CHAPTER 102: How to Manage a Pain Practice

INTRODUCTION

A well-managed pain management center is more than an economically successful pain clinic; it also provides high-quality multidisciplinary care that meets the changing needs of today's health care environment. Health care is in the initial stages of what is likely to be unprecedented change induced by unsustainable health care inflation and the growing realization that this level of expenditure has not led to uniformly world-leading outcomes.¹ The targeting of health care waste such as duplication of services; patient noncompliance; emphasis on doing, not preventing; and incentives that drive reactive care and utilization of services in an episodic manner are all mentioned as cost drivers. Just 1% of the U.S. population consumes 22% of health care expenditures. The magnitude for 5% and 10% of the U.S. population is also as striking.² There is also a widespread notion that chronic diseases such as heart disease, diabetes, and cancer are examples of cost drivers. Yet as recognized by Gaskin and Richard, chronic pain's cost exceeds the cost of heart disease, diabetes, and cancer combined.³ Yet chronic pain is rarely recognized by health care policy debates for the impact it has on expenditures overall. According to the Institute of Medicine report, there are 100 million Americans with chronic pain at a cost of $635 billion per year for treatment and lost productivity. Yet there is only one pain specialist per 33,000 patients.⁴ A forward-thinking pain management center that is prepared to deliver services in a timely, efficient manner and can provide high-quality services within the framework of rapidly changing delivery systems will have significant opportunities in this new era.

Earlier attempts at controlling the cost of health care using coordinated care models such as disease management programs did not work because of the cost needed to established and maintain these programs and the lack of coordination of care among specialties.^5,6

For these changes to occur, a movement away from fee-for-service reimbursement schemes to a value-based reimbursement model needs to occur.⁷ The insurance industry has initially been slow to adopt these changes. This inertia is beginning to break.⁸ This transition period will be difficult for all practices but particularly for specialty practices such as pain management centers. More than ever, keeping track of outcomes and what value interventions bring to value-based care will be required for pain management programs.

Medical practices of all types will need to understand the implications of new types of organizations and payment models. The complexities of transitioning a practice from fee-for-service to these new care models will require in-depth planning and establishing new partnerships while closely tracking local trends and understanding the implications of regulatory implementation at a national level. Some of these new types of organizations and payment models include the following:

• The patient-centered medical home (PCMH) is a care delivery system that seeks to enhance the communication between ...