Here are five best practices for pain management practices.
1. Create an integrated pain practice. Scott Anderson, COO, Prairie Spine and Pain Institute in Peoria, Ill., says primary care physicians, who amount to a large number of referrals to a pain practice are looking for a pain clinic to offer comprehensive services. This is where many pain practices have fallen short, he says.
"The number one thing a primary care physician is looking for is to meet the needs of their chronic pain patient population by taking over the management of that patient's condition," Mr. Anderson says. "When you take over the management of that patient's condition, you will see a significantly higher number of referrals. Of course you will need to build a team to manage this new influx of patients and their unique needs, as your specialists cannot afford to coordinate care for this patient population."
Richard Kube, MD, CEO, founder and owner of Prairie Spine and Pain Institute estimates that 95 percent of pain management practices operating today are moving toward a procedure-based model instead of an integrated care model.
"A lot of the pain practices are trying to become very much in tune with and involved with doing procedures all the time," he says. "As such, the very reason for primary care physicians to refer the patient to you in the first place is being diminished by most pain practices. Chronic pain management is a part of pain management. If you're going to be a pain center, you really have to do all of it."
2. Create a team of specialists. The most important thing to creating an integrated pain practice is to recruit a team of specialists that can look at a pain patient from different angles and offer alternative treatments, Thomas Schrattenholzer, MD, pain management physician and medical director at Legacy Good Samaritan Medical Center Pain Management Center in Portland, Ore., says. He says the method requires three components to be successful: a physician, a psychologist or psychologist nurse practitioner and a physical therapist.
Even if a center doesn't employ all of the specialists, that conversation is still important, Dr. Schrattenholzer says.
"The most important part is to create dialogue and to reach out to other members in your community that provide pain service, particularly pain psychiatrists and physical therapists who could help work on active approaches to chronic painful conditions," he says. "Oftentimes we get locked into the one thing that we do to help improve pain, and we don't reach outside our scope of practice to get other specialties to add important components such as treatment of depression or the mind/body approach to pain reduction. Those can have more value than what you are offering."
The Legacy Good Samaritan Medical Center Pain Management Center employs a social worker, even though it does not get reimbursed for the social worker's services. Dr. Schrattenholzer says a social worker is an important part of the team who organizes the educational piece of the program and serves as a liaison between the substance abuse program and the chronic pain program. Many patients, regardless of opioid use, are started with pain education services.
"A lot of what drives the pain experience is the fear of pain," he says. "Education helps you understand how a pain experience is generated and what are some things we do to magnify that pain experience. If we can remove the fear, we can oftentimes remove the magnification and reduce the overall pain experience."
3. Create a unique plan for each patient. Each pain patient requires different treatment, and often that treatment falls out of the traditional realm of medication, medical procedures and surgery. Dr. Schrattenholzer offers the example of a patient who has a painful back condition that may lead to a disability, loss of insurance, loss of family and even a dependency on pain medication.
"We think that an epidural injection is going to help that," he says. "It's not. What we really need to do is to start treating all the things that come with a chronic pain condition. The most important thing is to make sure you conduct a good intake evaluation and tailor a program that fits the patient," he says. "The goal of the pain management program has very little to do with being on or off any particular medication. The goal is always the reduction of a painful experience and improvement in function."
Dr. Schrattenholzer gives the example of a 79-year-old man who has pain from spinal stenosis but has not had an adequate workup. Dr. Schrattenholzer would start by obtaining the man's history and ordering an MRI. Based on the results, the man would probably be recommended for a surgical evaluation. The psychologist and physical therapist can be skipped because what the patient really needs is a decompression, he says. Another example is a 29-year-old who still has moderate to severe back pain from a degenerative disc disease even though he has already had a decompression. Obtaining the patient's history reveals a record of opioid misuse. That patient would most likely be referred to the psychologist and physical therapist.
4. Ensure procedures provide the best value. As reimbursements decrease and healthcare budgets shrink, Standiford Helm II, MD, medical director of Pacific Coast Pain Management Center in Laguna Hills, Calif., and president of the American Society of Interventional Pain Physicians, thinks procedures that increase patient function and decrease pain for the best value will be the procedures that take off.
