Scott Glaser, MD, co-founder and president of the Pain Specialists of Greater Chicago, shares his views on several of the trends shaping the present and future of the interventional pain management field. Obstacles barring access to care
"The interventional pain management field has exploded in the past 20 years. We know more about the causes and neural pathways of pain and how to treat those with minimally invasive techniques," says Dr. Glaser. "But there is a crisis. Our ability to help patients is being severely constricted."
The vast majority of procedures in the pain management field are elective. With the advent of sweeping healthcare reform, many patients are facing rising deductibles and co-pays. Several payers are enacting stricter policies for covering pain management procedures. For example, a major payer has instituted a policy restricting coverage for facet joint injections to one injection per area of the spine every three years. "Patients who used to get these elective procedures now either can't afford it or they can’t receive them under their policy," says Dr. Glaser. He goes on to describe the only option for most patients- adding medications or increasing doses "These patients end up on stronger and stronger pain medications as there tolerance develops.” Eventually this increase in dosing increases the risks associated with pain medication, especially the risk of accidental poisoning, which is in the national news regularly as it reaches epidemic proportions.
Anti-inflammatory medications are not an effective long-term treatment plan and the field has already stressed the importance of shifting away from opioids. "Pain management procedures, such as radiofrequency and nerve blocks, treat the source of pain or transmission of pain through the nervous system," says Dr. Glaser. "We have guidelines for performing these procedures backed up by scientific data. Lack of access to these procedures is the problem."
Industry advocacy
Patient access to care and adequate physician reimbursement are widespread concerns across nearly every specialty in medicine. Giving voice to those concerns can help reverse the trends physicians fight against. The American Society of Interventional Pain Physicians, formed in 1998, focuses on supporting the interventional pain management field in a number of ways, included political advocacy. "It is so important for us and our patients to have a voice in Washington. Every pain management physician needs to support ASIPP and its political action committee," says Dr. Glaser.
Concierge medicine
The question of physician independence has been echoing throughout healthcare. For many specialties independence has a future, while in others large multispecialty groups and hospital employment may be the answer. Whether or not physicians remain independent, the way care is delivered will not remain the same.
Dr. Glaser and his partner intend to remain independent and think this strategy to be viable for interventional pain management for many reasons. One is the need for this care. Although elective in the eyes of the payors, when an individual is suffering from pain it is not elective to them. Dr. Glaser states, "This need will always be there and only increase in the future." Another is the adoption of alternative payment models. Pain management procedures are less cost prohibitive than surgical care and patients often need long-term management of their condition. Concierge medicine and cash pay models are a natural fit for the field. "I have had a patient tell me he would pay $10,000 a year to have personal access to my care and interventions when he needs them," says Dr. Glaser. Lastly, motivated well trained interventional pain management physicians can become leaders in the area of musculoskeletal pain, especially spine pain, and provide care as soon as the pain is not going away. Dr. Glaser states, "Controlling the flow of these patients through the medical system as efficiently and as cost effectively as possible in the future fulfills the goals of the Affordable Care Act and makes us very valuable."
Advances in the field
Though the field is not without its challenges, innovation has continued to thrive in interventional pain management. The mild procedure, though denied coverage by Medicare, is proving an efficacious treatment for some lumbar spinal stenosis patients. Dr. Glaser states, "The results of the mild procedure are usually astounding and the risk/benefit ratio is unparalleled compared to surgery." Spinal cord stimulators also continue to improve. "Three companies make spinal cord stimulators and they are battling one another to produce the latest innovations," says Dr. Glaser. "And this competition only benefits the patient."
New procedures and techniques continue to enter the field. For example, Kenneth Reed, MD, board-certified internal medicine physician, anesthesiologist and pain management physician, pioneered the Reed Procedure, a peripheral nerve stimulation treatment for migraine headaches. Dr. Glaser states, "This is a remarkable advancement in the treatment of chronic daily headaches of any type and has unequivocally changed the lives of hundreds of individuals." Dr. Glaser is an associate of the Reed Migraine Center and performs evaluations and trial stimulation in Chicago.
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