Accountable care organizations depend on the provision of quality care at a low price. Here Scott Glaser, a pain management specialist with Pain Specialists of Greater Chicago, and board member of American Society of Interventional Pain Physicians, discusses three ways interventional pain management could benefit ACOs.
1. Interventional pain management provides cost-effective care. While the details of ACO construction are still murky, most agree that the driving force behind ACOs will be the provision of cost-effective, quality care. For many experts, that structure necessarily includes bundled payments, which compensate the hospital and the ACO a pre-decided amount for a specific episode of care. Bundled payments would supposedly incentivize physicians to work together to reduce cost — but Dr. Glaser thinks otherwise.
"Bundled payments are just kind of a blunt instrument," he says. "They're basically saying, 'You're going to get less money for these episodes of care. Fight amongst yourselves', which doesn't necessarily incentivize doctors to work together or lead to higher quality care. It also does not take into account the treatment of chronic conditions. What it will do is create a power struggle to control the ACOs."
He adds that bundled payments over-simplify physicians' motives, reducing them to mere responders to economic carrots and sticks. "Doctors are professionals, and they're not just going to respond to economic incentives," he says. "They really do care about patients, they care about providing high quality care, and, believe it or not, we understand the importance of cost-effectiveness."
To that end, Dr. Glaser says ASIPP is working to maintain access to the use of interventional pain management procedures from well-trained physicians for patients with musculoskeletal pain, especially spinal pain. Because interventional pain management is rooted in cost-effective treatment — using minimally invasive procedures instead of major surgery or excessive drug prescription — Dr. Glaser believes it could be essential in accomplishing the goals of an ACO.
2. Reduced drug prescriptions could reduce unnecessary admissions. According to Dr. Glaser, pain treatment is currently spread out between various specialties and provider types. Some patients seek out surgeons; some seek out interventional pain management specialists; some seek out chiropractors. According to Dr. Glaser, pain is often treated by prescribing prescription pain killers which do not target the source of pain and do not work long-term. "There is little evidence of benefit when [prescription pain killers] are used chronically, and the complications of accidental deaths and prescription drug abuse are just now being appreciated," he says.
Dr. Glaser thinks pain medication is often prescribed too frequently, and patients are allowed to use it and sometimes abuse it without the necessary close monitoring required by a physician. "Seventy-five people die each day in America from accidental poisoning because they've gotten so used to narcotic painkillers, so they take more pills or they may mix them with another medication, illicit drug or alcohol," he says.
Dr. Glaser says ER visits and hospital admissions due to complications of prescription drug abuse have risen dramatically over the past several years, a huge cost to insurers and an unnecessary one. He says if patients were treated with minimally invasive methods and judicious prescriptions with close monitoring, the cost of treating pain would drop and quality of life of afflicted patient’s would improve. "You have to warn patients and educate them about the risk of treating pain with narcotics, and you should pursue minimally invasive treatment to locate and reduce the actual source of the pain," he says.
3. Interventional pain management specialists could improve the "continuum of care." One of the principal aspects of healthcare reform and ACOs focuses on the "continuum of care," in which the patient experiences a streamlined care delivery from providers who communicate with each other. Dr. Glaser says he and his fellow interventional pain management specialists are working with orthopedic groups to set up peri-operative treatment for orthopedic patients. "Since patients need pain control before the operation and during the recovery, we can be involved in the peri-operative care of the patient," Dr. Glaser says.
He says the leading cause of death following spine fusion surgery is caused by narcotic overdose, a problem that could be curbed through better communication with patients through closer monitoring by an expert in the use of these medications. In Dr. Glaser's experience, many patients who undergo major orthopedic surgery to treat a painful large joint or spinal surgery are on narcotic pain medications pre-operatively. After the operation, they are suffering from severe post-op pain, and there is no smooth transition from inpatient to outpatient. He says providers also fail in communicating about the patient's condition or following up with the patient after surgery. He says this absence of care increases the risk that patients will misuse their medications and possibly die from a narcotic overdose or have a generally unpleasant experience following surgery.
