The overlooked chronic spinal leak care market is valued at a conservative estimate of approximately $400 billion in the US. This market offers a career path for anesthesiologists who are wondering how to start a pain management clinic as a cash-based anesthesia business model.
You're probably familiar with the seemingly instant relief an epidural blood patch provides to patients dealing with post-dural puncture headaches (PDPH) if you're an experienced regional or obstetric anesthesiologist. One moment, your patient is in agony, and relief comes instantly once the patch is administered. Many anesthesiologists live for such moments because of the satisfaction they get from providing what appears to be immediate relief for their patients.
While you may be limited in your ability to administer epidural blood patches in a hospital setting–both due to other physicians failing to diagnose and put in an order, and due to insurance reimbursement rates, the reality is that patients are spending $500 to $750 cash per blood patch with anesthesiologists in private practice, over $10,000 cash on a myelogram with the hope of then being given a blood patch for which they would also pay cash, and paying $24,000 out-of-pocket on IV saline as a known conservative treatment option long-term.
Current research by anesthesiologists has shown that the idea of PDPH being self-limiting does not hold water. This longitudinal research study showed that the majority of people who had an accidental dural puncture will continue to be symptomatic at 18-month follow-up points. As the authors in this groundbreaking study highlighted, the financial implication for the patients here is significant.
The immense demand worldwide for spinal leak care due to untreated or inadequately treated spinal leaks has thus created this large market. These patients predominantly receive care from interventional radiology despite anesthesiology’s superior epidural skills and knowledge of flow dynamics due to radiology’s availability and awareness of chronic spinal leaks. Anecdotally, patients overwhelmingly report a greater emphasis on avoiding invasive testing in anesthesiology and of better patient outcomes in anesthesiology.
The primary issue is access in an outpatient setting as many physicians who moved from a residency in anesthesiology to a pain management fellowship and then a pain management private practice have not performed blood patches in private practice unlike anesthesiologists who spent a decade or more having to meet strict quality and performance requirements in a hospital setting.
The end result is a satisfying and lucrative opportunity for anesthesiologists ready to step out of the hospital system and start a cash-based pain management clinic.
Understanding spinal leaks and why pain management clinics best serve patients
Working as an anesthesiologist in the typical hospital environment gives a narrow view of the epidural blood patch procedure. Patient interactions are typically limited to a single encounter when providing the patch. Most patients display drastic improvements once the treatment has been completed and are soon discharged from the hospital. This is typically where the interaction ends.
The immediate relief patients experience after getting an epidural blood patch may be only temporary, caused by the tamponade effect, which occurs when the injected blood compresses the spinal cord, pushing cerebrospinal fluid into the head.
While cerebrospinal fluid being pushed into the head and buoying the brain provides instant relief, it isn't the healing mechanism of epidural blood patches. The actual healing mechanism occurs when the blood clot formed by the patch encourages fibroblast activity, which helps heal the dura.
Research has replicated the long-held assertion that approximately half of the patients who get epidural blood patches within 24 to 48 hours after a puncture will experience a blood patch failure and need a repeat patch–even if the patients experience the first phase of relief due to the tamponade effect. A blood patch is not determined as success or failure based on the presence of immediate relief but on the presence of lasting relief starting within 48 hours after blood patch administration according to Shin (2022) as one of the leading articles on the topic listed by the American Society of Anesthesiologists.
However, testing success versus failure of an epidural blood patch by lasting relief rather than immediate relief is often not practiced. Patients with immediate relief from a blood patch may return home only for their relief to disappear within a few days. The idea that a blood patch works an arbitrary percentage of time–not taking into account the many variables involved in patching–may lead to physicians viewing blood patches as working 95% of the time and rounding this up to 100%, believing that any person patched in any way should be automatically healed and lingering symptoms involve other diagnoses. Many anesthesiologists only interact with patients once, so they miss out on the opportunity to understand and refine how they address spinal leaks.
The market for pain management clinics offering spinal leak care: A hidden goldmine
Spinal leaks, ranging from those caused by epidurals given during labor to those caused due to disc issues, are more common than many realize, with over 2 million new cases in the U.S. annually from iatrogenic spinal leaks. Many of these patients often receive inadequate treatments, like a single epidural blood patch or misdiagnosis. This has created a large market for underserved patients willing to pay for more effective long-term care.
Patients who have spinal leaks spend an average of about $24,000 annually on unnecessary procedures due to being misdiagnosed and for conservative symptom management. Many patients are willing to pay for out-of-pocket care that targets their condition's root cause and provides long-term relief.
A cash-based, subscription spinal leak care clinic that offers personalized, long-term treatment plans for spinal leaks can charge around $4,000 per year to provide effective care, which is only a fraction of patients’ medical bills on misdiagnoses and costs from loss of income.
The bottom line is that it’s cheaper for patients to thrive from competent spinal leak care from anesthesiology than it is to suffer while struggling to survive. With a subscription business model that charges each patient $100 per month as the subscription fee, $300 per quarterly visit, and $800 per blood patch with an estimate of two blood patches needed per person per year, retaining 100 patients per year provides $400,000 in annual recurring revenue.
At Medical Office Marketing, we don’t stop there as we recognize the importance of continuing education and of community involvement for physicians. We focus on adding business-to-business (B2B) elements as corporations want to invest in improving employee absenteeism due to spinal leaks and as non-profits want to partner with for-profits to create community education materials on spinal leaks.
This adds a non-clinical, low-overhead revenue source for anesthesiologists with their own business that allows them to value their time highly while reviewing current research and teaching community members on current research. Diversifying revenue sources is key when creating a strong foundation for growth in business.
Setting up a pain management clinic as an anesthesia business model: A pathway to freedom and fulfillment
Leaving the hospital system to start a private clinic might be daunting, but it comes with many rewards, primarily if your clinic focuses on treating spinal leaks. You'd have a regular 9 to 5 schedule with a patient load of about 100 to 200 patients annually.
The atmosphere of a private clinic allows for a more meaningful doctor-patient relationship, and unlike when working within the hospital system, you get to see the long-term impact of the care you provide to your patients.
Let's play with the numbers.
Charging 100 patients $4,000 yearly gives you $400,000 in annual recurring revenue. Double your patient load, and you're at $800,000. You can increase your earnings further by offering additional B2B services for non-clinical services such as community education projects.
Using this approach for your anesthesia business model also allows you to educate your patients about more accurate diagnostic tools, like the Bern score, which is more effective than conventional tools for diagnosing spinal leaks like lumbar punctures, which only measure opening pressure. Patients with spinal leaks can have normal opening pressure, leading to them being misdiagnosed.
You can differentiate your pain management clinic from the competition by positioning yourself as a spinal leak care expert who uses cutting-edge, non-invasive diagnostic tools and minimally-invasive treatments.
A more rewarding career path: Fulfillment, financial success, and patient impact
Specializing in spinal leak care offers a unique opportunity for anesthesiologists who are wondering how to start a clinic and looking for ideas for an anesthesia business model. You can walk away from the high-stress environment of hospitals and focus on a high-demand area where you can truly make an impact while being valued for your time in cash.
The spinal leak care market is enormous, largely untapped, and fast-growing. You get to make a significant difference in the lives of patients who are desperate for effective care, guide them through their recovery journey, and enjoy the rewards of running a cash-based pain management clinic
