Here are five new initiatives in spine and interventional pain management discussed by a panel at the 11th Annual Orthopedic, Spine & Pain Management-Driven ASC Conference in Chicago. The panel included Michael Port, MD, medical director of DISC Sports and Spine in Marina del Rey, Calif.; Fred Davis, MD, partner at Michigan Pain Consultants; and CEO and Chairman of the Board for the American Society of Interventional Pain Physicians Laxmaiah Manchikanti, MD.
1. Independent comprehensive spine care facilities. As specialists become employed by hospitals, more independent-minded spine surgeons and specialists are opting to form larger spine groups covering several aspects of spine care.
"We have no hospital affiliations. When we started our group we were working on one and have since cut all ties. The spine surgeons are on staff at hospitals for bigger cases, but we designed a surgery center with integrated spine care," said Dr. Port. The ASC has the ability to keep patients overnight for bigger surgical cases and manage them with a variety of non-operative ways as well.
"In our area the newest innovation is the concept of the integrated medical group for integrating surgical and non-surgical spine. There is synergy between interacting with different patients and staff, as well as imaging and other specialists in a real-time fashion," said Dr. Port.
2. Strengthening relationships with referring physicians and specialists. In addition to providing good clinical care, do what you can to develop referral relationships, especially in primary care. Become involved in the integrated network of referring physicians in your area.
"In Michigan, there is an evolving environment where they are going toward organized systems of care," said Dr. Davis. As medicine becomes more centralized and primary care physicians are employed by hospitals, these larger institutions control referral patterns.
"We have to show our value to those entities," said Dr. Davis. "We must embrace the patient’s treatment for the long-term throughout the patient's life."
3. New reimbursement models and risk-sharing for patient care. Accountable care organizations, bundled payments and other new payment models are becoming more standards today. Physicians and hospitals are now sharing risk with insurance companies in pay-for-performance. In this environment, it's important to work on developing solid relationships with referrals and figuring out how to navigate these new payment models, said Dr. Davis.
However, one of the biggest threats to spine and pain care is the pre-certification process, which has become more strenuous. "We are going to spend more on regulations and there will be more Medicare patients and government payers with strict coverage policies. In the future we may only be treating severe pain," said Dr. Manchikanti.
"We are constantly battling with insurance companies about what surgeries we are allowed to do what implants and biologics we use. Even if we are contracted with them, we are battling them about what we are able to do," said Dr. Port. There could be a multi-tier system with increasing divergence that could make providing care more difficult in the future.
4. Managing medication overuse in back pain patients. The major threat for interventional pain management is the over-utilization of medical management. Many patients have experienced adverse events from accidental overdoses on pain medication, and addiction is a real problem for many patients.
"One of the things we are trying to do is mitigate the risk of medication overdose," said Dr. Davis. "It is a real issue. For us, focusing on understanding our patients and what qualities usually indicate the potential for abnormal behavior is important. We want to identify these patients earlier before they get on opioids to mitigate that risk."
Physicians can make medications safer to by having systems and guidelines in place to monitor the patients. It’s needed for some patients but not every patient.
5. Developing the right protocols for spine treatment patients. Good outcomes for minimally invasive spine surgery in ASCs are dependent on several things, including patient selection, nursing staff to promote getting up and moving and surgeons with the right mindset. The patients should also have the right mindset that they will be leaving the ASC the same day of surgery, said Dr. Port. More cases are coming into ASCs and the landscape for spine and pain management continues to develop.
"There is going to be continued change, but I think the rate of change will accelerate," said Dr. Davis. "I think we are going to start seeing more creative ways of coalescing as providers and more creative payment methods. As we try new things to see what works and what doesn’t, we’ll narrow down to fewer systems in healthcare. For all the negatives there are opportunities for us because we have a new playing field. Good providers can be on the good side of this if we look at things differently to improve care provided."
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