Orthopedics-driven ambulatory surgery centers looking to continue growth and expansion should consider adding pain management.
"Orthopedics and pain management are a natural fit under the same roof because they compliment each other," says Paul Skowron, senior vice president, operations at Regent Surgical Health. "The specialists refer to each other, so if you are able to bring the specialists under one roof you are increasing their practice volume as well as ASC volume."
Large orthopedic groups may also decide to recruit pain management specialists to provide the continuum of care in their facility. The overall goal is for these physicians to eventually become investors in the ASC when shares are available. Here are five things to know about bringing pain management into an orthopedics-driven ASC.
1. Find the right pain specialist for your center. Screen potential pain physicians and groups in the area for the best chance of building a relationship with these potential future partners. Consider courting individual pain physicians who aren't currently employed within a hospital or practice, or small groups that aren't able to invest in the equipment necessary to perform injections and procedures in-house.
"The pain physicians who would rather use their office space entirely for patient evaluation instead of becoming a mini surgery center are ideal candidates," says Mr. Skowron. "They can participate in surgery center investment where there's proper equipment and staff to perform these procedures in a high volume setting."
If the right type of practitioners aren't available in the community, consider looking internally for surgeons who can perform pain procedures.
"As you think about your strategy, consider whether there are already spine surgeons at the center who can do simple pain injections in addition to complex spine procedures on an outpatient basis," says Mr. Skowron. "You may want to consider asking the spine surgeon to expand procedures to include pain instead of recruiting someone new to save resources there."
2. Investigate the physician's reputation and patient satisfaction. Pain patients report notoriously low satisfaction scores because of their pain. As patient satisfaction and quality scores become more important for provider reimbursement and success, consider how lower pain scores might impact the center and take whatever steps necessary to ensure your physicians will have the highest ratings possible.
"ASC administrators should be concerned about patient satisfaction surveys because managed care companies are now looking at them more closely," says Mr. Skowron. "Pain, as it turns out, are a high contributor to low satisfaction scores at ASCs by nature of patients being in pain. The postoperative staff must be well-trained in addressing the pain patient before discharge."
ASC leaders should also perform due diligence on the pain physician's reputation in the community. High profile issues with patient satisfaction, or lower scores than other pain physicians in the area, are red flags to avoid.
3. Be ready to retrain staff. Pain physicians use much of the same equipment as orthopedic surgeons for their procedures, which means there won't be a big capital investment to bring in pain procedures. However, retraining staff is a necessary step to efficiency with pain patients.
"The length and complexity of orthopedics cases is different from pain cases," says Mr. Skowron. "Pain procedures are usually 15 to 20 minutes long while orthopedics cases are usually more than an hour. As a result, the clinical staff must have the ASC mentality to move quickly and efficiently between cases."
Make sure your transfer staff are familiar with the pace of pain procedures and can perform very quick turnovers to maximize patient volume. At the same time, staff members must also evaluate the patient's pain before they leave.
"Those skills are required and separate from what you would find at the hospital," says Mr. Skowron. "Work with your personnel to make this transition or hire new people who can complement the pain volume."
4. Maximize revenue with high volume and diverse payer mix. Cost per case is low for pain management, and usually payer mix is diverse enough for average net revenue per case to contribute positively to the ASC's margin. However, significant volume is required to cover all of the cost of equipment purchase and incremental staff.
"Make sure the schedulers are ready for physicians with high volume pain procedures," says Mr. Skowron. "They should assign the physicians a block where they can come in and do 10 procedures per day. This is often different from what schedulers at orthopedics-driven ASCs are used to."
Schedulers and office staff will likely also increase communications with insurance companies for pain patients and should pay more attention to insurance verification since the rejection rate is higher for pain cases.
"Make sure the margins are good," says Mr. Skowron. "The physicians should have a good payer mix and be willing to standardize supplies across practitioners and use GPOs for best pricing."
5. You can work together on an occupational pain program. When courting a pain physician or group, make your ASC more attractive by working with the pain practitioner on building an occupational pain program. If the pain physician has a good reputation and can bring a high volume into the ASC, expanding the occupational pain program is another way to partner with those specialists.
"The program can be part of the surgery center, but there is no particular facility fee for it," says Mr. Skowron. "If you have a hospital partner that has not yet developed its own occupational pain program, that mix of investors can really work well together to develop a diverse occupational pain program."
Depending on your goals, you can either work with interventional pain specialists or physiatrists who do outpatient work. If you are working on a truly comprehensive program, you may want to target both.
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