"Pain procedures that are going to thrive are those which add value," he says. "A good example is the MILD procedure, which treats stenosis at a cost far below surgery. In a fixed budget world, that difference will be definitive as to what therapy, if any, is provided. While patients will be interested in increased function, the insurers or ACOs will be more likely to respond to decreased utilization of resources."
Another example of a "good value" procedure is peripheral nerve stimulation for intractable headache. In this procedure, an electrical current is applied to nerves outside the brain and spinal cord. Dr. Helm also predicts that standard procedures will undergo greater scrutiny.
"Providers will need to show that their usage of our bread and butter procedures, epidural injections and facet procedures, adds value and is not over utilized," he says.
5. Pain treatments are moving past medication and injections. Pain management procedures are becoming more and more advanced, Robert Saenz, CEO of Tulsa Pain Consultants and president of VIP Medical Consulting, says. Gone are the days when all pain was treated with medication or a series of epidural steroid injections for inflammation. Nowadays, pain management physicians are performing more radiofrequency ablations for chronic pain patients who have tried injections. Physicians are also increasingly performing spinal cord simulation trials in their offices, then taking the procedure to the surgery center when appropriate.
Mr. Saenz says these procedures are perfect for surgery centers because the atmosphere decreases patient stress and increases convenience for repeat visits.
"You've got a patient suffering from so many issues, and lessening anxiety and stress by avoiding the hospital is critical," he says.
Spinal cord implants are also becoming more attractive to patients because of the problems, such as infection and blockage, that can arise with pain pumps, Mr. Saenz says. Refills for pain pumps are not well reimbursed by federal or commercial payors, while spinal cord implants don’t need refills and the procedure receives better reimbursement, he says.
Related Articles on Pain Management:
What procedure has been most helpful to the patients in your practice in 2011? 5 Physician Responses
How Does Pain Management Physicians' Compensation Stack Up: A Comparison to Physicians in Other Top ASC Specialties
Does Acupuncture Have a Place in Western Medicine?
1. Create an integrated pain practice. Scott Anderson, COO, Prairie Spine and Pain Institute in Peoria, Ill., says primary care physicians, who amount to a large number of referrals to a pain practice are looking for a pain clinic to offer comprehensive services. This is where many pain practices have fallen short, he says.
"The number one thing a primary care physician is looking for is to meet the needs of their chronic pain patient population by taking over the management of that patient's condition," Mr. Anderson says. "When you take over the management of that patient's condition, you will see a significantly higher number of referrals. Of course you will need to build a team to manage this new influx of patients and their unique needs, as your specialists cannot afford to coordinate care for this patient population."
Richard Kube, MD, CEO, founder and owner of Prairie Spine and Pain Institute estimates that 95 percent of pain management practices operating today are moving toward a procedure-based model instead of an integrated care model.
"A lot of the pain practices are trying to become very much in tune with and involved with doing procedures all the time," he says. "As such, the very reason for primary care physicians to refer the patient to you in the first place is being diminished by most pain practices. Chronic pain management is a part of pain management. If you're going to be a pain center, you really have to do all of it."
2. Create a team of specialists. The most important thing to creating an integrated pain practice is to recruit a team of specialists that can look at a pain patient from different angles and offer alternative treatments, Thomas Schrattenholzer, MD, pain management physician and medical director at Legacy Good Samaritan Medical Center Pain Management Center in Portland, Ore., says. He says the method requires three components to be successful: a physician, a psychologist or psychologist nurse practitioner and a physical therapist.
Even if a center doesn't employ all of the specialists, that conversation is still important, Dr. Schrattenholzer says.
"The most important part is to create dialogue and to reach out to other members in your community that provide pain service, particularly pain psychiatrists and physical therapists who could help work on active approaches to chronic painful conditions," he says. "Oftentimes we get locked into the one thing that we do to help improve pain, and we don't reach outside our scope of practice to get other specialties to add important components such as treatment of depression or the mind/body approach to pain reduction. Those can have more value than what you are offering."
