Pain management, also known as pain medicine, is a rapidly growing medical specialty intended to help reduce the pain for a wide spectrum of conditions. Statistics estimate that more than 116 million Americans suffer from chronic pain, and a greater awareness of the condition is leading to an increase in demand and performance for pain management procedures and pain medicine in general.
According to leaders and owners of pain management practices across the country, overcoming reimbursement challenges, benchmarking, and hiring wisely are some effective techniques to maximize efficiency for Ambulatory Surgery Centers (ASC).
Pain Management Reimbursement
Don’t let this become a major pain! Reimbursement, or lack of it, can impact the way in which pain is treated. For example, although the primary task for the ASC is to manage pain, the ability to do so may be influenced by the patient’s limited financial resources as well as the issue of decreased reimbursements and healthcare budgets. Verify insurance information and financial liability thoroughly prior to patient arrival, and, if possible, request payment upfront. Be sure to collaborate with patients and families when selecting pain management strategies to ensure costs do not overburden a patient.
Aside from the procedure itself, costs in pain management consist of compensating personnel, such as the pain specialist and physician, along with the costs of the medical equipment. Procedures covered by the payor also vary based on insurer and the state, so be sure you maintain a solid understanding on reimbursement policies for your center in particular. Then, make certain only procedures pre-approved by the billing department are performed so your center receives full reimbursement.
Benchmarks are becoming increasingly important for all medical professionals. Through their benchmarks of over 300 ambulatory surgery centers across the country, Surgical Outcomes Information Exchange (SOIX®) has detected a trend in pain cases shifting from hospitals to ASCs.
Pain management centers are advised to benchmark various data from their practice to ensure they measure up to the standards. One of the most important benchmarks is patient satisfaction, as the ultimate goal for pain management is patient recovery – with improvements in mobility, functionality, and essentially the quality of life. Other levels to focus on for pain management include outcomes benchmarks, comparing results based on the patient’s pain level before and after intervention; physician/staff satisfaction benchmarks to maintain high employee satisfaction and low turnover; and the financials benchmark to help compare costs, expenses, patient volume, reimbursements, and efficiency to help determine whether changes are necessary for office management.
In order to confidently pay for your services, payors would like to see evidence-based medical practices and ongoing improvement efforts. President of SOIX, Lou Rossiter, PhD, states “managed care companies want to know what your outcomes are and often you will lose a contract because you cannot tell them.”
C-Arm used in pain management study.As with any organization, it is ideal to hire knowledgeable, multitalented employees who understand all facets of the business. We’re not just talking high level doctors and specialists, but all personnel. For example, try to find a C-Arm technician that makes sure all the supplies are available, has a vision about future trends in ASC, and is always ready to go with each procedure.
With all the skilled members on your team, be certain there is plenty of communication among everyone. There should be a common understanding on how procedures are done, why it is being done, and how much time should be spent with the intervention. Speaking of time, physicians in particular should be aware of the importance of turnover time and patient management options. Stay away from turning an ASC procedure into an impromptu office visit, which can dramatically slow down efficiency and turnover.
For additional questions and comments on pain management, health care reimbursements, and other topics, feel free to give me a call or drop me an email.
John (JB) Brant