative because the surgeon makes more money doing surgery, so they should spend time doing that," says Dr. Blatman. "The pain physicians have their own expertise and can deal with patients who don't need surgery."

Bringing on pain management physicians and other back pain specialists can increase patient flow to the practice. At The Southeastern Spine Institute, physicians do more than 1,000 injections and rhzotomies per month. Overall, the pain management physicians have performed spinal cord stimulator implantations for 7,000 patients since joining the practice. The increased patient flow means additional revenue, and if the patients reach a point where non-operative care isn't effective, they will use your surgical services as well.

"It's convenient because we are in the same building, so the surgeons will send patients to the pain management physicians, but it's also not unusual for pain management physicians to send us their patients who have developed more complex problems, such as disc degeneration," says Don Johnson, MD, medical director at Southeastern Spine Institute. "When their patients have a new trauma, I get a call from the pain management physician saying they have a patient they need the surgeon to see right away. We can deal with those patients here as well, so it's not a one-way referral street."

2. Ancillary service lines. Including ancillary services at your practice can bring in additional cases to enhance the practice's overall revenue stream. Dennis Crandall, MD, who now serves as the practice president and CEO at Sonoran Spine Center in Phoenix and his partners are exploring ancillary services as a new way to bring revenue into the group. Sonoran Spine Center currently includes an in-house X-ray and physical therapy.

"Most practices have an X-ray, but since we do a lot of spinal deformity cases we have a machine that allows us to shoot 18x36 inch long spine films," Dr. Crandall says. "That's something that can't be done at just any outpatient radiology center, so we brought it in-house."

When it was time to bring in physical therapy, Dr. Crandall was initially skeptical of its profitability because overseeing the collection of $10-$20 copays can be onerous; the office staff spend time tracking down these small payments, which may not amount to much value. However, soon after incorporating those services the profitability became clear.

"It really has been a good, revenue positive decision to add physical therapy," he says. "We have tight control on the therapists and how the therapy is delivered. Our communication between the physicians' and therapists' offices is fantastic, which makes working together with a patient so much easier."

Now, when Dr. Crandall recommends therapy for the patient, he can call a therapist into the office to the office during the patients' visit to discuss their treatment plan. This boutique level of care projects a positive image of the practice with highly integrated care.

3. Ambulatory surgery centers. Single-surgeon or small group practices depend on case volume to drive their business, but in today's market that revenue stream alone often runs dry. Surgeons can supplement their private practice income by investing in a surgery center, which doesn't necessarily have to include 10 or more surgeons to become profitable.

"Surgeons are dependent on how many cases they do, and if they aren't operating on many there is no revenue," says Khawar Siddique, MD, a California spine surgeon with Beverly Hills Spine Surgery. "Surgeons have to break that thought and turn to ancillary income. The single most important thing that has helped Beverly Hills Spine Surgery is going into the ASC business."

Benefits of owning and operating a surgery center include the independence of running your practice and flexibility in taking care of patients. However, surgeons should be careful not to violate federal or state laws about physician ownership of surgery centers.

"The first thing you have to do is hire a good healthcare attorney who knows the surgery center business and understands how to structure it in your state so you don't violate any laws," says Dr. Siddique. "You can't do it by yourself, but you can have a profitable surgery center with just four surgeons who are committed to bringing cases. If you do it right, you can get a return on investment in a few years. Our surgery center was profitable from the first month and we had a return on investment in two years."

4. Minimally invasive procedures.
Knowledge and ability of minimally invasive techniques allow you to perform cases at outpatient surgery centers, which can enhance your profitability. Once you are a partner with an ASC, or have permission to bring cases to the center, that can help you build referrals.

"Other partners of ASCs tend to have referral sources, such as related health care providers," says Dr. Massoud. To jumpstart increasing patient volume for the practice, identify a high volume partner organization where spine procedures are not currently done. "That can help you build your practice," says Brian Massoud, MD, an orthopedic spine surgeon at Spine Centers of America in Fair Lawn, N.J. "Plus they can benefit from the ASC membership." Additionally, if you decide to be a partner at a surgery center you would be a stakeholder and could share in profits from the center.

Minimally invasive techniques increase your exposure inside and outside your community. If you can build a level of expertise where you become a respected minimally invasive surgeon, you may become involved in a variety of activities that increase your exposure.

"You can receive a teaching affiliation which could really get your name out there. If potential patients research you and see you teach courses at a local university or medical school, and that you are instructing other physicians regularly, they would have more assurance that you are skilled in those techniques," says Dr. Massoud. "That is how a teaching affiliation becomes valuable for patient referrals."

5. Social media marketing.
Most spine practices and surgery centers are seeking to use social media as a form of marketing and engagement with the public, but some may have questions about how to best utilize Twitter, Facebook and other social networks in a savvy way that leads to more patients. Identifying stories or issues that are making headlines and adapting them to involve spine health is one way to "inject yourself into the social stream of consciousness," Mr. Goldberg says. "Social media is a great way to increase your exposure as well as highlight your accomplishments"

But, he adds, content should never be overly promotional. "A spine center's blog should become a resource for information, instead of a solicitation for services," he says. The key is to be subtle about the spine centers' use of social media. "Entice users to want to visit your pages or read your content by making it interesting and relevant," he says.

"For instance, if there is a story about an athlete who had a spine injury, write or blog about that athlete and then let readers know of your services and how your practice can help if they have a similar injury." Mr. Goldberg adds that patient testimonials are a great way to promote without sounding too promotional.

"The goal of social media is to drive traffic to your website where they can get more information about your practice and services," Mr. Goldberg says. "Very few people will call to make an appointment because they saw you on Twitter, but they may see something relevant on your Twitter account and then navigate to your website."

Blogging, Twitter and Facebook are one "cog in the machine of branding," as Mr. Goldberg puts it. He says that taking a multi-faceted approach to branding and marketing will yield the highest results for a spine center or other specialty clinics. 

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