Read more about interventional pain management:
-Dr. Louis Borjab Performs Michigan's First Minimally Invasive Lumbar Decompression
-Interventional Spine Receives U.S. Patent for Spinal Compression System
1. Interventional pain management provides cost-effective care. While the details of ACO construction are still murky, most agree that the driving force behind ACOs will be the provision of cost-effective, quality care. For many experts, that structure necessarily includes bundled payments, which compensate the hospital and the ACO a pre-decided amount for a specific episode of care. Bundled payments would supposedly incentivize physicians to work together to reduce cost — but Dr. Glaser thinks otherwise.
"Bundled payments are just kind of a blunt instrument," he says. "They're basically saying, 'You're going to get less money for these episodes of care. Fight amongst yourselves', which doesn't necessarily incentivize doctors to work together or lead to higher quality care. It also does not take into account the treatment of chronic conditions. What it will do is create a power struggle to control the ACOs."
He adds that bundled payments over-simplify physicians' motives, reducing them to mere responders to economic carrots and sticks. "Doctors are professionals, and they're not just going to respond to economic incentives," he says. "They really do care about patients, they care about providing high quality care, and, believe it or not, we understand the importance of cost-effectiveness."
To that end, Dr. Glaser says ASIPP is working to maintain access to the use of interventional pain management procedures from well-trained physicians for patients with musculoskeletal pain, especially spinal pain. Because interventional pain management is rooted in cost-effective treatment — using minimally invasive procedures instead of major surgery or excessive drug prescription — Dr. Glaser believes it could be essential in accomplishing the goals of an ACO.
2. Reduced drug prescriptions could reduce unnecessary admissions. According to Dr. Glaser, pain treatment is currently spread out between various specialties and provider types. Some patients seek out surgeons; some seek out interventional pain management specialists; some seek out chiropractors. According to Dr. Glaser, pain is often treated by prescribing prescription pain killers which do not target the source of pain and do not work long-term. "There is little evidence of benefit when [prescription pain killers] are used chronically, and the complications of accidental deaths and prescription drug abuse are just now being appreciated," he says.
Dr. Glaser thinks pain medication is often prescribed too frequently, and patients are allowed to use it and sometimes abuse it without the necessary close monitoring required by a physician. "Seventy-five people die each day in America from accidental poisoning because they've gotten so used to narcotic painkillers, so they take more pills or they may mix them with another medication, illicit drug or alcohol," he says.
Dr. Glaser says ER visits and hospital admissions due to complications of prescription drug abuse have risen dramatically over the past several years, a huge cost to insurers and an unnecessary one. He says if patients were treated with minimally invasive methods and judicious prescriptions with close monitoring, the cost of treating pain would drop and quality of life of afflicted patient’s would improve. "You have to warn patients and educate them about the risk of treating pain with narcotics, and you should pursue minimally invasive treatment to locate and reduce the actual source of the pain," he says.
3. Interventional pain management specialists could improve the "continuum of care." One of the principal aspects of healthcare reform and ACOs focuses on the "continuum of care," in which the patient experiences a streamlined care delivery from providers who communicate with each other. Dr. Glaser says he and his fellow interventional pain management specialists are working with orthopedic groups to set up peri-operative treatment for orthopedic patients. "Since patients need pain control before the operation and during the recovery, we can be involved in the peri-operative care of the patient," Dr. Glaser says.
He says the leading cause of death following spine fusion surgery is caused by narcotic overdose, a problem that could be curbed through better communication with patients through closer monitoring by an expert in the use of these medications. In Dr. Glaser's experience, many patients who undergo major orthopedic surgery to treat a painful large joint or spinal surgery are on narcotic pain medications pre-operatively. After the operation, they are suffering from severe post-op pain, and there is no smooth transition from inpatient to outpatient. He says providers also fail in communicating about the patient's condition or following up with the patient after surgery. He says this absence of care increases the risk that patients will misuse their medications and possibly die from a narcotic overdose or have a generally unpleasant experience following surgery.
Read more about interventional pain management:
-Dr. Louis Borjab Performs Michigan's First Minimally Invasive Lumbar Decompression
-Interventional Spine Receives U.S. Patent for Spinal Compression System