Patients with chronic pain conditions are often 100 percent dependent on their providers for their condition, while they need to be much more dependent on themselves. We know that when patients become more actively involved in their care, their outcomes are often stronger. When they are exclusively dependent on their healthcare providers, they are less likely to adhere to treatment plans and more likely to demonstrate medication dependency issues or higher levels of pain.
When you want patients to be more actively involved in their care, a good solution to consider is to build an "Integrated Care" spine and pain program. When building your new integrated care program your review should include:
1. Available community programs and resources
2. Staff training
3. Executive leadership involvement (buy-in)
4. Allied health recruiting programs
5. Chronic disease management system registry (a component of your EMR)
6. Facility Healthcare Delivery Systems Design
7. Patient self-care management "Health Coach" programs
For purposes of this article we will focus on the issues involved with adding community programs and resources as a component of your new integrated care program.
"Adding these resources to your new program is absolutely critical when you are trying to build a successful patient care program," says Scott Anderson, COO of Prairie Spine & Pain Institute in Peoria, Ill. "One of the key ways we achieve patient self care management is through the discussion of available community services with the patient. All of these discussions are done with your health coach which is a billable visit. Of course, our number one goal is to get the patient to manage their own life."
There are several areas in which pain physicians and groups can support their patients, or guide their patients to the support they need:
• Peer-to-peer support
• Educational opportunities
• Exercise opportunities
• Nutritional support
Here are five ways groups can help their patients find these opportunities in the community. To download Mr. Anderson's integrated patient care program outline, click here.
1. Develop a list of community resources. Pain groups should compile a list of community resources to help patients manage their condition. This list should go beyond specialists in the area to cover functional and emotional support as well. "The very first excuse that patients always come up with when they aren't coming to their appointments is they can't get there — they are too busy or they don't have a car," says Mr. Anderson. "That creates a huge problem for pain practices. How can we solve those problems before they become an issue? Head it off before it even starts."
Providing patients with these resources gives them the solution before a problem arises. These resources can include:
• Public resources — transportation, education, recreational activities
• Private resources — local and regional business sponsorship opportunities
• Faith based resources — local and regional church groups interested in outreach
"It isn't easy to manage pain in patients who are on narcotics," says Mr. Anderson. "Thus, a lot of physicians don't even try to manage them. With a properly designed program, you will see more patients because you can help them succeed."
2. Implement onsite programs. Chronic pain patients need many more services than just physician visits and interventional treatment. Many require lifestyle changes in addition to medical care, and providing assistance programs at the practice is convenient for the patients and improves their chances of success with self-management. These programs can also provide ancillary revenue to the group.
Onsite programs include:
• Nutrition classes — cooking courses, diet education classes
• Exercise — physical therapy, exercise physiologist
• Patient education materials
• Behavioral specialists — health planning, goals development and action planning
"Providing these services can be a great marketing tool to ensure that primary care physicians refer more patients to the integrated care services at your practice," says Mr. Anderson. "It's a wonderful thing for patients and if it's good for business at the same time, that's exciting."
One of the onsite programs at Prairie Spine & Pain Institute, the practice of Richard Kube, MD, is a Wii fit program. Patients can come in and do their programs—which many enjoy—and spend time with their family and friends simultaneously. "Wii Fit isn't reimbursable, but it becomes part of the overall program that is reimbursable," says Mr. Anderson.
3. Encourage lifestyle changes. Many patients with chronic pain would benefit from exercise or increased mobility, but they have trouble meeting their activity goals because of the pain. While having physical therapy onsite is helpful, patients also need to take initiative to continue their program correctly offsite as well. Direct them toward community programs or gyms that can help them stay on track. There are also internet resources patients can use to promote self-management.
"There are some people that don't have space at their homes for exercise," says Mr. Anderson. "Help them find those spaces. All of these things are clinically and medically appropriate to help patients grow toward self-management."
One of the websites Mr. Anderson suggests is Exercise is Medicine, which supports both patients and providers to review physical activity and set goals for the future.
http://exerciseismedicine.org/
4. Focus on patient education. There are several tools pain physicians and groups can use to educate their patients about chronic pain and management techniques. There are simple handouts and software available with patient diagrams and information that is valuable for effectively implementing self-management programs.
"Patients must know about their condition and how different treatment plans are working to make them better," says Mr. Anderson. "These educational tools can help patients develop goals for their program. We want to lead the horse to water so it can drink."
5. Implement these programs simultaneously. Many treatment programs are set up like a checklist: patients go through one solution and if it doesn't work they move on to the next. Patients might be directed toward conservative therapy, injections, physical therapy, narcotics, interventional pain procedures and then behavioral services. Instead of using an algorithm like a flow chart, give patients all of these resources simultaneously so the care is truly integrated.
"Interventional can be very beneficial, but it isn't the whole story," says Mr. Anderson. "If you send someone to conservative treatment after interventional therapy, they feel like they have been sent to the penalty box. It should be a simultaneous process with interventional, behavioral, nutritional and functional therapy."