The Legacy Good Samaritan Medical Center Pain Management Center employs a social worker, even though it does not get reimbursed for the social worker's services. Dr. Schrattenholzer says a social worker is an important part of the team who organizes the educational piece of the program and serves as a liaison between the substance abuse program and the chronic pain program. Many patients, regardless of opioid use, are started with pain education services.
"A lot of what drives the pain experience is the fear of pain," he says. "Education helps you understand how a pain experience is generated and what are some things we do to magnify that pain experience. If we can remove the fear, we can oftentimes remove the magnification and reduce the overall pain experience."
3. Create a unique plan for each patient. Each pain patient requires different treatment, and often that treatment falls out of the traditional realm of medication, medical procedures and surgery. Dr. Schrattenholzer offers the example of a patient who has a painful back condition that may lead to a disability, loss of insurance, loss of family and even a dependency on pain medication.
"We think that an epidural injection is going to help that," he says. "It's not. What we really need to do is to start treating all the things that come with a chronic pain condition. The most important thing is to make sure you conduct a good intake evaluation and tailor a program that fits the patient," he says. "The goal of the pain management program has very little to do with being on or off any particular medication. The goal is always the reduction of a painful experience and improvement in function."
Dr. Schrattenholzer gives the example of a 79-year-old man who has pain from spinal stenosis but has not had an adequate workup. Dr. Schrattenholzer would start by obtaining the man's history and ordering an MRI. Based on the results, the man would probably be recommended for a surgical evaluation. The psychologist and physical therapist can be skipped because what the patient really needs is a decompression, he says. Another example is a 29-year-old who still has moderate to severe back pain from a degenerative disc disease even though he has already had a decompression. Obtaining the patient's history reveals a record of opioid misuse. That patient would most likely be referred to the psychologist and physical therapist.
4. Ensure procedures provide the best value. As reimbursements decrease and healthcare budgets shrink, Standiford Helm II, MD, medical director of Pacific Coast Pain Management Center in Laguna Hills, Calif., and president of the American Society of Interventional Pain Physicians, thinks procedures that increase patient function and decrease pain for the best value will be the procedures that take off.
"Pain procedures that are going to thrive are those which add value," he says. "A good example is the MILD procedure, which treats stenosis at a cost far below surgery. In a fixed budget world, that difference will be definitive as to what therapy, if any, is provided. While patients will be interested in increased function, the insurers or ACOs will be more likely to respond to decreased utilization of resources."
Another example of a "good value" procedure is peripheral nerve stimulation for intractable headache. In this procedure, an electrical current is applied to nerves outside the brain and spinal cord. Dr. Helm also predicts that standard procedures will undergo greater scrutiny.
"Providers will need to show that their usage of our bread and butter procedures, epidural injections and facet procedures, adds value and is not over utilized," he says.
5. Pain treatments are moving past medication and injections. Pain management procedures are becoming more and more advanced, Robert Saenz, CEO of Tulsa Pain Consultants and president of VIP Medical Consulting, says. Gone are the days when all pain was treated with medication or a series of epidural steroid injections for inflammation. Nowadays, pain management physicians are performing more radiofrequency ablations for chronic pain patients who have tried injections. Physicians are also increasingly performing spinal cord simulation trials in their offices, then taking the procedure to the surgery center when appropriate.
Mr. Saenz says these procedures are perfect for surgery centers because the atmosphere decreases patient stress and increases convenience for repeat visits.
"You've got a patient suffering from so many issues, and lessening anxiety and stress by avoiding the hospital is critical," he says.
Spinal cord implants are also becoming more attractive to patients because of the problems, such as infection and blockage, that can arise with pain pumps, Mr. Saenz says. Refills for pain pumps are not well reimbursed by federal or commercial payors, while spinal cord implants don’t need refills and the procedure receives better reimbursement, he says.
Related Articles on Pain Management:
What procedure has been most helpful to the patients in your practice in 2011? 5 Physician Responses
How Does Pain Management Physicians' Compensation Stack Up: A Comparison to Physicians in Other Top ASC Specialties
Does Acupuncture Have a Place in Western Medicine?