At the 11th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference on June 15, Graf Hilgenhurst, MD, chief physician and founder of Precision Pain Care, discussed the future of pain management care during a presentation titled "Will Non-Physicians Compete Aggressively With Pain Management Physicians – Key Legislative and Business Issues." 1. Pain management practiced by non-specialists. In early 2000, the field of pain management experienced explosive growth. Medicare increased pain management reimbursement outside of the hospital. As a consequence of the growth, interventional pain management began to rise in popularity.
"On the downside, no credentialing was required. Non-physicians and non-specialists began to perform pain management procedures," said Dr. Hilgenhurst. Chiropractors, middle level providers and family practice physicians will often advertise themselves as interventional pain management specialists. In 2012, CMS published a final ruling allowing nurse anesthetists to practice chronic pain management. It is questionable that anyone aside from a pain management physician has the qualifications to practice pain management, said Dr. Hilgenhurst.
2. The rise of pill mills. "Pill mills are poor quality medical practices that give out prescriptions without gathering a careful medical history from their patients," said Dr. Hilgenhurst. As pain management grew, so did the incidence of pill mills and the number of drug overdose-related deaths.
3. Board-certification. The American Academy of Pain Medicine is a legitimate organization that grants physicians board certification in pain medicine, but there are a number of other organizations that provide questionable certification. Certification should be a rigorous process, but some organizations will provide certification after only a series of short tests.
4. Pain management physicians fight back. In 2010, Dr. Hilgenhurst explained that a group of pain management physicians banded together to fight the encroachment of non-specialists in the field. The group worked with state legislators to build legislation limiting pill mills and interventional pain management procedures. "State legislators are accessible. Meet with them and build a relationship," said Dr. Hilgenhurst. Pain management physicians should also partner with lobbying groups that have clout.
If the field of pain management cannot find a level of cohesion, there will be consequences, said Dr. Hilgenhurst. Interventional pain management specialists and pain management physicians disagree over the number of procedures being done and prescriptions being written. Unqualified individuals practice in the field. The number of procedures and prescriptions in the field is becoming unjustifiable. "If nothing is done, CMS will eventually put its foot down and organized pain management will be over as we know it will be over," said Dr. Hilgenhurst.
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"On the downside, no credentialing was required. Non-physicians and non-specialists began to perform pain management procedures," said Dr. Hilgenhurst. Chiropractors, middle level providers and family practice physicians will often advertise themselves as interventional pain management specialists. In 2012, CMS published a final ruling allowing nurse anesthetists to practice chronic pain management. It is questionable that anyone aside from a pain management physician has the qualifications to practice pain management, said Dr. Hilgenhurst.
2. The rise of pill mills. "Pill mills are poor quality medical practices that give out prescriptions without gathering a careful medical history from their patients," said Dr. Hilgenhurst. As pain management grew, so did the incidence of pill mills and the number of drug overdose-related deaths.
3. Board-certification. The American Academy of Pain Medicine is a legitimate organization that grants physicians board certification in pain medicine, but there are a number of other organizations that provide questionable certification. Certification should be a rigorous process, but some organizations will provide certification after only a series of short tests.
4. Pain management physicians fight back. In 2010, Dr. Hilgenhurst explained that a group of pain management physicians banded together to fight the encroachment of non-specialists in the field. The group worked with state legislators to build legislation limiting pill mills and interventional pain management procedures. "State legislators are accessible. Meet with them and build a relationship," said Dr. Hilgenhurst. Pain management physicians should also partner with lobbying groups that have clout.
If the field of pain management cannot find a level of cohesion, there will be consequences, said Dr. Hilgenhurst. Interventional pain management specialists and pain management physicians disagree over the number of procedures being done and prescriptions being written. Unqualified individuals practice in the field. The number of procedures and prescriptions in the field is becoming unjustifiable. "If nothing is done, CMS will eventually put its foot down and organized pain management will be over as we know it will be over," said Dr. Hilgenhurst.
More Articles on Pain Management:
Electrical Anesthesia: The Future of Non-Opioid Pain Relief?
4 Strategies for Running an Efficient, Market-Driven Pain Management ASC
3 Ways to Reshape the Pain Management Paradigm of Care