Clinical Component

Navigating the Clinical Component

At Comanche County Memorial Hospital, the clinical setup is tailored to ensure optimal efficiency, patient care, and professional growth for the incoming Pain Management Specialist. The hospital's emphasis on patient-centered care is reflected in the resources, facilities, and support available to the medical team.

The Practice
The new pain management doctor can focus on interventional pain management or add some medical pain management. You can grow your practice the way you want to. We do spines, joints and migraines, and Botox for migraines, and there is no real competition to do certain procedures. Dr. Berry will be leaving by March 2025 to be closer to family. He came here 15 years ago out of PMR training but is not fellowship trained in Pain Management. He grew up in Tulsa but was familiar with Southwest Oklahoma.

A new pain management doctor can be residency trained in anesthesiology or Physiatry. There is a need for a general PMR that would like to spend their outpatient practice doing a lot of pain management, and if they can do EMG’s there is a great need. We have an EMG machine to do Botox for spasticity. The new doctor could also do work in brain injury, head strokes we can Botox their arms, set them up for therapies and work with bracing companies for splits. Our other PMR (name?) just does inpatient only. Dr. Berry covers the inpatient unit, when he is on vacation about 4 weeks a year. Dr. Berry also takes call every other weekend for the inpatient unit, but he rarely gets called in, since they typically call the inpatient PMR guy.

We have an injection suite next to the clinic and the hospital does the billing. We typically do not use anesthesia in the clinic but may give a patient a valium. We have one c-arm and working on getting a second c-arm for our second procedure room. We have a need for some medical pain and that percent of your practice is up to the new provider . We have a lab that does quantitative analysis that the practice needs. Our lab uses LCMS liquid crystal mass spectroscopy to help us minimize risk with our patients. For our dependency patients, we have a contracted drug screen company that is in house and collects all the drug screens that get sent out. This helps control our medication management program

Dr. Hanna has been in town for 25 years. His wife is an oncologist. He is well liked and performs epidurals, cervical, lumbar and thoracic we do spinal cord stimulations as well as radio frequency ablations. We order a lot of physical therapy for our patients. We treat cancer patients and prescribe opioids for those patients. As a practice, we are not actively prescribing opioids but treat those patients and try and get them clean. We have chronic pain patients and practice evidence-based medicine for those patients and all our patients. Our first approach with chronic pain patients is to provide injections and non-opioid therapies first.

We have 15-minute slots and can see 20-24 patients. The clinic is upstairs and the rehab unit is downstairs. Our support staff will enter the pain score and risk assessment scores into the history of present illness. We have a certified medical technician program at the hospital to help keep enough support staff. It’s not too busy of a practice. On Mondays he will see 8-10 new patients. On procedure days he can do 14-16 epidurals and on clinic days he can see 20-24 patients. We have two procedure rooms. Dr. Hanna takes a half day on Friday and sees 12-15 patients. We have 3 RN’s on the procedure side with 2 Radiology Technicians with a fluoroscopy machine. On the clinic side we have 3 LPNs, 3 staff members that do insurance and 3 staff in front. Chris is our nurse practitioner and has been with us for 2 years. His wife is one of our OBGYNs. He sees follow up patients now and does some trigger point injections. But when Dr. Berry leaves, he will see some new patients too, with Dr. Hanna doing the procedures.

We use e-Clinical Works EMR for another 2 years but migrating to Meditec in summer 2026. Our inpatient software is Paragon that will migrate to Meditec. The injections are done under Paragon and the outpatient is done in e-Clinical Works, but the staff has a work around to ease that administrative process. 

Scope of Practice:

  • Interventional Pain Management: The primary focus includes a variety of procedures such as cervical, thoracic, and lumbar epidurals, radiofrequency ablations, spinal cord stimulator trials, and joint injections. These are conducted under fluoroscopy in state-of-the-art procedure rooms.
  • Medical Pain Management: Opportunities to incorporate treatments such as Botox for migraines, management of spasticity, and opioid dependency treatment. The practice actively minimizes long-term opioid use and prioritizes non-opioid therapies.
  • Diverse Patient Base: Includes chronic pain patients, cancer pain cases, and individuals requiring dependency management. Acute pain management is typically limited to current patients experiencing acute exacerbations.

Clinic Infrastructure:

  • Integrated Setup: The clinic and procedure rooms are conveniently located within the same facility, eliminating the need for travel. The clinic is upstairs and the rehab unit is downstairs. Our support staff will enter the pain score and risk assessment scores into the history of present illness. We have a certified medical technician program at the hospital to help keep enough support staff.
  • Dedicated Procedure Rooms: Two well-equipped procedure rooms, with plans for an additional C-arm to improve throughput and efficiency. We have an injection suite next to the clinic and the hospital does the billing. We typically do not use anesthesia in the clinic but may give a patient a valium. We have one c-arm and working on getting a second c-arm for our second procedure room. We have a need for some medical pain and that percent of your practice is up to the new provider .
  • Laboratory Services: Onsite lab offers advanced quantitative analyses using LCMS technology, supporting precise medication management and ensuring patient safety.
  • Support Staff: Comprehensive support includes:
    3 RNs on the procedure side.
    2 Radiology Technicians specializing in fluoroscopy-guided interventions.
    A robust clinic team with 3 LPNs and dedicated administrative personnel.
    Nurse Practitioner (Chris) with us for 2 years (wife is OBGYN in town) He sees follow up patients now and does some trigger point injections. But when Dr. Berry leaves, he will see some new patients too, with Dr. Hanna doing the procedures.

Patient Flow and Scheduling:

  • Daily Caseload: Providers can expect to see 20–24 patients, with 15 minute time slots, in the clinic and handle 12–16 procedures on designated procedure days.
  • New Patient Appointments: Mondays are reserved for initial consultations, with 8–10 new patients typically scheduled.
  • Follow-Ups: Nurse practitioners and support staff facilitate follow-up appointments and preliminary patient workups to optimize physician efficiency.

Collaborative Environment:

  • Team Approach: The clinical team includes a nurse practitioner experienced in trigger point injections and medication management. Collaboration with other specialists and physical therapy services ensures a comprehensive approach to care.
  • Flexible Practice Design: Physicians are encouraged to tailor their practices to include areas of interest such as EMGs, stroke recovery, or spasticity management.

Technological Advancements:

  • EMR Systems: Currently utilizing eClinicalWorks for outpatient and Paragon for inpatient documentation, with a transition planned to a unified Meditech system in 2026.
  • Onsite Imaging: Fluoroscopy is available for all interventional procedures, ensuring precise and effective treatment delivery.

Additional Considerations:

  • Referral Network: A large referral base of 100+ primary care providers ensures consistent patient volume.
  • Credentialing Support: The hospital facilitates credentialing for new procedures, fostering growth and expanding clinical capabilities.

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