What is an Epidural Steroid Injection?
Epidural steroid (ESI) are widely used by Interventional Pain Physicians to help patients who have spinal pain. See our page about Epidural Steroid Injections if you are unfamiliar with what they are and how they help with pain management.
In what healthcare settings do patients receive ESIs?
Patients have traditionally received ESIs in one of three healthcare settings, the hospital or hospital outpatient department, a surgery center, or in the office of the interventional pain physician. All of these settings should have some common safety elements for a safely performed procedure.
- Pain fellowship board certified interventional pain physician who evaluates the patient prior to the injection and identifies the correct level and injection type
- Fluoroscopic guidance (x-ray) for proper placement of injection
- Adequate staffing to assist the doctor
- Resuscitation equipment in case of emergency
Why does the healthcare setting matter?
As long as the proper equipment and safety protocols are in place ESIs can be safely and adequately performed in any of these settings. Over time more and more procedures are being done in physician offices and surgery centers and less in the hospital setting. Part of the reason for this is that the physician office can provide a greater flexibility of times to do the procedure. At our clinic, NWA Interventional Pain, we offer appointments morning or afternoon four days a week. Hospitals or surgery centers have to follow block times, which don’t allow patients the choice in appointment times. This can lead to increased days of work missed for patients and/or their driver.
Besides greater flexibility of scheduling, one increasing factor is cost. Healthcare costs are unfortunately rising at an accelerated rate and health insurers including Medicare are passing the costs onto the patient. ESIs when done in a hospital might cost the patient $500-$1000. This same procedure with the same safety measures and medications could be done in a doctors office for less than half the cost. Insurance might pick up some of this extra cost but most Medicare and Medicare replacement plans pass this increased cost on to the patient. We’ve had Medicare patients tell our staff that an epidural at one of the local hospitals would cost them a $300 copay but when they have the same ESI done in our office it only costs them a $45 copay.
Why have hospitals been the setting for ESIs in the past?
Hospitals can provide things like Intravenous sedation for a patient that might not be able to be rendered in a doctors office. If a patient needed medication to calm their nerves this was an option for a patient. However Medicare has changed their guidelines for how ESIs should be performed and Medicare will no longer pay for IV sedation. This rule takes place nationwide 12/12/2021. If. you are getting an ESI at a hospital and expect to be sedated for the procedure you will either be denied this sedation or you will incur the sedation costs and be personally responsible for hundreds of dollars.
Why a physician office setting might be the best option for your ESI
Besides the flexibility and far lower costs already mentioned above, the changes in eliminating sedation for ESIs will not have to cause our physician office setting any change in practice. At NWA Interventional Pain we have already been doing 99% of our procedures without any IV sedation.
- We have had over a decade of practice in using far thinner needles
- Our procedure times are shorter
- We provide constant communication with the patient so as not to frighten or surprise
Thinner needles for less pain?
It takes far greater technical skill and training to do the same injection with a thinner needle. Our lumbar ESIs are done with the same thickness needle as we would use to numb your skin. Those doctors who have been relying on sedation to make up for their larger needles are going to have a more difficult time in retraining with a more bendable thinner needle. We are able to talk patients through the procedure such that most of those who are new to the process exclaim “that was it?” “I was expecting more than that.”We can still prescribe some oral medications to help with anxiety if patients are still anxious. So where we are now in late 2021 it might make the most sense to have your interventional procedures done in a doctors office. A place that already has the experience in doing injections without sedation, with greater schedule flexibility, and at far lower out of pocket cost.