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One private medical practice with an office in Coon Rapids is facing reduced income while trying to provide more services to patients in need.

Nura Precision Pain Clinic is expanding its offering of home infusions while struggling with delays in elective surgeries that bring in much of the clinic’s income.

“We’re small businesses like any other small business, but there’s a fundamental difference between a medical practice business and a restaurant,” Founder Dr. David Schultz said. “Our primary goal is patient care, not profit. We’re focused very much on our patients during this crisis, but the reality of any small business is that if you can’t make your financial obligations, you can’t stay in business to take care of patients.”

Nura’s home infusion program refills pain pumps — implanted devices used to manage pain — for patients in their own homes.

“Pain pumps are devices that deliver spinal medications to block pain at the spinal level, keeping the brain free of drug effects,” Schultz said.

Patients who use these pumps tend to have had multiple spinal surgeries and were on high doses of opioids taken orally, Schultz said. By targeting the spinal cord, patients can avoid common drug side effects like sleepiness and mental clouding, and they have reduced addiction potential, Schultz said.

Normally patients can come into the clinic to get their pump filled every few months. Before the COVID-19 pandemic, Nura’s home infusion team was visiting some patients to fill their pumps, but now the clinic has expanded that to filling pumps for patients whose insurance would not cover the at-home visit.

“We’re doing it kind of as a free service for patients who really would be at high risk for coming into the clinic,” Schultz said. “We just feel like it’s the right thing to do even though we know we’re not going to get paid for it.”

One patient receiving home infusions is Brenda Strandmark, who suffers from a blood disorder called Langerhans cell histiocytosis.

“If I don’t get my pump filled, I end up going into withdrawal, and I end up in the hospital,” Strandmark said. “It’s one of the worst places for me to be.”

Strandmark has had her pain pump for about 12 years, she said. Before getting the pump, she was in so much pain she couldn’t leave a hospital bed. Due to the risks associated with going into a hospital or clinic, Strandmark called home infusions a life-or-death matter for her.

The specialized nature of the skills required to fill the pumps limits which patients will be able to receive an at-home infusion. If a patient requests it, Nura will weigh how risky it would be for them to come into a clinic. If they have greater risk factors, they may get the service at home.

To protect themselves, nurses don masks and gloves before heading into each home. Every patient is assumed to be a potential asymptomatic carrier of COVID-19, Schultz said.

Patients are screened both at their home and the clinic by checking their temperature and other symptoms. If the signs indicate possible infection, the clinic will suggest they follow government guidelines, Schultz said. Thus far the clinic has not seen any patients screen positive, but Schultz expects it to happen.

There are additional concerns with opioid use, because physical therapy and surgical options are unavailable. That leaves the clinic providing patients with high-dose opioids for short-term care.

“We’re worried that some of the patients who used to be on high-dose opioids will go back to taking those drugs — that’s a problem,” Schultz said.

While Nura is expanding its in-home visits, it’s also taking a hit financially. The clinic mostly supports itself through elective surgeries, such as epidural steroid injections and radiofrequency nerve ablations.

“These are just minimally invasive procedures to get rid of pain so that people can go about their business,” Schultz said. “That’s the bread and butter procedure work that we do.”

Those procedures have been halted with the COVID-19 pandemic. Gov. Tim Walz ordered the delay of elective surgeries March 19.

Nura and other pain clinics and medical facilities are working with the government to determine what procedures are necessary. Currently the clinic plans to do nothing, unless the delay would cause permanent impairment to a patient, Schultz said.

“It’s very scary,” Schultz said. “I don’t know what the future holds.”

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