Amy Mowles is president and CEO of Mowles Medical Management.
Q: Is single-specialty pain management still viable?
Amy Mowles: There's a big misconception, even from people in the know, about pain management. The short answer is: Single-specialty pain management is definitely still viable.
If you're good at something, why do you want to jump outside of your comfort zone? If you're good at pain and you've carved out a niche in the community — whether it is that you have an expertise in a certain procedure or you speak the language of the community — why would you not want to capitalize on your strengths and add volume rather than stick your neck out and try to add something new that you know nothing about?
Q: What about the viability of pain in multi-specialty surgery centers?
AM: With pain in multi-specialty ASCs, there can often be a lot of turf battles going on between different specialists doing the same procedures.
For example, if there's a neurosurgical center and it has an anesthesia group that wants to do some pain procedures in there also, if the space is available, that can work well as it can add volume, assuming the anesthesia group still has the time to provide anesthesia. But now you might have neurosurgeons figuring out that there's not a huge amount of their patients that fit the criteria to do them in the ASC. So what are they doing? They're turning to pain management — procedures like nucleoplasty, kyphoplasty. Maybe they're doing the higher end pain procedures, but they're still doing them, so now you have created a turf battle right there. But who is actually trained to perform these procedures?
Q: It seem like you think pain management is best for single-specialty ASCs rather than adding it to a multi-specialty facility. Why is that the case?
AM: I'm not a big fan of multi-specialty centers. The bigger it is, and the more diverse it is, the governing board can become exactly like the hospital you wanted to leave in the first place — no one can make a decision.
What I've found is I have a whole lot more leverage in dealing with payors if it's single-specialty pain management. I know what to show them: benchmarking data, quality assessment studies throughout the year and algorithms. I can't do that as easily in a multi-specialty center because it becomes too convoluted.
Now let's consider a new startup venture where I don't have any of that benchmarking data yet. I can still tell the payors that we want to have a mutually beneficial relationship with the insurance companies. We don't want to charge astronomical fees at non-fair market value and either penalize the patients for going to an out-of-network provider or arbitrarily write things off, which is never a good idea.
When it comes to negotiating with insurance companies, we're in a flux right now as the insurance companies are either using the old groupers or they are modeling their payments using the new APCs. For typical pain physicians, the old groupers are going to work out so much better for pain management — nine times out of 10. That's not going to be true if they are in a multi-specialty center with orthopedics. Orthopedics is better served under APC payments. But you can't typically have both with the payors — it's either one or the other.
Q: What would your advice be for a pain physician considering opening a single-specialty ASC now?
AM: If you have the volume to support it and you have a mission, this is a win-win situation. Don't be muddying the waters with a specialty you know nothing about. Stay with the grouper system if your procedure mix warrants it. Capitalize on your strengths as a pain management physician as these patients are not going to go away.
The reality is the specialty is highly scrutinized right now. Why? Because there are a lot more people in chronic pain. We're living longer, we're wearing out our parts. In an ASC, if you are doing interventional pain procedures and you have a mission and a vision of how and whom you want to treat, if you can get up over 6,000 billable procedures out of one room, you'll have a viable center.
Learn more about Mowles Medical Management.
More Articles Featuring Amy Mowles:
Understanding and Surviving Surveys: What Surgery Centers Must Know
6 Best Specialties for Surgery Centers
Current and Future State of Surgery Center Pain Management