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Winter 2009

Building a Successful Pain Practice

Ruth D. Morton, Ph.D.
Vice President for Administration & Organizational Development Anesthesiologists Associated, Inc. (AAI)

Meet AAI client William Binegar, MD, who practices in the relatively small market of Boise, Idaho. Boise is a small city (pop. 200,000) surrounded by a rural area where a board certified anesthesiologist might not see much potential for building a pain practice. But Binegar possessed the vision, motivation, business acumen, and clinical skills to build what has become a successful pain practice.

Dr. Binegar started practicing in Boise in 1991 after completing his anesthesia residency at the Mayo Clinic in Rochester. As a member of a group providing anesthesia at a local hospital he was given some pain cases that utilized his training in the sub-specialty of Interventional Pain Management. Binegar became board certified in Pain Management in 1994, shortly after the first certification exam was offered. From there, responding to the need in the Boise community, the pain practice gradually grew as he transitioned from the OR into a full pain practice through the hospital’s pain management services.

With a sound business plan that included an emphasis on marketing, Dr. Binegar launched his own practice in early 2004. He bought and rehabilitated a building in the city core with good visibility and in a high traffic location. His RN wife, Wendy Binegar, with sound business and marketing instincts, guided many aspects of the construction, clinic set-up, and marketing. They hit the ground running. While he initially feared that business would be slow and that he would need to tap the line of credit he had arranged, the fear was unwarranted. In four years the business has experienced steady growth. Today, Dr. Binegar enjoys a robust and satisfying practice—Pain Care Boise&,dash;that employs a PA, five medical assistants, a Nursing Administrator, and a Practice Representative at his pain clinic and AAAHC fully accredited ambulatory surgery center in downtown Boise.

Factors Contributing to Growth and Success

When Dr. Binegar started he was among the first in the greater Boise area to provide chronic pain services. But today there is more competition with at least 15 pain practitioners and a pain center at one of the two largest hospitals. Several factors have contributed to the growth and success of Pain Care Boise despite the increasingly competitive environment.

Clinical Expertise and Motivation

Dr. Binegar is board certified in both Anesthesiology and Pain Medicine, and he keeps current with new technology, techniques, and treatments through CME courses. He has gained the confidence of referring physicians, whom he regards as customers in this context, with referrals from well over 200 referring physicians in a year. Among them are orthopedic surgeons, neurosurgeons, neurologists, chiropractors, oncologists and family practitioners. By providing services in both a clinic and an ASC, he has diversified his product line to include:

    • Spinal Cord Stimulation
    • Radiofrequency Ablation
    • Peripheral Nerve Injections
    • Discograms
    • IntraDiscal ElectroThermal Annuloplasty
    • Coblation/Nucleoplasty
    • IDD Therapy / Advanced Traction Technology
    • Stellate Ganglion Blocks
    • Lumbar Sympathetic Blocks
    • Epidural Steroid Injections/Interlaminar Technique
    • Nerve Root Injection/Tranforaminal Epidural
    • Facet Joint Injections

Dr. Binegar uses his skills and has invested in current technology and competent staff to aid him in providing “treatment for improved life.” In part, this tag line of his practice informational material reflects his motivations. He enjoys performing interventions, talking with patients and getting to know them. Helping patients with their pain – having them return and say “You saved me” – is very satisfying. The gratitude of patients is evidenced by several hand-written “thank you” notes posted behind the scenes on the clinic lunch room bulletin board. Beyond the satisfaction of his work, clinic and ASC ownership provides independence from the dynamics of the hospital and surgeon relationships, and supports his own quality of life and family lifestyle with no call or night-time trauma work. And, in turn, he is dedicated to improving the quality of life for all whom he treats.

Patient Focused Care and a Caring Clinic/ASC Environment

Observation of the Clinic and ASC during business hours reveals many examples of intentional patient-focused practices and protocols that Pain Care Boise has developed. Patients are welcomed warmly by front office staff. Wait times are kept to a minimum by appropriate scheduling and efficient work flow design, so patients feel valued and important. Interactions with patients are respectful and friendly without seeming patronizing. Staff members take time to listen to patient stories and field their expressions of angst. Patients are provided with written information about procedures and treatments that help them make informed decisions. The practice web site provides downloadable patient forms that can be completed at the convenience of the patient. When scheduling new patients who have no internet access the office mails a packet complete with information about the practice, financial information, printed forms, a business card, and HIPAA materials.