More Articles on Spine & Pain Management:
5 Points on Incorporating a Health Coach Into a Spine & Pain Group
Start to Finiah in 3 Months: 8 Reasons Why Prairie SurgiCare Could Make it Happen
5 Best Practices for Pain Management
When you want patients to be more actively involved in their care, a good solution to consider is to build an "Integrated Care" spine and pain program. When building your new integrated care program your review should include:
1. Available community programs and resources
2. Staff training
3. Executive leadership involvement (buy-in)
4. Allied health recruiting programs
5. Chronic disease management system registry (a component of your EMR)
6. Facility Healthcare Delivery Systems Design
7. Patient self-care management "Health Coach" programs
For purposes of this article we will focus on the issues involved with adding community programs and resources as a component of your new integrated care program.
"Adding these resources to your new program is absolutely critical when you are trying to build a successful patient care program," says Scott Anderson, COO of Prairie Spine & Pain Institute in Peoria, Ill. "One of the key ways we achieve patient self care management is through the discussion of available community services with the patient. All of these discussions are done with your health coach which is a billable visit. Of course, our number one goal is to get the patient to manage their own life."
There are several areas in which pain physicians and groups can support their patients, or guide their patients to the support they need:
• Peer-to-peer support
• Educational opportunities
• Exercise opportunities
• Nutritional support
Here are five ways groups can help their patients find these opportunities in the community. To download Mr. Anderson's integrated patient care program outline, click here.
1. Develop a list of community resources. Pain groups should compile a list of community resources to help patients manage their condition. This list should go beyond specialists in the area to cover functional and emotional support as well. "The very first excuse that patients always come up with when they aren't coming to their appointments is they can't get there — they are too busy or they don't have a car," says Mr. Anderson. "That creates a huge problem for pain practices. How can we solve those problems before they become an issue? Head it off before it even starts."
Providing patients with these resources gives them the solution before a problem arises. These resources can include:
• Public resources — transportation, education, recreational activities
• Private resources — local and regional business sponsorship opportunities
• Faith based resources — local and regional church groups interested in outreach
"It isn't easy to manage pain in patients who are on narcotics," says Mr. Anderson. "Thus, a lot of physicians don't even try to manage them. With a properly designed program, you will see more patients because you can help them succeed."
2. Implement onsite programs. Chronic pain patients need many more services than just physician visits and interventional treatment. Many require lifestyle changes in addition to medical care, and providing assistance programs at the practice is convenient for the patients and improves their chances of success with self-management. These programs can also provide ancillary revenue to the group.
Onsite programs include:
• Nutrition classes — cooking courses, diet education classes
• Exercise — physical therapy, exercise physiologist
• Patient education materials
• Behavioral specialists — health planning, goals development and action planning
"Providing these services can be a great marketing tool to ensure that primary care physicians refer more patients to the integrated care services at your practice," says Mr. Anderson. "It's a wonderful thing for patients and if it's good for business at the same time, that's exciting."
One of the onsite programs at Prairie Spine & Pain Institute, the practice of Richard Kube, MD, is a Wii fit program. Patients can come in and do their programs—which many enjoy—and spend time with their family and friends simultaneously. "Wii Fit isn't reimbursable, but it becomes part of the overall program that is reimbursable," says Mr. Anderson.
3. Encourage lifestyle changes. Many patients with chronic pain would benefit from exercise or increased mobility, but they have trouble meeting their activity goals because of the pain. While having physical therapy onsite is helpful, patients also need to take initiative to continue their program correctly offsite as well. Direct them toward community programs or gyms that can help them stay on track. There are also internet resources patients can use to promote self-management.
"There are some people that don't have space at their homes for exercise," says Mr. Anderson. "Help them find those spaces. All of these things are clinically and medically appropriate to help patients grow toward self-management."
One of the websites Mr. Anderson suggests is Exercise is Medicine, which supports both patients and providers to review physical activity and set goals for the future.
http://exerciseismedicine.org/
4. Focus on patient education. There are several tools pain physicians and groups can use to educate their patients about chronic pain and management techniques. There are simple handouts and software available with patient diagrams and information that is valuable for effectively implementing self-management programs.
"Patients must know about their condition and how different treatment plans are working to make them better," says Mr. Anderson. "These educational tools can help patients develop goals for their program. We want to lead the horse to water so it can drink."
5. Implement these programs simultaneously. Many treatment programs are set up like a checklist: patients go through one solution and if it doesn't work they move on to the next. Patients might be directed toward conservative therapy, injections, physical therapy, narcotics, interventional pain procedures and then behavioral services. Instead of using an algorithm like a flow chart, give patients all of these resources simultaneously so the care is truly integrated.
"Interventional can be very beneficial, but it isn't the whole story," says Mr. Anderson. "If you send someone to conservative treatment after interventional therapy, they feel like they have been sent to the penalty box. It should be a simultaneous process with interventional, behavioral, nutritional and functional therapy."
More Articles on Spine & Pain Management:
5 Points on Incorporating a Health Coach Into a Spine & Pain Group
Start to Finiah in 3 Months: 8 Reasons Why Prairie SurgiCare Could Make it Happen
5 Best Practices for Pain Management