Starting a profitable pain management practice specializing in spinal leak care allows anesthesiologists to escape the frequently chaotic environment of a hospital while still enjoying the fulfillment they get by providing relief to patients.
The field of anesthesiology is evolving, and with these changes comes a unique opportunity to specialize in spinal leak care.
As an anesthesiologist, you’re already familiar with administering epidurals and managing post-dural puncture headaches (PDPH), but you might not be aware of the increasing demand for spinal leak care. The increasing need for epidural blood patches provides a lucrative opportunity for anesthesiologists looking to transition to private practice and compete in a field with minimal competition.
Many patients with spinal leaks, regardless of their root cause, remain undertreated as their interactions with anesthesiologists are often limited in a hospital setting. You administer an epidural blood patch and witness the instant relief it appears to provide. That’s typically the end of the interaction. However, more than 58% of people with obstetric spinal leaks remain symptomatic 18 months after getting epidural blood patches.
Spinal leak care is no longer only about managing post-dural punctures; it’s a comprehensive, long-term process involving diagnostics, patient care, and a level of expertise that anesthesiologists possess.
Diagnostic challenges in spinal leak care
One of the biggest hurdles regarding spinal leak care is accurately diagnosing the patient’s condition. While acute PDPH is straightforward to recognize, diagnosing chronic spinal leaks can be quite a challenge.
Chronic vs. acute spinal leaks
Most spinal leak cases are only identified in the chronic stage due to physicians practicing a wait-and-see approach under the misconception that spinal leaks last only 7 to 10 days, which does not align with current research.
After this period, the patient’s complaints that their spinal leaks persist often aren’t taken seriously despite research reinforcing the tendency of spinal leaks to be unrelenting without proper intervention.
By the time patients are finally diagnosed correctly with a spinal leak as the underlying cause of their condition, a decade might have passed since the labor epidural with an accidental dural puncture that changed these patients’ lives and caused significant disability.
Many secondary health issues will often have emerged such as malnutrition due to secondary MCAS where patients report improvement in new-onset food and medication intolerances after a dural puncture when they finally receive a blood patch that works and increases their intracranial spinal fluid volume. These secondary health issues must be addressed as they could possibly impact the efficacy of spinal leak care such as in the case of B12-deficiency thrombocytopenia or general poor healing due to malnutrition.
Long-term care and follow-up are required to give these patients permanent relief. Anesthesiologists are rarely part of any follow-up care in a hospital setting, leading to patients wasting as much as $20,000 annually on ineffective treatments and conservative pain management like IV saline.
The challenge is recognizing that chronic spinal leaks mimic other health conditions, so more advanced, non-invasive diagnostic tools are needed.
Advanced diagnostic testing for spinal leaks
One of the reasons that led to the current spinal leak care crisis is the outdated, invasive methods many physicians use to diagnose the condition, like lumbar punctures, despite research showing that non-invasive methods like the Bern score are more effective.
Lumbar punctures focus on opening pressure despite studies showing that people with spinal leaks can remain within the normal range. The Bern score and magnetic resonance imaging (MRI) can be used to analyze brain changes consistent with spinal leaks. This use of the brain MRI with a better approach to analyzing many subtle changes in brain structures is a vital tool and diagnostic approach for identifying chronic cases that would otherwise go unrecognized.
Neurological pitfalls in spinal leak care
Despite their experience, neurologists often use outdated methods to diagnose spinal leaks. For example, a lumbar puncture might be used to check for intracranial pressure despite studies indicating many patients with spinal leaks have normal or elevated pressures. This makes lumbar punctures not only potentially harmful for patients in causing a new spinal leak or other complications but also unreliable as a diagnostic approach.
As an anesthesiologist, you can avoid these pitfalls by focusing on more precise, non-invasive diagnostic tools and approaches. This spares patients from unnecessary invasive tests while positioning you as an expert on spinal leak care who is far more capable of leading the spinal care treatment process than other specialists.
In fact, some patients report that they pay cash-based anesthesiologists $750 per epidural blood patch simply due to the fact that the anesthesiologist does not require a lumbar puncture first while many radiologists do.
Becoming the center of the care team
Some of the things anesthesiologists must do to start a profitable pain management practice include:
1. Advocacy and expertise
Anesthesiologists are in a perfect position to provide long-term care to patients who need spinal leak care because of their unique expertise in administering epidural blood patches. Anesthesiologists are equipped to manage a patient’s recovery from start to finish, which often includes educating patients and other healthcare professionals, like radiologists, about the value of non-invasive diagnostics and the need for comprehensive long-term plans.
The instant relief patients typically experience after epidural blood patches is caused by the tamponade effect, and many patients require follow-up care in as little as 48 hours.
Building solid relationships with radiologists and neurologists will solidify your central role.
2. Building a solid case for treatment
Documentation is your strongest ally regarding spinal leak care. By utilizing noninvasive diagnostic techniques like the Bern score and magnetic resonance imaging, you can make solid cases for the necessity of epidural blood patches and other treatments for spinal leaks. Research currently indicates that the blood patch is the gold standard for spinal leaks, including chronic cases. It ets a strong precedent for providing care outside the standard acute PDPH scenario.
Being thorough with your diagnoses empowers you to advocate for more effective care centered around patients while protecting you in an era of high medicolegal scrutiny.
Creating a profitable practice
Some of the steps required to start a profitable pain management practice that focuses on non-invasive spinal leak diagnosis and long-term care include:
1. Setting up a cash-based model
Starting a cash-based pain management clinic focusing on spinal leaks can be incredibly lucrative. Many insurance providers have reimbursement rates as low as $75 per epidural blood patch administered, but anesthesiologists can charge as much as $800 per patch in a concierge-style practice.
A cash-based clinic specializing in spinal leak care can earn $1,200 per patient with a monthly subscription, charge $300 per quarterly visit, and administer epidural blood patches for $800 per patch. This brings the annual revenue from each patient to about $4,000. With 100 patients, the clinic’s annual revenue would be $400,000.
2. Diversifying revenue streams
A pain management clinic specializing in spinal leak care allows anesthesiologists to diversify their earnings by offering additional services like consulting, second opinions, and patient education workshops.
A low-risk, high-reward transition for anesthesiologists
Starting a profitable pain management practice focusing on spinal leaks allows anesthesiologists to transition from the often stressful hospital environment while continuing to enjoy the fulfillment they get from providing relief to patients.
When you run a spinal leak care clinic, you have complete control of your schedule and financial freedom. The market for spinal leak care in the U.S. is estimated at almost a trillion dollars, so the opportunities are vast.
As an anesthesiologist, you already have the skills to run a pain management clinic; it’s only a matter of leaping into this specialized, financially lucrative field.