The clinic and ASC physical environments were carefully designed and decorated to be friendly and comforting as well as safe, efficient, and professional. Dr. Binegar intentionally reinforces the facility design as he purposefully takes his time with patients, and focuses on enjoying what patients bring to him, while also staying on task and on time.

Exceptional Marketing and Communication

Pain Care Boise utilizes a multi-dimensional approach to marketing and branding that others can emulate. First and foremost they have a clear marketing plan. Second, they have one individual in charge of marketing. Their approach to patient care, the patient experience, and “treatment for life” are integral to their branding and the practice identity. All elements of their marketing weave similar messages and themes — whether in their user-friendly web site (“”), their print informational materials for patients and physicians, or their billboard, newspaper, or radio ads. They utilize patient testimonials excerpted from the patient satisfaction surveys they routinely conduct and from voluntary expressions of gratitude sent to the practice. Testimonials, along with information about Dr. Binegar, are played while telephone callers are placed on hold. Patients recently gave live testimonials for radio spots produced at a local station studio.

Two other elements are key components of their marketing and communication process: 1) a strong tracking and referral program, and 2) a comprehensive internal marketing program.

Referral Program—Essential to launching any new specialty practice is the referral chain. Wendy Binegar initially took on the role of Practice Representative to reach out to potential referring physicians, educate them about services, and ensure that communication is effective in maintaining a referring relationship once established. Care is taken to provide appropriate patient information to referring physicians so they are assured of their patient’s care. When patients come on their own, they are asked the identity of their primary care physician, and if it is permissible to share treatment information with the other physician. If the patient agrees, Dr. Binegar sends a report to the primary care physician as a courtesy. In this process of “reverse referral”, the Practice Representative follows up with a letter and visit to the physician, providing information on all the services provided by Pain Care Boise.

Additionally, referrals often come from satisfied patients. When patients are the source of a referral, Dr. Binegar calls them to thank them for their trust and their referral. Dr. Binegar also annually meets individually with physicians who give him frequent referrals, seeking to learn if he is accomplishing what the referring physicians intend.

Internal Marketing—Office staff are responsible for helping the practice deliver on its brand promise. They reinforce, through their behavior, a caring and competent practice. They also utilize protocols and “scripts” that help them listen to potential patients carefully; ask questions that solicit information relevant to future treatment; provide information about Dr. Binegar, treatments, insurance, and costs, and guide patients and potential patients appropriately.

Excellent Employee Programs

Employees are selected and developed in alignment with the practice goals of high clinical quality and a caring environment. Clinical protocols were developed and documented to guide staff in preparing and assisting in the treatment of patients. Office procedures were also developed and documented and all medical assistants are cross-trained in their roles in both the clinic and ASC, as well as in office positions. An employee manual spells out employment policies, benefits, and expectations. Innovative incentives for efficiency and new patient scheduling, celebrations of marriages, birthdays, and births, and employee social events build staff camaraderie and enhance staff commitment to the practice. The range of excellent employee programs increases the capability of employees, in marketing terms, “to deliver on the brand promise.”

Billing Partner that Supports the Business Goals

Integral to the successful growth of Pain Care Boise has been its relationship with its billing company – Anesthesiologists Associated, Inc. (AAI), which is now the West Coast division of ABC. Based in Oregon, AAI, with a nearly 50 year history of serving anesthesiologists, provides expertise in facility and anesthesia and pain billing. AAI’s approach to business echoes Dr. Binegar’s approach to his customer – it makes the practice feel “valued” and know that AAI will do what it takes to make things better. This has meant being responsive to his questions and concerns, providing great follow-up, and delivering information and reports that he needs. For example, when Dr. Binegar needed to know which procedures were profitable, AAI implemented a tracking system that provided data on payments by insurance carriers. Overall, AAI was and is very willing to work with Dr. Binegar and his staff and to grow with the practice. ABC is likewise delighted to continue supporting AAI and ABC clients in all their endeavors.

Starting or Growing Your Pain Practice

The decision to start or grow a pain practice is one that merits in-depth consideration – of market, lifestyle, finance, clinical expertise, referrals, human resources, facilities, etc. Dr. William Binegar’s success in building his pain practice provides a solid model for those posed to make such a decision.

For a review of factors to consider in starting a pain practice, see “Group Considerations in Anesthesia Group Pain Practices” by Paul Kennelly, AAI Regional Director, in this issue of the Communiqué.